The concept of a poller screw is based on the principle that the malalignment induced by oblique, proximal and distal fractures can be counteracted by the nail-directing effect of the screw. Therefore, its position should aim to counteract the displacement of the fracture. Most often it is therefore placed in the short side in the distal fragment. If there is a wide canal, two screws can be placed on either side of the path of the nail.
It is advisable to insert the poller screw prior to reaming, and in case of unreamed nailing, prior to nail insertion, in order to provide adequate contact between the nail and the screw. If the poller screw is inserted after reaming, the path of the nail is already set and the poller screw may not work. A small fracture screw or a locking screw can be used as a poller screw, depending on the local anatomy.
The reaming process in the presence of the poller screw must be performed very carefully in order not to harm the reamer tip.
The most frequent indication for poller screws is a proximal or distal oblique fracture which tends to shift when the axial knee blow technique is used to close any fracture gap, or when the patient is mobilized.
In these cases, prophylactic poller screws are very helpful.
Stedtfeld HW, Mittlmeier T, Landgraf P et al. The Logic and Clinical Applications of Blocking Screws. J. Bone Joint Surg. Am. 2004; 86-A Suppl 2:17-25.