Comparison between interlocking nailing and plate fixation of tibial diaphyseal fractures in adults

Objectives Tibial diaphyseal fractures (TDFs) often result from high-energy forces and occur mostly among young adults. The mainstay of the treatment is operative fixation. We compare the outcome between locked intramedullary nailing (IMN) and plating of TDFs. Material and Methods This was a prospective comparative study conducted over an 18-month duration. Patients were selected in a randomized fashion and data were collected with a pro forma. Clinical, radiographic, and functional results were evaluated using Johner–Wruh’s criteria. Data were analyzed using the Statistical Package for the Social Sciences version 21. Significant statistical inference was <0.05. Results Ninety-six patients with hundred TDFs were recruited, and 10 patients were lost to follow-up leaving a total of 90 TDFs in 86 patients (45 fractures in each group). Locked IMN had an average duration of surgery of 115.16 ± 16.7 min, while it was 95.87 ± 14.74 min for plate fixation. The average duration of hospital stay was 18.12 ± 10.78 and 21.4 ± 12.94 days for plate fixation and locked IMN, respectively. At 18 weeks, the bone union had been achieved in 97.8% of locked IMN group and 91.1% of plate fixation group. There was a statistically significant wound infection rate of 4.4% in the locked IMN group and 17.8% in the plating group. The overall limb length discrepancy was 17.8% in the locked IMN group and 8.9% in the plating group. Conclusion Locked IMN technique is marginally superior to plate fixation. They can be used for the treatment of tibial shaft fractures.