Comparison of intramedullary nailing versus plate fixation in tibial shaft fractures: A retrospective clinical and radiological analysis

Abstract

Aim: Treatment for tibial shaft fractures typically involves plate fixation or intramedullary nailing (IMN). Our objective in this study was to compare the radiological and clinical outcomes of plate fixation with IMN for tibial shaft fractures

Method: Fifty-two patients (33 males, 19 females; mean age 36.9±13.8 years; range, 16 to 68 years) who underwent surgery for tibial shaft fracture) between 2003-2011 were retrospectively evaluated. Patients were compared in terms of union time, radiological healing time, weight-bearing time, infection, malunion, and malalignment. Final clinical evaluations of the patients was performed according to the R. Johner and O. Wrush criteria.

Results: The average time to weight-bearing was significantly longer in the plate fixation group (7.63±2.27 weeks) compared to the intramedullary nailing group (4.04±1.06 weeks, p=0.000). Similarly, the radiological healing time was longer with plate fixation (12.37 months) by 4.30 months (p=0.000). There were no significant differences in pain between the groups (p=0.535), walking ability (p=0.431), joint range of motion (p=0.243), or strenuous activities (p=0.449). According to the R. Johner and O. Wrush criteria, 68% of patients in both groups achieved excellent outcomes, with the remaining patients having a similar distribution between good and fair categories.

Conclusions: The study's findings demonstrated that, in terms of clinical and functional results, both treatment approaches are comparable. Aligning seems to be easier with plates, while the healing period appears to be shorter with IMN. To shed further light on these matters, Randomized Prospective evaluation may be recommended and it may provide detailed information on the costs/expenses associated with these fractures.