New Insight on an Old Technique - Temporary Placement of K-WIRES Instead Of Poller Screws with Intramedullary Nailing Of Metaphyseal Fractures of the Femur and the Tibia

Intramedullary nailing is the most frequently used technique for fixation of tibia and femur shaft fractures. When dealing with midshaft fractures, insertion of the nail through a narrow canal automatically reduces the fracture. However nailing of metaphyseal fracture is a much more technically difficult procedure, especially in obtaining a satisfactory reduction in both the coronal and sagital planes. The incidence of malalignment is reported to be as high as 58% for proximal tibia fractures, 14% for distal tibias, 30% for proximal femurs and 10% for distal femoral fractures. Poller screws originally described by Krettek et al., aid in obtaining satisfactory alignment during surgery and provide additional stability. When strategically placed these screws guide the nail to a suitable trajectory, thereby achieving indirect reduction. In practice, the Poller screws creates new narrow canal for the nail and turn a metaphyseal problem to a sort of easier "midshaft" problem. Incorrect position of screws can either block the nail or even cause secondary comminution during insertion of the nail. We describe technique, which uses temporary K-wire localization instead of Poller screws. K-wires can be easily placed and replaced,while precisely guiding the nail. Its flexibility prevents either blockage of the nail or damage to soft tissue and bone. This modified technique makes metaphyseal fracture treatment a simple task.

Methods: Retrospective review of patient`s charts and electronic data. Ten patients (49 ± 27 years) presented with metaphyseal fractures of the femur and tibia. Those metaphyseal fractures have a long, oblique configuration or significant communition that makes closed reduction difficult. K –wires narrows the canal of the metaphyseal fragment approximately 3cm from the fracture line .Than nail insertion toward the deviation side reduces the fracture.

Results: All patients had a satisfactory alignment at the end of operation and on routine visits, all k- wires were removed at the end of surgery, no complications were recorded.

Conclusion: Using k-wires instead of poller screws eases treatment of metaphyseal fractures. Wire elasticity reduces damage to soft tissue and prevents risks of bone weakening and secondary comminution that might be caused by poller screws. This new modification of old technique is fairly simple to apply and should be considered a part of any orthopedic surgeon`s auxiliary tools.