Intramedullary Nail Supplemented with Poller Screws for Proximal and Distal 1/3(rd) Shaft Tibial Fracture: A Prospective Interventional Study from North India

Introduction: The shaft of the tibia is the most common long bone fracture. The treatment goal for shaft tibial fracture is to achieve union with correction of both axial and rotational alignment and, maintain initial fracture length. Higher malunion rates are seen in fractures of the proximal and distal 1/3(rd) of the shaft of the tibia. However, Intramedullary (IM) nailing is the preferred choice of operative management of diaphyseal fractures of the lower limb. Aim: To evaluate the functional and radiological outcomes of IM nail supplemented with poller screws for proximal and distal 1/3(rd) shaft tibial fractures. Materials and Methods: A prospective, interventional study was conducted in the Government Medical College, Patiala, Punjab, India from May 2020 to November 2021. A total of 30 fracture patients in the age group of 18 to 60 years were included in the study. All the subjects were treated with IM nail supplemented with poller screws for proximal and distal 1/3(rd) shaft tibial fractures. Twenty cases were closed fractures and 10 were open (grade I or II according to Gustilo Anderson's classification of compound tibia fracture). Patients were followed-up at 3 weeks, then 6 weekly till union. Patients were evaluated by Karlstro'm-Olerud's functional evaluation criteria.The data was statistically analysed using IBM Statistical Package for the Social Sciences (SPSS) software version 23.0. Results: The mean time of fracture union was 17.33 +/- 2.59 weeks with a maximum (n=19) patients in <= 15 weeks, followed by 15-20 weeks (n=10) and only one patient had delayed union (> 20 weeks). According to Karlstro''m-Olerud's functional evaluation scale 18 (60%) patients had excellent outcome followed by good outcome in 8 (26.7%) patients, while 2 (6.7%) patients had satisfactory and 2 (6.7%) patients moderate outcomes. The total mean varus/valgus deformity preoperatively was 10.17 +/- 4.15 degrees while postoperatively it was 1.63 +/- 2.3 degrees. The total mean antecurvatum /recurvatum deformity preoperatively was 6.47 +/- 5.97 degrees while postoperatively it was 0.20 +/- 0.61 degrees. Postoperative complications were observed such as shortening of the leg (n=2), movement loss in the ankle (n=4), movement loss in the knees (n=3), muscle wasting (n=6) and subtalar movement loss (n=6). One patient had a superficial skin infection (oozing of purulent discharge from distal locking skin suture site), which was treated with prolonged antibiotics. Conclusion: Poller screws were found to be effective in achieving fracture alignment and hence, serve as a effective fracture reduction tool. Also helps to maintain the fracture aligned until it healed, preventing the loss of the initial reduction.