Functional outcome of tibial metaphyseal fractures treated with intramedullary nailing with blocking screws (Poller Screws)

Introduction: Management of metaphyseal fractures of the tibia is a big challenge to the operating surgeon. The treatment aims on reduction of sagittal and coronal mal-alignment, establishment of length and rotational alignment and maintaining the same until fracture union. Intramedullary Interlocking nailing is still the gold standard treatment for closed fractures of the tibial diaphysis. However, it is also been used to treat proximal and distal diaphyseo- metaphyseal junctional fractures. Intramedullary nails are currently becoming the effective method in treating extra-articular tibial metaphyseal fractures due to its advantages such as reduced hospital stay, early full weight bearing and time for bony union. Materials and Methods: This is a prospective interventional study done at the Department of Orthopaedics Government Medical College at Rajouri between August 2023 and August 2024. Twenty patients with tibial metaphyseal fractures treated with statically locked intra medullary nailing with supplementary poller screws were included in our study. All the patients were followed up for a minimum of 12 months. Observation and Results: There were 16 males and 4 female patients with a mean age of 37.75 years. Injury was on the right side in 12 cases. The mechanism of injury was Road traffic accident in all except three in whom it was fall from height in two and fall of a heavy object over the leg in one. There were five type A, eleven type B and four type C fractures. At the isthmus level, the mean diameter of the medullary canal is 9.85mm and at the fracture level is 12.3mm. All the fractures eventually united in a mean period of 11.5 weeks. Karlstrom-Olerud score was excellent in 13 fractures (65%), good in 6 patients (25%) and fair in 2 patients (10%). Post operative residual mean varus alignment is 1.8 degree and residual mean valgus alignment is 2.6 degree. Post operative mean antecurvatum angulation is 3.0 degree and mean recurvatum angulation is 4.8 degree Post operatively one case was complicated with delayed surgical wound healing. Conclusion: Poller screws, when supplemented the intramedullary nailing of metaphyseal fractures of tibia Were effective in achieving the fracture alignment, acting as a reduction tool They also Improved the stability of the bone – implant construct, by functionally reducing the medullary width and maintained the fracture alignment till union, preventing loss of initial reduction.