Clinical Efficacy Analysis of Kirschner Wire Levering Assisted Closed Reduction and Intramedullary Fixation for Distal Tibial Fractures

Fan Rui; Chen Xiaoheng; Liu Zuwei; Yan Ling

Abstract：Objective To compare the clinical efficacy of Kirschner-wire levering with blocking-screw assistance during closed reduction and intramedullary nailing of extra-articular distal tibial fractures.Methods A retrospective analysis enrolled 44 patients treated between January 2019 and January 2024.Kirschner-wire levering group:23 patients[9 males,14 females;age 20～60 year mean(45.5±15.1)year].Blocking-screw group:21 patients[10 males,11 females;age23～69 year,mean(52.7±15.6)year].All patients underwent intramedullary nailing.We compared general data,peri-operative variables(operation time,blood loss,incision length),fracture healing time,hospital stay,partial and full weight-bearing times,VAS pain scores at 3 d,7 d,1 month,3 month and 6 month,and the Johner-Wruhs tibial fracture score at 12 month.Results No significant differences were observed between the two groups in general characteristics,operation time,blood loss,incision length,fracture healing time,hospital stay,partial or full weight-bearing time,VAS scores at any post-operative interval,or 12 month Johner-Wruhs scores(P＞0.05).At the last follow-up,the distance from the distal-most fracture line to the articular surface,angulation of the fracture fragments,coronal and sagittal angles of the nail tip,and distances from the nail tip to the medial/lateral and anterior/posterior cortices differed significantly(P＜0.05).Conclusion Compared with blocking screws,Kirschner-wire levering increases intramedullary fixation points,aids reduction,strengthens fixation,and allows more accurate central placement of the nail tip within the distal metaphyseal canal,resulting in better reduction quality.Therefore,Kirschner-wire levering offers a valuable reference for selecting an auxiliary technique in intramedullary nailing of distal tibial fractures.