Immediate Unreamed Nailing Versus Delayed Nailing in Compound Tibial Shaft Fracture

Introduction: Tibia is largely covered with thin soft tissue envelope, hence high chance of open fracture and exposure of bone.

Method: We conducted a prospective, randomized control trial study on 52 patients of open grade IIIA and IIIB (Gustilo and Anderson classification) fractures regarding immediate unreamed interlocking nail in 26 patients and external fixation followed by interlocking nail (delayed nailing) in remaining half of the patients distributed as par randomisation plan and the outcome was measured.

Results: In open Type IIIA fractures, union occurred after 18.09 and 26.5 weeks after immediate and delayed nailing group respectively while in IIIB union was achieved at 24.7week and 47.2weeks respectively. We obtained excellent results in 73.07% patients after immediate nailing and 53.84% after delayed nailing.

Conclusion: Un-reamed solid intramedullary interlocked nailing provides excellent results in function as well as union, especially in GA Type II fracture. Immediate nailing led to earlier union in this study. Statistically significant differences were found in case of union rate and full weight bearing in favour of immediate nailing. Overall, the results were better in the immediate nailing group.