The use of ‘blocking’ screws for the ‘closed’ reduction of difficult proximal and distal femoral fractures

Most meta-diaphyseal femoral fractures that are treated with intramedullary nailing can be reduced satisfactorily by skeletal traction without ‘opening’ the fracture site and therefore, complications such as nonunion, infection and wound healing problems are reduced. In cases where adequate fracture reduction cannot be achieved by skeletal traction, ‘reduction aids’ have been used during the operative procedure in order to avoid the exposure of the fracture site. The ‘blocking’ screw, as a reduction tool, was proposed initially for the ‘difficult’ metaphyseal fractures of the tibia. Subsequently, surgeons have tried to implement the ‘blocking’ screw technique in ‘difficult’ distal femoral fractures. This article presents the ‘blocking’ screw technique as an adjunctive process in the management of fractures of the proximal and distal femur which are found to be non-reducible by skeletal traction alone. The minimal invasiveness of the technique contributes greatly to the preservation of both the soft tissue integrity and the fracture haematoma and thus reduces the major complications that can occur by exposing the fracture site. Cite this article: EFORT Open Rev 2021;6:451-458. DOI: 10.1302/2058-5241.6.210024