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Systematic review on the outcomes of poller screw augmentation in intramedullary nailing of long bone fracture

Various technical tips have been described on the placement of poller screws during intramedullary (IM) nailing; however studies reporting outcomes are limited. Overall there is no consistent conclusion about whether intramedullary nailing alone, or intramedullary nails augmented with poller screws...

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Autores principales: Tennyson, Maria, Krkovic, Matija, Fortune, Mary, Abdulkarim, Ali
Formato: Online Artículo Texto
Lenguaje:English
Publicado: British Editorial Society of Bone and Joint Surgery 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7144892/
https://www.ncbi.nlm.nih.gov/pubmed/32296553
http://dx.doi.org/10.1302/2058-5241.5.190040
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author Tennyson, Maria
Krkovic, Matija
Fortune, Mary
Abdulkarim, Ali
author_facet Tennyson, Maria
Krkovic, Matija
Fortune, Mary
Abdulkarim, Ali
author_sort Tennyson, Maria
collection PubMed
description Various technical tips have been described on the placement of poller screws during intramedullary (IM) nailing; however studies reporting outcomes are limited. Overall there is no consistent conclusion about whether intramedullary nailing alone, or intramedullary nails augmented with poller screws is more advantageous. We conducted a systematic review of PubMed, EMBASE, and Cochrane databases. Seventy-five records were identified, of which 13 met our inclusion criteria. In a systematic review we asked: (1) What is the proportion of nonunions with poller screw usage? (2) What is the proportion of malalignment, infection and secondary surgical procedures with poller screw usage? The overall outcome proportion across the studies was computed using the inverse variance method for pooling. Thirteen studies with a total of 371 participants and 376 fractures were included. Mean follow-up time was 21.1 months. Mean age of included patients was 40.0 years. Seven studies had heterogenous populations of nonunions and acute fractures. Four studies included only acute fractures and two studies examined nonunions only. The results of the present systematic review show a low complication rate of IM nailing augmented with poller screws in terms of nonunion (4%, CI: 0.03–0.07), coronal plane malunion (5%, CI: 0.03–0.08), deep (5%, CI: 0.03–0.11) and superficial (6%, CI: 0.03–0.11) infections, and secondary procedures (8%, CI: 0.04–0.18). When compared with the existing literature our review suggests intramedullary nailing with poller screws has lower rates of nonunion and coronal malalignment when compared with nailing alone. Prospective randomized control trial is necessary to fully determine outcome benefits. Cite this article: EFORT Open Rev 2020;5:189-203. DOI: 10.1302/2058-5241.5.190040
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spelling pubmed-71448922020-04-15 Systematic review on the outcomes of poller screw augmentation in intramedullary nailing of long bone fracture Tennyson, Maria Krkovic, Matija Fortune, Mary Abdulkarim, Ali EFORT Open Rev Trauma Various technical tips have been described on the placement of poller screws during intramedullary (IM) nailing; however studies reporting outcomes are limited. Overall there is no consistent conclusion about whether intramedullary nailing alone, or intramedullary nails augmented with poller screws is more advantageous. We conducted a systematic review of PubMed, EMBASE, and Cochrane databases. Seventy-five records were identified, of which 13 met our inclusion criteria. In a systematic review we asked: (1) What is the proportion of nonunions with poller screw usage? (2) What is the proportion of malalignment, infection and secondary surgical procedures with poller screw usage? The overall outcome proportion across the studies was computed using the inverse variance method for pooling. Thirteen studies with a total of 371 participants and 376 fractures were included. Mean follow-up time was 21.1 months. Mean age of included patients was 40.0 years. Seven studies had heterogenous populations of nonunions and acute fractures. Four studies included only acute fractures and two studies examined nonunions only. The results of the present systematic review show a low complication rate of IM nailing augmented with poller screws in terms of nonunion (4%, CI: 0.03–0.07), coronal plane malunion (5%, CI: 0.03–0.08), deep (5%, CI: 0.03–0.11) and superficial (6%, CI: 0.03–0.11) infections, and secondary procedures (8%, CI: 0.04–0.18). When compared with the existing literature our review suggests intramedullary nailing with poller screws has lower rates of nonunion and coronal malalignment when compared with nailing alone. Prospective randomized control trial is necessary to fully determine outcome benefits. Cite this article: EFORT Open Rev 2020;5:189-203. DOI: 10.1302/2058-5241.5.190040 British Editorial Society of Bone and Joint Surgery 2020-03-02 /pmc/articles/PMC7144892/ /pubmed/32296553 http://dx.doi.org/10.1302/2058-5241.5.190040 Text en © 2020 The author(s) https://creativecommons.org/licenses/by-nc/4.0/ This article is distributed under the terms of the Creative Commons Attribution-Non Commercial 4.0 International (CC BY-NC 4.0) licence (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed.
spellingShingle Trauma
Tennyson, Maria
Krkovic, Matija
Fortune, Mary
Abdulkarim, Ali
Systematic review on the outcomes of poller screw augmentation in intramedullary nailing of long bone fracture
title Systematic review on the outcomes of poller screw augmentation in intramedullary nailing of long bone fracture
title_full Systematic review on the outcomes of poller screw augmentation in intramedullary nailing of long bone fracture
title_fullStr Systematic review on the outcomes of poller screw augmentation in intramedullary nailing of long bone fracture
title_full_unstemmed Systematic review on the outcomes of poller screw augmentation in intramedullary nailing of long bone fracture
title_short Systematic review on the outcomes of poller screw augmentation in intramedullary nailing of long bone fracture
title_sort systematic review on the outcomes of poller screw augmentation in intramedullary nailing of long bone fracture
topic Trauma
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7144892/
https://www.ncbi.nlm.nih.gov/pubmed/32296553
http://dx.doi.org/10.1302/2058-5241.5.190040
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