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Stabilisation of femoral non-union using
​Poller (Blocking) screws

-
​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.
femoral nail, femoral shaft fracture, locking screw, callus formation
femoral nail, femoral shaft fracture, locking screw, callus formation

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.

femoral nail, femoral shaft fracture, locking screw, callus formation
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.

femoral nail, femoral shaft fracture, locking screw, callus formation
femoral nail, femoral shaft fracture, locking screw, callus formation
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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  • Home
    • Knee Surgery >
      • Symptomatic Osteoarthritis of the Knee >
        • Primary Care >
          • Initial Management
          • Intermediate Care
          • Referral Treshold
        • Secondary Care >
          • Total Knee Replacement
          • High Tibial Osteotomy
          • Knee Arthroscopy
          • Complex Primary Total Knee Replacement
          • Postoperative Management
        • Procedures recommended by NICE
        • Procedures with limitations by NICE
        • Procedures not recommended by NICE
        • Viscosupplementation
      • Trauma to the Knee >
        • Meniscal Injuries
        • ACL Injury
      • Partial v Total Knee replacement
    • Limb Lengthening >
      • Femoral lengthening over the nail
  • Orthopaedic Trauma
    • Complex Trauma Impact
    • Principles of fine wire frame fixation >
      • Indications for fine wire frame
      • Complications >
        • Predictable complications
        • Unpredictable complications
      • Pin sites management
      • Activities >
        • Videos
        • Photos
    • Poller or Blocking screw >
      • Mechanic of Poller screw
      • Without and With a Poller Screw
      • Third Generation Poller Screws >
        • Epicentric poller screws in osteoporotic bone
        • Epicentric poller screws in comminuted spiral fracture
      • Use of Poller Screw(s) in Complex Cases >
        • Segmental Femoral Fracture
        • Low Supracondylar Femoral Fracture
        • Low Supracondylar Femoral Fracture 2nd case
        • Femoral Non-union - Antegrade Nail
        • Femoral Non-union - Retrograde nail
        • Distal Tibia Spiral Fracture
    • VAC irrigation
    • Complex Cases >
      • Femoral diaphysis defect
      • Capitellum Fractures
      • Distal Femoral Fractures
      • Proximal Humerus Fractures
      • Subtrochanteric Femoral Fractures
  • Osseointegration
    • Osseointegration-Physiotherapy
    • Osseointegration-Surgery
    • Osseointegration-NHS Perspective
  • Medico-legal
    • PI Solicitors
  • Blog
  • Contact
    • About
    • CV
  • Blog
  • New Page