Letter to the editor: Blocking screws: an adjunct to retrograde nailing for distal femoral shaft fractures.

To the Editor: We read with great interest the article by Gavaskar and Chowdary.1 1. What is the exact location of blocking screws, as being too close to the fracture site may risk propagation of the fracture line during nail insertion? Furthermore, there may be a risk of injuring the patellofemoral joint and neurovascular bundle while placing the blocking screws in an anteroposterior direction.2,3 Does the screw location differ depending on the pattern of the fracture? What was the authors’ view regarding this issue? 2. The authors stated that “the site for screw placement was identified with the nail in situ”. We believe that it is better to insert the blocking screws prior to reaming, and in cases of unreamed nailing, prior to nail insertion. This can provide adequate contact between the nail and the screw. The blocking screws may not function if inserted after reaming as the path of the nail is already set. What is the authors’ view regarding this concern? 3. It is technically challenging to insert the blocking screws in a precise location, for which the use of fluoroscopy is necessary. Did the authors measure the intra-operative radiation exposure time? 4. What were the absolute indications and contraindications of this procedure, as well as limitations of the study?