Benefits of Poller Screw in Improving Radiological Outcomes after Intra-Medullary Nailing for Distal Tibia Fractures; A Retrospective Cohort Study

Objectives: To compare the radiological outcomes after fixation of distal tibia fractures with IM nail between patients in whom poller screw was used vs those in whom it was not used. Methods: A retrospective cohort study was conducted between 1st January 2009 to 31st June 2019 including patients treated with IM nail for distal tibial metaphyseal fractures. Patients were divided into 2 groups based on whether a poller screw was placed during surgery or not. The exposed group consisted of patients who underwent augmentation of IM nail with a poller screw, while control group included patients who underwent fixation with nail alone. All adult patients aged ≥18 years were included and patients with pathological fractures, known metabolic bone disease were excluded from the study. Follow-up x-rays were viewed through our hospital database and fracture healing was classified as either union, malunion or non-union based on radiographic parameters. A Radiographic Union Score in Tibia (RUST) score was calculated and a score of ≥9 was considered conclusive for complete union. Results: 93 patients were included in the study with 21 patients in the exposed and 72 in the control group. According to the analysis, there were no significant differences in baseline characteristics of the study participants. The exposed group was found to be associated with increased rates of union and decreased non-union and mal-union rates compared to control group (P-value = 0.003). Mean RUST score was also noted to be significantly higher in exposed group compared to control group with a P-value of 0.025. Conclusion: Use of poller screw with IM nail in treatment of distal tibial fractures is important in improving post-operative outcomes and decreasing mal-union and non-union.