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The Logic and Clinical Applications of Blocking Screws
Hans-Werner Stedtfeld, MD, PHD; Thomas Mittlmeier, MD; Peter Landgraf, MD; Andreas Ewert, MD
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In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from B Braun Aesculap, Germany. In addition, one or more of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity (B Braun Aesculap). No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2004 Dec 01;86(suppl 2):17-25
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In 1999, Krettek et al. introduced the concept of placing screws around an intramedullary nail (so-called Poller screws)1,2. These screws were used in association with interlocking nailing of tibial fractures with either proximal or distal fragments to facilitate alignment and to prevent late loss of alignment. Krettek et al. recommended placing one screw proximally and one distally on the concave side of the displacement. These screws were thought to work by narrowing the medullary canal in the metaphysis to provide a tight mechanical fit for the intramedullary nail. Similarly, Biewener et al. employed the sequential placement of Kirschner wires to guide an intramedullary nail with a good central position into a distal short fragment3. This procedure was called the "pallisade method."
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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