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Third Generation Poller Screws


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. 

Osteoporotic bone example
Comminuted spiral example

Case No. 1

third generation poller screw, blocking screw, fracture reduction, fracture compression
third generation poller screw, blocking screw, fracture reduction, fracture compression

 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.

After the surgery

third generation poller screw, blocking screw, fracture reduction, fracture compression
third generation poller screw, blocking screw, fracture reduction, fracture compression

 Approximately 1 month after the injury

third generation poller screw, blocking screw, fracture reduction, fracture compression
third generation poller screw, blocking screw, fracture reduction, fracture compression

 And two months after the injury (fully weight bearing)

third generation poller screw, blocking screw, fracture reduction, fracture compression
third generation poller screw, blocking screw, fracture reduction, fracture compression

 And six months after the injury (fully weight bearing) 

third generation poller screw, blocking screw, fracture reduction, fracture compression
third generation poller screw, blocking screw, fracture reduction, fracture compression

20 months post surgery

third generation poller screw, blocking screw, fracture reduction, fracture compression
third generation poller screw, blocking screw, fracture reduction, fracture compression

Case No. 2

Open Injury Grade 3A
third generation poller screw, blocking screw, fracture reduction, fracture compression
third generation poller screw, blocking screw, fracture reduction, fracture compression


​3 weeks post injury, walking with a crutch and weight bearing as tolerated.
third generation poller screw, blocking screw, fracture reduction, fracture compression
third generation poller screw, blocking screw, fracture reduction, fracture compression

​2 and a half months post injury, fully weight bearing
third generation poller screw, blocking screw, fracture reduction, fracture compression
third generation poller screw, blocking screw, fracture reduction, fracture compression

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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