Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, United Kingdom
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Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, United Kingdom
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Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, United Kingdom
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Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, United Kingdom
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phases of their care ( Fig. 1 ). Figure 1 The ‘Leeds Major Trauma Risk Phaseout’ represents a graphic representation of the gradual decrease in the risk of death/disability following major trauma. These risks, at the time of the accident/’first hit
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Major Trauma Centre, Leeds Teaching Hospitals NHS Trust, University of Leeds, United Kingdom
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Segmental femoral fractures represent a rare but complex clinical challenge. They mostly result from high-energy mechanisms, dictate a careful initial assessment and are managed with various techniques. These often include an initial phase of damage control orthopaedics while the initial manoeuvres of patient and soft tissue resuscitation are employed.
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Definitive fixation consists of either single-implant (reconstruction femoral nails) or dual-implant constructs. There is no consensus in favour of one of these two strategies.
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At present, there is no high-quality comparative evidence between the various methods of treatment. The development of advanced design nailing and plating systems has offered fixation constructs with improved characteristics.
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A comprehensive review of the existing evidence with a step-by-step description of these different definitive fixation strategies based on three case examples was conducted. Furthermore, the rationale for using single vs dual-implant strategy in its case is presented with supportive references.
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The prevention of complications relies mainly on the strict adherence to basic principles of fracture fixation with an emphasis on careful preoperative planning, the quality of the reduction, and the application of soft tissue-friendly surgical methods.
West Hertfordshire Hospitals NHS Trust, London, United Kingdom
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James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, Norfolk, United Kingdom
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Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, Essex, United Kingdom
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School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
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Compared to other techniques, poller screws with intramedullary nailing are technically simple, practical, and reproducible for the fixation of metaphyseal fractures.
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In addition, poller screws do not require special instruments or hardware and are minimally invasive. This review takes a historical perspective to evaluate poller screws holistically.
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A non-systematic search on PubMed was performed using ‘Poller screw’ or ‘Blocking screw’ to find early use of poller blocking screws. Relevant references from these primary studies were then followed up.
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In 1999, Krettek et al. first coined the term poller screws after the small metal bollards that block and direct traffic.
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Poller screws were introduced as an adjunct to aid the union of metaphyseal long bone fractures during intramedullary nailing.
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However, as more evidence was published, the true effectiveness of poller screws was not appreciated, leading to split opinions.
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Through our research, we have built upon our understanding of poller screws, and we present a novel classification of poller screws over the years while exploring our novel technique and what we believe to be the fourth generation of poller screws.
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Currently, there is a paucity of research focussing on poller screws.
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However, studying the original evidence regarding poller screws through the most recent articles has demonstrated a confusion of research in this field. Therefore, we suggest a more organised approach to classify the use of poller screws.
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Fitzgerald M Misra MC Howard T Mathew J Rotter T Fiander M et al . Prehospital notification for major trauma patients requiring emergency hospital transport: A systematic review . Journal of Evidence-Based Medicine 2017 10 212 – 221 . ( https
Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
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Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
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NP Curry N Maegele M Brooks A Rourke C Gillespie S Murphy J Viscoelastic haemostatic assay augmented protocols for major trauma haemorrhage (ITACTIC): a randomized, controlled trial . Intensive Care Medicine 2021 47 49 – 59 . ( https
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as soon as possible; however, the benefits and risks of immediate reduction should be thoroughly assessed. Conclusions Cervical spine injuries are a common entity in major trauma patients but can also occur in minor trauma cases. Safe
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Department of Orthopedic Surgery, University Hospital Odense, Odense C, Denmark
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J Spoors L Masters JP Dutton S Madan J Costa ML . Standard wound management versus negative-pressure wound therapy in the treatment of adult patients having surgical incisions for major trauma to the lower limb-a two-arm parallel group
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. Spinal cord injury–incidence, prognosis, and outcome: an analysis of the TraumaRegister DGU . Spine J 2015 ; 15 : 1994 - 2001 . 21 Weber CD Horst K Lefering R . Major trauma in winter sports: an international trauma
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years at a major trauma center . Br J Neurosurg 2016 ; 30 : 658 - 61 . 19. Kinon MD Desai R Loriaux D Houten JK . Image-guided percutaneous internal fixation of sacral fracture . J Clin Neurosci 2016 ; 23
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mucosal epithelium. 14 , 15 Risk factors for SRMD Risk factors for SRMD include critical illness, mechanical ventilation for more than 48 hours, coagulopathy, septic shock, renal failure, hepatic failure, head injury, major trauma, cigarette
