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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.
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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.
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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.
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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).
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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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simple trochanteric fractures (AO-OTA 31-A1) and multi-fragmentary trochanteric fractures (AO-OTA 31-A2). Saudan et al performed a randomized controlled trial (RCT) comparing 106 DHS to 100 proximal femoral nails (PFN) in the treatment of low-energy AO
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Department of Orthopaedic Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
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60 years or older. The decision for cemented or cementless fixation was according to randomization in six prospective randomized controlled trials. In the rest, it was according to surgeon’s preference. In all selected studies, both groups were
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Department of Traumatology and Reconstructive Surgery including Department of Orthopedic Surgery, Charite Universitätsmedizin Berlin, Berlin, Germany
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groups, where satisfactory initial closed reduction is possible, a conservative treatment can lead to a comparable outcome. 52 A randomized controlled trial comparing close contact casting with surgery of unstable ankle fractures among 620 older
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Surgical Department, Hand Surgery Unit EOC, Locarno’s Regional Hospital, Locarno, Switzerland
Locarno Hand Center, Locarno, Switzerland
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Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
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Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
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randomized controlled trial . JBJS Open Access 2021 6 e21.00068 . ( https://doi.org/10.2106/JBJS.OA.21.00068 ) 32 Elerian S Singh T N Norris R Tan S Power D Jones J Chen Z Eltagy H , et al. Early results of a variable-angle volar locking
Department of Orthopaedics, Fengxian District Central Hospital, Shanghai, China
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Department of Orthopaedics, Fengxian District Central Hospital, Shanghai, China
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, two of them did not report the complete data of standard deviation or 95% CIs. Second, the studies included in our meta-analysis are all retrospective, therefore the level of the evidence is lower than that that provided by randomized controlled trials
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our quantitative analysis. Figure 1 Overview of the PRISMA study selection process. Containing a total of 639 patients, there were five randomized controlled trials (RCT), one prospective case–control and three retrospective case
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://www.ohri.ca/programs/clinical_epidemiology/oxford.asp ) 13 Abraham NS Byrne CJ Young JM Solomon MJ . Meta-analysis of well-designed nonrandomized comparative studies of surgical procedures is as good as randomized controlled trials . Journal of Clinical Epidemiology 2010 63 238 – 245 . ( https
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Department of Orthopaedic Surgery, University Hospital Antwerp, Antwerp, Belgium
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Department of Orthopaedic Surgery, University Hospital Antwerp, Antwerp, Belgium
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Department of Orthopaedic Surgery, University Hospital Antwerp, Antwerp, Belgium
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group . Computer-assisted versus non-computer-assisted preoperative planning of corrective osteotomy for extra-articular distal radius malunions: a randomized controlled trial . BMC Musculoskelet Disord 2010 ; 11 : 282 . 20. Stockmans F
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.9%. Most common complications included peri-implant fracture (4.2%), proximal thigh pain requiring implant extraction (2.0%), and lag-screw cutout (1.1%). 30-day mortality 9.5%. Zhang et al 19 Randomized controlled trial 180 Comminuted