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Maria Tennyson Department of Trauma & Orthopaedic Surgery, Cambridge University Hospital, Cambridge, UK

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Matija Krkovic Department of Trauma & Orthopaedic Surgery, Cambridge University Hospital, Cambridge, UK

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Mary Fortune The Department of Public Health & Primary Care, Strangeways Research Laboratory, Cambridge, UK

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Ali Abdulkarim Department of Trauma & Orthopaedic Surgery, Cambridge University Hospital, Cambridge, UK

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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.

  • 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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Faustine Vallon Division of Orthopaedic and Trauma Surgery, Department of Surgery, University Hospitals of Geneva, Switzerland

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Axel Gamulin Division of Orthopaedic and Trauma Surgery, Department of Surgery, University Hospitals of Geneva, Switzerland

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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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Ahmed Fikry Elmenshawy Department of Orthopaedic Surgery, RWTH Aachen University, Aachen, Germany

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Khaled Hamed Salem Department of Orthopaedic Surgery, RWTH Aachen University, Aachen, Germany
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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Patrick Pflüger Department of Trauma Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany

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Karl-Friedrich Braun Department of Trauma Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
Department of Traumatology and Reconstructive Surgery including Department of Orthopedic Surgery, Charite Universitätsmedizin Berlin, Berlin, Germany

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Olivia Mair Department of Trauma Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany

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Chlodwig Kirchhoff Department of Trauma Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany

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Peter Biberthaler Department of Trauma Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany

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Moritz Crönlein Department of Trauma Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, 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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Luca Pacchiarini Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland

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Lorenzo Massimo Oldrini Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland

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Pietro Feltri Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland

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Stefano Lucchina Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
Surgical Department, Hand Surgery Unit EOC, Locarno’s Regional Hospital, Locarno, Switzerland
Locarno Hand Center, Locarno, Switzerland

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Giuseppe Filardo Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland

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Christian Candrian Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
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

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Hua Luo Fengxian District Central Hospital Graduate Student Training Base, Jinzhou Medical University, Shanghai, China
Department of Orthopaedics, Fengxian District Central Hospital, Shanghai, China

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Yongwei Su The First Affiliated Hospital of Jinzhou Medical University, Graduate Student Training Base, Jinzhou Medical University, Jinzhou, China

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Liang Ding Department of Orthopaedics, Fengxian District Central Hospital, Shanghai, China

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Haijun Xiao Department of Orthopaedics, Fengxian District Central Hospital, Shanghai, China

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Ming Wu Department of Orthopaedics, Fengxian District Central Hospital, Shanghai, China

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Feng Xue Fengxian District Central Hospital Graduate Student Training Base, Jinzhou Medical University, Shanghai, China
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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Andreas Frodl Department of Orthopedics and Traumatology, Freiburg University Hospital, Freiburg, Germany

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Johannes Hauss Department of Orthopedics and Traumatology, Freiburg University Hospital, Freiburg, Germany

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Andreas Fuchs Department of Orthopedics and Traumatology, Freiburg University Hospital, Freiburg, Germany

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Markus Siegel Department of Orthopedics and Traumatology, Freiburg University Hospital, Freiburg, Germany

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Hagen Schmal Department of Orthopedic Surgery, University Hospital Odense, Odense, Denmark

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Jan Kühle Department of Orthopedics and Traumatology, Freiburg University Hospital, Freiburg, Germany

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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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Maria Anna Smolle Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria

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Sandra Bösmüller AUVA Trauma Centre Vienna Meidling, Vienna, Austria

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Paul Puchwein Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria

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Martin Ornig Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria

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Andreas Leithner Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria

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Franz-Josef Seibert Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria

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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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Maartje Michielsen Department of Orthopaedic Surgery, University Hospital Antwerp, Antwerp, Belgium

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Annemieke Van Haver Department of Orthopaedic Surgery, University Hospital Antwerp, Antwerp, Belgium

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Matthias Vanhees Department of Orthopaedic Surgery, University Hospital Antwerp, Antwerp, Belgium
Department of Orthopaedic Surgery, University Hospital Antwerp, Antwerp, Belgium

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Roger van Riet Department of Orthopaedic Surgery, University Hospital Antwerp, Antwerp, Belgium
Department of Orthopaedic Surgery, University Hospital Antwerp, Antwerp, Belgium

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Frederik Verstreken Department of Orthopaedic Surgery, University Hospital Antwerp, Antwerp, Belgium
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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Ian Garrison Department of Orthopaedic Surgery, University of South Alabama, College of Medicine, Alabama, USA

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Grayson Domingue Department of Orthopaedic Surgery, University of South Alabama, College of Medicine, Alabama, USA

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M. Wesley Honeycutt Department of Orthopaedic Surgery, University of South Alabama, College of Medicine, Alabama, USA

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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

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