Treatment of Diaphysio-Metaphyseal Fracture of Tibia by Intramedullary Nail in Combination with Poller Screw

It is known fact that proximal and distal fractures of tibia tend to angulate into varus when treated with intramedullary nails or functional braces. Proximal fractures of tibia tend to angulate into anterior bowing when fixed with nail when fibula is intact. Intramedullary nailing for metaphyseal tibial fractures with short proximal and distal fragment is associated with frontal and sagittal plane malalignment. This may be attributed to an inaccurate entry site, displacing muscular forces and residual deformity along with discrepancy between voluminous area of the metaphyseal-diaphyseal junction and size of nail [2,3]. In the absence of metaphyseal cortex contact, the nail may translate along interlocking screws, owing to the play between screws and the nail holes. This can be limited by the use of blocking or poller screws [4-7]. The blocking screws are placed so as to effectively reduce the size of the medullary canal either proximally or distally and thereby guide both the guide wire and the nail into an acceptable position. They can be placed in any plane but are usually placed in either the sagittal or coronal planes [8-17].