Intramedullary fixation of proximal tibial fractures

is challenging owing to the relatively high chance of displacement during nail insertion. The stability of the proximal fixation is inferior because of the wider diameter of the intramedullary canal in the metaphysis. This has led to the use of Poller screws for additional blocking during intramedullary fixation of proximal or distal tibial fractures.1 The effects of Poller screw is two-fold. First, fracture reduction is better maintained during nail insertion, which reduces the chance of malunion. Second, the stability achieved by additional Poller screws enables quicker fracture union. Stability can be further enhanced by modifying nail design and locking options,2 such as increasing the number of locking screws inserted into the metaphyseal fragment, and using angularly stable locking screws that diminish the amount of nail wobble in the screw hole.3 Commentary: Intramedullary nailing supplemented with Poller screws for proximal tibial fractures