J Korean Fract Soc.  2015 Oct;28(4):230-236. 10.12671/jkfs.2015.28.4.230.

The Usefulness of Poller Screw with Antegrade Nailing in the Initial Treatment of Infraisthmal Femur Shaft Fracture

• Yoo JH
• Kim HS
• Kim CG
• Kwak HI
• Song SH

• KMID: 2070349
• DOI: http://doi.org/10.12671/jkfs.2015.28.4.230

Abstract

PURPOSE
The purpose of this study was to evaluate the radiologic and clinical outcomes after intramedullary nailing with Poller screw insertion at initial stage in infraisthmal femur shaft fractures.
MATERIALS AND METHODS
Seven consecutive patients (7 femurs) treated with antegrade intramedullary nailing with Poller screw insertion for the infraisthmal femur shaft fracture were reviewed retrospectively. There were 4 male and 3 female patients. Mean age was 46.1 years (20-72 years). Operative time including Poller screw insertion, time for union, malalignment, and range of motion were evaluated.
RESULTS
All 7 cases had primarily healed successfully. Mean time for radiologic union was 19.1 weeks (16-24 weeks) postoperatively. One case had 5 degree valgus malalignment. One case of 15 mm shortening was reported and he required shoe lift orthosis. All cases had a full range of motion in hip and knee joint.
CONCLUSION
Antegrade intramedullary nailing with Poller screw insertion is useful in the initial treatment of infraisthmal femur shaft fracture, because it could provide additional stability. An additional 20 minutes were required but a Poller screw should be considered according to the anatomic location of a femur shaft fracture.

Keyword

Femur; Fracture fixation; Intramedullary nailing; Poller screw

MeSH Terms

Female
Femur*
Fracture Fixation
Fracture Fixation, Intramedullary
Hip
Humans
Knee Joint
Male
Operative Time
Orthotic Devices
Range of Motion, Articular
Retrospective Studies
Shoes

Figure

• 

  Fig. 1 (A) Three-dimensional-reconstructed computed tomography image shows a fragmented wedge fracture at the femur shaft infraisthmal area. (B) Intra-operative C-arm images show the sequence of Poller screw insertion. (C) Postoperative radiograph shows a well reduced femur with good positioned Poller screws.

• 

  Fig. 2 A 20-year-old male was poly-traumatized after a traffic accident. (A) Anteroposterior radiograph shows an irregular complex femur shaft fracture with a non-displaced fracture of the ipsilateral femoral neck. (B) He underwent damage control-external fixator application at the time of brain surgery in the neurosurgery department. (C) After 3-weeks, he underwent antegrade nailing with two Poller screws after closed reduction with preservation of fracture site biology. Serial radiographs (D: initial postoperative, E: postoperative 2 month, F: postoperative 4 months) show bridging callus progression until radiologic healing.

• 

  Fig. 3 (A) Three-dimensional-reconstructed computed tomography images at postoperative 5 months show full consolidation of a complex femur shaft fracture including neck fracture component. (B) However standing lower extremity scanogram shows a limb length discrepancy of 15 mm.

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