Radiologic Outcomes of Intramedullary Nailing in Infraisthmal Femur-Shaft Fracture with or without Poller Screws

Abstract

Background: Intramedullary nails have been the treatment of choice for acute femur-shaft fractures in adults. However, the infraisthmal location has a high risk of nonunion and is easy to malalign. This study evaluated radiologic outcomes of initial supportive use of poller screws in combination with antegrade femoral nailing in infraisthmal femur-shaft fracture.

Methods: A total of 49 patients who had undergone antegrade nailing with or without supportive poller-screw insertion for infraisthmal femur-shaft fracture were included in this retrospective cohort study (23 patients with poller screws in group 1 versus 26 patients without poller screws in group 2). Patient demographics including sex, age, classification, mechanism of injury, operative time, poller-screw time, and radiologic outcomes, including union rate, time to union, and number of malunions, were evaluated.

Results: Union rate in group 1 (95.6%) was significantly higher than that in group 2 (84.6%) (p = 0.04). Time to union was 19.8 weeks in group 1 and 20.3 weeks in group 2 (p = 0.31).

Conclusion: Initial supportive insertion of two poller screws after nailing took a mean of 21minutes additionally but could lessen the risk of nonunion significantly in this study. We believe that these findings may have important clinical relevance for the treatment of infraisthmal femur-shaft fracture.

Figure 1

Intraoperative C-arm images show the procedure and position of poller-screw insertion. (a) Find the location of poller screws medial and lateral to the intramedullary nail in the metaphyseal area and drill a hole. (b) Confirm the position of the drill hole. (c) Insert one poller screw and make another drill hole. (d) Insert poller screws under C-arm guidance. (e) Confirm the final position after insertion of interlocking screws.