Third Generation Poller Screws
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First Generation of Poller screws were screws inserted to create a corridor inside the bone.
Second Generation of poller screws are inserted in the way that the fracture is reduced and compressed using elastic properties of a nail. The nail would deflect and create long term compression on the fracture. It was not rare occurrence that reductio has improved over the time. But the poller screws are placed on one side of the fracture only (one fragment). Third Generation of poller screws are screws inserted on both sides of the fracture, basically principles of second generation applied on the both side of the fracture. I am getting slowly better understanding of it and short term results are impressive. Case below is an open proximal tibia fracture (Grade GA 3A), which was nailed using the Third generation poller screws principles two months ago. Recently patient walked unaided into examination room without any limp. X-rays are below. Another example can be found here where femoral non-union was revised using thinner nail without any reaming but applying the third generation poller screw principles. |
Case No. 1
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Apart from standard treatment for open tibia fractures third generation poller screw technique was used. Image intensifier pictures are below.
You will notice that distal screw was initially put in the fracture line and was then replaced but did not allow passage of a nail, therefore was replaced again. Until today I have not seen any problem or complication due to the "inaccurate" positioning of the poller screws which needed replacing.
You will notice that distal screw was initially put in the fracture line and was then replaced but did not allow passage of a nail, therefore was replaced again. Until today I have not seen any problem or complication due to the "inaccurate" positioning of the poller screws which needed replacing.
After the surgery
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Approximately 1 month after the injury
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And two months after the injury (fully weight bearing)
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And six months after the injury (fully weight bearing)
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20 months post surgery
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Case No. 2
Open Injury Grade 3A
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3 weeks post injury, walking with a crutch and weight bearing as tolerated.
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2 and a half months post injury, fully weight bearing
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