A Comparison between Unreamed Tibial Nailing and Plate in the Treatment of Closed Tibial Diaphyseal Fractures

Abstract

Background:Tibial diaphyseal fracture is the most common fracture of long bones. Reamed intramedullary nailing is the method of choice for internal fixation of closed fractures. In Iran, plating and unreamed tibial nailing (UTN) are the most commonly used methods; because of paucity of equipments such as c-arm and reaming sets the reamed method is rarely used. This study compared the results of these two methods in the treatment of uncomminuted closed tibial shaft fractures. Methods: A randomized clinical trial study including 100 patients (78 males, 22 females; mean age 24 years; range 16 to 50 years) was performed. Fifty patients were in unreamed locked intramedullary nailing and plate-screw groups. The patients were evaluated with regard to the union time and complications after a mean follow up of 16 months (12-20 months). Findings: The mean time to union was 16 weeks in the UTN group and 14.3 weeks in the plate-screw fixation group (P > 0.05). There were 4 (8%) and 3 (6%) non-union after UTN and plating respectively (P > 0.05). Plain radiographs showed angulation in 3 patients in each group, all of them were in distal third fractures and in varus (6%). There was no infection after UTN but one superficial infection after osteosynthesis with plate and screw (2%). 4 patients after UTN and 3 patients after fixation with plate-screw required reoperation (8% versus 6%). Conclusion: Plate-screw osteosynthesis yields satisfactory results in uncomminuted closed fractures of the tibial shaft and has comparable results with UTN. Key words: Close fracture, Tibial diaphysis, Unreamed tibial nailing (UTN), Plate-screw.