Abstract
Various technical tips have been described on the placement of poller screws during intramedullary nailing however studies reporting outcomes are limited. Overall, there is no consistent conclusion about whether intramedullary nailing alone, or intramedullary nails augmented with poller screws is more advantageous. In a systematic review, we asked: (1) What is the proportion of non-unions with poller screw usage? (2) What is the proportion of malalignment, infection and secondary surgical procedures with poller screws usage?
We conducted a systematic review of multiple databases including Pubmed, EMBASE, and the Cochrane Library. Seventy-four records were identified, twelve met our inclusion criteria.
Twelve studies with a total of 348 participants and 353 fractures were included. Mean follow up time was 21.4 months and mean age of included patients was 40.1 year. Seven studies had heterogenous population of non-unions and/ or malunions in addition to acute fractures. Three studies included only acute fractures and two studies examined non unions only. Four of the twelve studies reported non unions with an overall outcome proportion of 4%. Six studies reported coronal malalignment with an overall outcome proportion of 6%. The secondary surgical procedures rate ranged from 2 – 40% with an overall outcome proportion of 8% and included grafting, revisions and any reported cases of removal of metal work.
When compared with existing literature our review suggests intramedullary nailing with poller screws has lower rates of non-unions and coronal malalignment than those reported in the literature for intramedullary nailing alone. Prospective randomized control trial is necessary to fully determine outcome benefits.
