Functional Outcomes of Early vs. Delayed Weight Bearing After Tibial Intramedullary Nailing

Background: Tibial shaft fractures are among the most common long bone injuries, primarily caused by high-energy trauma such as road traffic accidents. Intramedullary nailing has become the standard treatment due to its biological and biomechanical advantages. However, the optimal timing of weight bearing following surgery remains controversial. While traditional protocols advocate delayed mobilization, emerging evidence suggests that early weight bearing may accelerate union, enhance functional recovery, and reduce rehabilitation-related morbidity. Aim: To compare the functional outcomes of early versus delayed weight bearing after intramedullary nailing in patients with tibial shaft fractures. Methods: This prospective comparative study was conducted in the Department of Orthopedics, SK Medical College and Hospital, Sikar, from August 2023 to July 2024. Sixty patients with tibial shaft fractures fulfilling the inclusion criteria were enrolled and divided into two groups of 30 each. Group A patients were allowed early weight bearing within 2 weeks of surgery, while Group B patients commenced weight bearing after 6 weeks. Demographic data, fracture characteristics, operative details, and postoperative rehabilitation were recorded. Outcomes were assessed using clinical and radiological union time, complications, and functional results based on the Johner and Wruhs criteria. Statistical analysis was performed using SPSS v26.0, and a p-value < 0.05 was considered significant. Results: The mean union time was significantly shorter in the early weight bearing group (18.4 ± 2.6 weeks) compared to the delayed group (21.2 ± 3.1 weeks). At six months, excellent and good outcomes were observed in 90% of Group A patients versus 70% in Group B. Complication rates, including superficial infection, malalignment, delayed union, and implant failure, were low and comparable between groups, with no statistically significant difference. Non-union was rare and occurred only in the delayed group. Conclusion: Early weight bearing following intramedullary nailing of tibial shaft fractures is safe and effective, resulting in faster fracture union, superior functional outcomes, and better joint mobility without increasing complication rates. Adoption of early mobilization protocols may improve recovery and reduce the socioeconomic burden associated with prolonged rehabilitation.