Functional Outcome of Intramedullary Nailing vs Plating in Tibial Shaft Fracture

Abstract

Fractures of the tibial shaft are typical long-bone injuries that are accompanied by a high rate of morbidity. Surgical procedures such as intramedullary nailing and plate fixation are common, although there is controversy over the most effective approach owing to variations in healing rates and complication rates. Objective: To compare the functional outcomes of intramedullary nailing and plate fixation in patients with tibial shaft fractures. Methods: This was a prospective comparative study conducted in the Department of Orthopedics, Hayatabad Medical Complex, Peshawar, from March 2023 to August 2024. 110 patients aged between 18 and 60 years were enrolled. Both closed fractures and Gustilo-Anderson type I and II open fractures were considered eligible. Pathological fracture, polytrauma with intensive care, neurovascular injury, Gustilo type III open fracture, or previous surgery of the affected limb in patients were excluded. Results: A total of 110 patients were included. Mean time to union was significantly shorter in the intramedullary nailing group than in the plating group (16.2 ± 3.8 vs. 19.1 ± 4.5 weeks; p=0.001). Overall, union was achieved in 92.7% of patients. Excellent to good functional outcomes were higher in the intramedullary nailing group compared with the plating group (83.6% vs. 72.7%), although the difference was not statistically significant (p=0.180). Conclusions: Intramedullary nailing offers earlier fracture union and faster recovery, while both techniques provide comparable functional outcomes. The choice of fixation should be individualized based on patient and fracture characteristics.