Does timing matter? Impact of early versus delayed intramedullary nailing on healing and complications in isolated tibial shaft fractures

This study aimed to compare the effects of early (<48 hours) and delayed (>48 hours) intramedullary nailing on fracture union time and complication rates in patients with isolated tibial shaft fractures. A total of 68 patients who underwent intramedullary nailing for isolated tibial shaft fractures were retrospectively included in the study. Patients were divided into two groups based on the timing of surgery: early surgery group (n=34) and delayed surgery group (n=34). Demographic data, AO classification, time to union, and complication rates were compared between the groups. The mean time to union was significantly shorter in the early surgery group (15.2 ± 3.4 weeks) compared to the delayed group (17.6 ± 4.1 weeks) (p=0.011). There was no statistically significant difference between the groups in terms of complication rates, including superficial/deep infections, nonunion, and implant failure (p>0.05). Fracture types according to the AO classification were evenly distributed between the groups. Early intramedullary nailing significantly shortens the union time in isolated tibial shaft fractures. However, surgical timing does not appear to have a significant effect on complication rates. Therefore, the decision on surgical timing should be individualized based on patient characteristics and soft tissue condition.