Clinical and Radiological Outcome in Closed Unstable Diaphyseal Fracture of Tibia Managed with Dynamic Interlocking Nailing Supplemented with Functional Bracing

Introduction: Unstable tibial diaphyseal fractures from high-energy trauma are challenging due to displacement, comminution, and risk of non-union. This study evaluates dynamic interlocking intramedullary nailing (IMN) with functional bracing to enhance stability, promote union, and allow early mobilization. Methods: A prospective observational study was conducted at Maharaja Agrasen Medical College, Agroha, from May 2023 to September 2024, involving 40 skeletally mature patients (aged 18–60) with closed, unstable tibial fractures (AO types A1, A2, B1–B3, C1–C3). All underwent infrapatellar dynamic IMN followed by functional bracing post-swelling. Outcomes were assessed at 4, 12, and 24 weeks using modified Ketenjian and Shelton criteria. Results: Mean age was 36.3 years; 85% were male. Road traffic accidents caused 70% of injuries. Most fractures were mid-shaft (77.5%) and AO 42A1 (45%). Mean surgery time was 86 minutes; union occurred at 19±1 weeks. At 24 weeks, 94.91% showed excellent/good outcomes. Complications included two delayed unions, one non-union, one superficial infection, and one screw migration. No deep infections, malalignment, or implant failures were observed. Conclusion: Dynamic IMN with functional bracing is a safe, effective approach for unstable tibial fractures, enabling early rehabilitation and high union rates with minimal complications. Further studies are recommended for broader validation.