Strategies in Trauma and Limb Reconstruction

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VOLUME 11 , ISSUE 3 ( November, 2016 ) > List of Articles


The use of blocking screws with internal lengthening nail and reverse rule of thumb for blocking screws in limb lengthening and deformity correction surgery

Saravanaraja Muthusamy, S. Robert Rozbruch, Austin T. Fragomen

Keywords : Limb lengthening, Deformity correction, Intramedullary lengthening nail, Reverse rule of thumb, Blocking screws

Citation Information : Muthusamy S, Rozbruch SR, Fragomen AT. The use of blocking screws with internal lengthening nail and reverse rule of thumb for blocking screws in limb lengthening and deformity correction surgery. 2016; 11 (3):199-205.

DOI: 10.1007/s11751-016-0265-3

License: CC BY-NC-SA 4.0

Published Online: 01-12-2014

Copyright Statement:  Copyright © 2016; The Author(s).


Internal lengthening nail (ILN) is a recent development in limb lengthening and deformity correction specialty. The ILN has the distinct advantage of combining acute deformity correction with gradual lengthening of bone. While using ILN, the short metaphyseal bone fragment may develop a deformity at the time of osteotomy and nail insertion or during bone lengthening because of the wide medullary canal. These deformities are typically predictable, and blocking screws (Poller screws) are helpful in these situations. This manuscript describes the common deformities that occur in femur and tibia with osteotomies at different locations while using ILN in antegrade and retrograde nailing technique. Also, a systematic approach to the appropriate use of blocking screws in these deformities is described. In addition, the “reverse rule of thumb” is introduced as a quick reference to determine the ideal location(s) and number of blocking screws. These principles are applicable to limb lengthening and deformity correction as well as fracture fixation using intramedullary nails.

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