Percutaneous Clamp-assisted Reduction Before Intramedullary Nailing for Tibial Shaft Fractures to Improve Reduction Outcomes: A Retrospective Cohort Study.

Abstract

This retrospective cohort study aimed to compare the clinical outcomes of percutaneous clamp-assisted reduction (PCR) and conventional direct reduction (DR) techniques prior to intramedullary nailing (IMN) in the management of tibial shaft fractures. The medical records of 68 consecutive patients treated via IMN via the infrapatellar approach between January 2020 and December 2023 were retrospectively reviewed. After the inclusion/exclusion criteria were applied, patients were divided into PCR (n=37) and DR (n=31) groups. Demographic data, fracture characteristics, surgical data, and prognostic outcomes were analyzed. Baseline characteristics showed no significant intergroup differences. PCR demonstrated a longer reduction time (25.3±1.9 min vs 21.4±1.4 min, <i>P</i><0.01) but required less fluoroscopic exposure (18.0±1.4 vs 22.0±1.4, <i>P</i><0.01), shorter surgical duration (73.0±3.1 min vs 88.7±8.6 min, <i>P</i><0.01), and reduced blood loss (101.6±17.2 mL vs 153.2±52.9 mL, <i>P</i><0.01). No open reductions occurred in the PCR group, whereas five cases occurred in the DR group (16.1%, <i>P</i><0.05). Approximate anatomical union rates significantly favored PCR (62.2% vs 16.1%, <i>P</i><0.01). No statistically significant differences were observed between the two groups in terms of American Orthopaedic Foot and Ankle Society score, union time, delayed union rate, or malunion rate. Compared with conventional DR, PCR prior to IMN improves fracture reduction quality, reduces intraoperative invasiveness, and enhances procedural efficiency, with superior anatomical alignment outcomes. [<i>Orthopedics</i>. 2025;48(3):e147-e152.].