Stabilisation of femoral non-union using
Poller (Blocking) screws
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Advanced Technique for Retrograde Femoral Nails
Apart from the left femoral fracture patient sustained right femoral shaft fracture which was nailed and open right tibia segmental fracture which is being treated with TSF, free flap and callus distraction to equalise the leg lengths. Good reduction of the mid shaft femoral fracture post initial fixation but due to the weight bearing fracture drifted into varus.
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Images above represent excellent reduction, but proximal locking screw is broken. We can expect fracture to unite even faster (dynamisation) but this is usually not the case. I personally do not believe in dynamisation. It is just wrong concept which does work evrytime there is no problem with fracture healing but never in the opposite case.
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Long leg alignment film showed difference in leg lengths. Estimate leg length discrepancy is around 5 cm. And this was before straightening the left femur. Now it is probably even more.
Unfortunately the X-rays showed also varus deformity on the left femur which was also clinically obvious. In my opinion there was no other option than to correct the deformity before it heals. There are certainly different philosophies and approached to the problem. Certain group of surgeons would let it heal and then correct if patient still complains about. Certainly acceptable option but patient was already complaining about the deformity. Would they get used to it and stop complaining? Exchanging nail technique for a thicker nail is a "standard" option for treatment which I do not completely understand. In this case I believe that after exchanging of the nail for a thicker one, the difference would be only in the size of the nail, everything else would more or less remain the same. Removing of the nail and replacing it with a plate is certainly most reliable option but involve significant dissection of soft tissues and increasing the infection risk unnecessarily. Certainly can be done. In my opinion this is a perfect case for poller screw(s). Remove the nail, put poller screws in and insert new, thinner nail. Certainly thinner and not thicker nail. Thick nail will break the bone, when thin nail will deform. The main difference. And in cases like this you have to use at least two poller screws to control the tilt of mobile fragment. Makes sense? |
How I use Poller (Blocking) screws in antegrade nailing of femur is described below. If you have any questions please email me.
Patient was discharged on the same day. He noticed the difference in leg alignment straight after the surgery.
Whole femur X-rays after the fixation are below.
Whole femur X-rays after the fixation are below.
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Post operative X-rays of the femur where you can see position of poller screws and perfect alignment of fragments. Easy and effortless technique.
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