Abstract: Background: Proximal one-third tibial fractures are challenging to treat due to the high incidence of malalignment and non-union. The use of poller screws in combination with intramedullary nailing has been proposed to improve reduction and alignment in these fractures.Methods: A prospective observational cohort study was conducted on 40 patients with proximal one-third tibial fractures treated with intramedullary nailing and poller screws. Radiological outcomes were assessed by measuring the antecurvatum/recurvatum and varus/valgus angles. Functional outcomes were evaluated using the Karlstrom-Olerud scoring system. The mean follow-up period was 9 months.Results: The mean antecurvatum/recurvatum angle improved from 2.72 ± 4.22° preoperatively to 0.4 ± 1.13° postoperatively (p = 0.0002) and 0.15 ± 0.7° at union (p = 0.0002). The mean varus/valgus angle improved from 6.25 ± 11.01° preoperatively to 1.45 ± 3.5° postoperatively (p = 0.001) and 0.68 ± 3.14° at union (p = 0.0003). The mean time to union was 13.27 ± 1.71 weeks. According to the KarlstromOlerud scoring system, 92.5% of patients achieved excellent or good outcomes.Conclusion: The use of poller screws in combination with intramedullary nailing is an effective method for the treatment of proximal one-third tibial fractures, resulting in significant improvements in fracture alignment, high rates of union, and good functional outcomes.