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Clinical Cases in mineral and bone metabolism

The use of Poller screws in intramedullary nailing is associated with decreased callus formation

Original Article, 216 - 220
doi: 10.11138/ccmbm/2018.15.2.216
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Abstract
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The use of the Poller screw technique in tibial nailing has been shown in biomechanical studies to improve stability at the fracture site. However no study to date has investigated the in vivo effect of Poller screws on callus formation at the fracture site.
This study had three purposes. First, to investigate the association between Poller screw use and the size of callus formed at the fracture site. Second, to investigate if there is a difference in size between the ipsilateral and contralateral callus in the plane of action of the Poller screw. Third, to investigate if there is a difference between callus size in and out of the plane of action of the Poller screw.
A retrospective cohort was formed of 24 patients treated with tibial intramedullary nailing and use of a Poller screw between December 2007 and December 2014. These were compared to a control group of 11 patients from the same period with comparable injuries treated with intramedullary nailing without use of a Poller screw. Followup radiographs were utilised to measure the maximum width of the cortex, the maximum callus width and the maximum width of the cortex and corresponding callus on each side of the fracture (in order to quantify callus formation).
This was repeated in anterior-posterior and lateral radiographic planes. The position and plane of action of the screw in reference to all measurements was recorded. One-tailed paired t-tests were computed for hypothesis testing. In order to evaluate the relationship between callus size, age and injury classification, an analysis of variance (ANOVA) was performed.
The Poller screw group formed significantly less callus than the control group. In the plane of action of the Poller screw, the contralateral callus was significantly smaller than the ipsilateral callus relative to the Poller screw location.
There was no significant difference in callus size in and out of the plane of action of the Poller screw. This study demonstrates an association between the use of Poller screws in intramedullary nailing of tibial fractures and decreased callus formation in vivo. This supports the findings of previous biomechanical studies which show increased stability at the fracture site when Poller screws are placed.

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