Comparison of Kirschner-wire-distractor assisted reduction versus manual reduction in elastic stable intramedullary nailing for pediatric AO/OTA 32-A3 femoral fractures: A retrospective cohort study.

Abstract

Femoral shaft fractures represent common pediatric injuries. AO/OTA 32-A3 fractures pose significant challenges for closed reduction due to shortening displacement and muscular traction, frequently necessitating open reduction. This study describes a novel Kirschner-wire distractor-assisted technique and evaluates its efficacy versus traditional manual reduction in children with AO/OTA 32-A3 femoral shaft fractures. A retrospective study was conducted on 33 pediatric patients with AO/OTA 32-A3 femoral shaft fractures treated at our hospital from October 2014 to January 2025. The patients were divided into two groups (Group A and Group B) based on the reduction methods used. Group A (n = 15) underwent closed reduction assisted by a Kirschner-wire distractor, whereas Group B (n = 18) received traditional manual reduction. Both groups underwent fracture stabilization using elastic stable intramedullary nailing. We compared closed reduction success rates between Group A and Group B. Group B was further subdivided into successful closed reduction cases (Subgroup B1) and failed closed reduction cases (Subgroup B2). Surgical parameters including incision length, operative time, number of intraoperative fluoroscopy exposures, intraoperative blood loss, postoperative pain scores, and bone union time were then compared between Group A and B. The K-wire distractor group (Group A) achieved 100 % closed reduction success (15/15) versus 66.7 % (12/18) in the manual reduction group (Group B) (P = 0.02). Compared to Group B1, Group A required significantly fewer fluoroscopies and less operative time (P = 0.01), no statistically significant differences were observed in the remaining postoperative parameters, include incision length, intraoperative blood loss, postoperative pain scores and bone union time. Compared to Group B's failed reduction subgroup (B2), Group A showed superior outcomes in all parameters (all P < 0.001): shorter incision, operative time, reduced Fluoroscopy, reduced blood loss, lower pain scores, and faster union. Kirschner-wire distractor-assisted closed reduction demonstrates superior efficacy compared to conventional manual reduction for AO/OTA 32-A3 femoral fractures.