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Poller K-Wires versus Screws in Distal Tibial Nailing: Non-Inferior Union with Superior Efficiency and Better
Ahmet Muçteba Yildirim1, Serkan Bayram2, Muhammed Ibrahim Karaçam2
1Department of Orthopaedics and Traumatology, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Turkey.
Purpose Of The Study:
To compare the short-term outcomes and complications of the poller screw (PS) and the poller K-wire (PW) in distal tibia nailing.
Material And Methods:
In the present study, a retrospective analysis was performed on prospectively collected data, 43 cases were included in the study. 16 patients were included in the PS group and 27 patients in the PW group. Demographic data, fracture union times, RUST scores, alignment in the coronal and sagittal planes, associated fibula fractures and fixation, malunion, and complications were compared. A subgroup analysis was performed according to fibula fixation and the number of distal locking screws.
Results:
There was no significant difference between PS and PW groups in respect to age, gender, trauma etiology, fracture-joint distance and AO classification of fractures. In the PS group, the operation time and final coronal angulation were significantly higher (operation time: 81.5 ± 15.27 minutes and 72.22 ± 11.79 minutes, respectively, p = 0.031; coronal angulation: 3.12° ± 3.2° and 1.24° ± 1.76°, respectively, p = 0.044). No statistically significant difference was found in terms of fracture healing time and RUST scores. Non-union was observed in one patient in the PS group. There was no significant difference in fracture healing times and RUST scores when subgroup analysis was performed according to fibula fixation and distal locking screw numbers.
Discussion:
The PW technique offers significant advantages in terms of surgical efficiency and reduction quality in the coronal plane. Although the risk of wire displacement remains a disadvantage that must be minimised with careful technique, these advantages make PW a preferable alternative to PS for assisting reduction in distal tibial nailing, where PS has disadvantages such as longer operating times and less optimal alignment control.
Conclusions:
The use of PW instead of PS has no negative effect on fracture union time and also improves alignment and decreases the operative time.
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