Application of

Blocking Screws
(Poller Screws)

W Y Shen

1
 Nailing Upper Tibial Fractures
Common Problems
„ Intra-articular extensions
„ Proximal fragment often fixed with varus /
valgus / flexion deformity, and gaps that delay
union.

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WKK, M/67,
Closed fracture

Sharp
prominence
tenting the skin

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WKL, F/54
Closed segmental fracture

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This is despite well reduced fracture held with
clamps during nailing.

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3 months 4.5 months 13 months 21 months
Dynamised United

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 LSW, M/48
Open fracture
Grade IIIa

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 Debridement, Lavage & Spanning Ex Fix
Conversion to IM Nail 2 days later

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 Nail inserted without Poller Screw

Note anterior gap.

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Nail removed, and drill for Poller screw using radiolucent drill

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Guide wire passed after Fracture reduction
insertion of Poller Screw

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 Nail inserted with Poller Screw

Poller Screw prevents anterior

12 translation of prox fragment.
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 Before and after tightening of Compression Screw.
13 Fracture gap approximated. © W Y Shen
 Open wound closed.

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 Post-Op. 3 months

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 Use of Blocking Screw (Poller screw)

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 Use of Blocking Screw (Poller screw)
Control of Flexion Deformity

17 Ricci et al, Journal of Orthopaedic Trauma, 2001 © W Y Shen

 Use of Blocking Screw (Poller screw)
Control of Varus / Valgus Deformity

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Ricci et al, Journal of Orthopaedic Trauma, 2001
© W Y Shen
RCH, F/78, Old neglected plateau fracture.
New Metaphyseal fracture 4 years ago.
Non-union after plaster application. Failed
LISS fixation.

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 LISS removed.

Fibular fibrous
union disengaged.

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Broken Screw from LISS

The latero-medial Poller

Screw inserted.

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 Locating the entry site for the AP Poller Screw, using a long
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guide rod to locate the corrected axis of the leg.
© W Y Shen
The AP Poller
Screw inserted.

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AP View after insertion of
nail and proximal locking.
Broken screw

Prox. Locking screws

L-M Poller Screw

AP Poller Screw
Prevents valgus deformity

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Lat View after insertion of
nail and proximal locking.
Broken screw

AP Poller Screw

L-M Poller Screw Prox. Locking

Prevents flexion screws
deformity and
anterior
translation of
prox fragment.

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 TCP with Marrow
blood inserted

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 3 months 9 months

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 Application in Distal Tibia
„ Prevention of anticipated Varus – Valgus
deformities

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 M/45, Closed fracture.
Broken screws found at 6 weeks

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 Medial blocking screw Anterior blocking screw

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Loose anterior screw removed.

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3.5 months after
Poller Screw insertion

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 Application in Distal Femur
„ Prevent anterior translation of retrograde nail in
distal fragment – cutting through the inter-
condylar groove.

„ Use Steimenn Pin instead of screw so as to

control varus-valgus reduction at the same time.

„ “Blocking” Pin removed once locking screws are

inserted.
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WWC, F/55, Polio, small curved femur.

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 Reduction was easy!

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 Chosen nail was overlapped to
check for position for the
blocking pin.

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 4mm Steinmenn Pin
inserted as blocking pin.
Steinmenn pin also used
for control of varus-
valgus alignment.

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 Location for skin incision.

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 Locating entry point with K-wire - AP.

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 Locating entry point with K-wire - Lat.

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 K-wire inserted.

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 Straight cannulated awl over K-wire.

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 Straight cannulated awl over K-wire.

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 Reduction guide rod inserted,
serial reaming from 8mm to 10mm.

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 Nail inserted gently. At
first, the fracture site was
hyper-extended.

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 Hyper-extension gradually corrected.

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 Nail fully seated.

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 Lateral view at upper end. Nail
curvature matched that of femur.

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 AP view at lower end.

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 Condylar screw was too long!.

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 Correct condylar screw inserted.

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 Second distal locking hole drilled.

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 Second distal locking screw inserted.

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 Proximal locking screw inserted.
Open dissection down to bone
to avoid neuro-vascular injury.
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 Lateral view at upper end.

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 Lateral view at lower end after
distal locking.

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 Insertion of set screw (cap)
through nail holding sleeve.

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 Final AP view.

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 Good alignment on AP view.

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 Good alignment on lateral view.

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 Blocking screws (Poller Screws)
„ Applied to strategic locations to prevent
anticipated angular or translational deformities

„ A powerful way to extend the versatility of

locking nails

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 References
„ Krettek, The use of Poller screws as blocking screws
in stabilising tibial fractures treated with small
diameter intramedullary nails. JBJS(Br.) Vol. 81-
B(6), 1999
„ Krettek, The Mechanical Effect of Blocking Screws
("Poller Screws") in Stabilizing Tibia Fractures
With Short Proximal or Distal Fragments After
Insertion of Small-Diameter Intramedullary Nails.
J Orthop Trauma Vol. 13(8), 1999
„ Ricci, Fractures of the Proximal Third of the Tibial
Shaft Treated With Intramedullary Nails and
Blocking Screws. J Orthop Trauma Vol. 15(4), 2001
„ Stedtfeld, The Logic and Clinical Applications of
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Blocking Screws. JBJS(Am.) Vol. 86-A Supp. 2, 2004
© W Y Shen