Clinical outcomes of intramedullary nailing for tibial shaft fractures caused by low-energy gunshot versus Gustilo-Anderson type I tibial shaft fractures

BACKGROUND: Tibial shaft fractures caused by low-energy gunshot injuries represent a rare but challenging clinical problem. The optimal treatment approach, particularly in comparison with Gustilo-Anderson Type I open fractures, remains controversial. METHODS: This was a retrospective comparative study that included patients who underwent intramedullary nailing for tibial shaft fractures. Group 1 consisted of low-energy gunshot-induced fractures, while Group 2 included Gustilo-Anderson Type I open fractures. Demographic data, union time, Radiographic Union Score for Tibial Fractures (RUST), Johner-Wruhs functional classification, need for additional surgical intervention, and infection rates were compared. RESULTS: A total of 128 patients were included (68 in Group 1 and 60 in Group 2). No significant differences were observed between the groups regarding demographic characteristics, follow-up duration, union time, RUST scores, or Johner-Wruhs functional outcomes (p > 0.05). However, the infection rate was significantly higher in the low-energy gunshot group compared with the Gustilo-Anderson type I group (20.6% vs. 5.0%, p = 0.020).Nonunion and reoperation rates did not differ significantly between the groups. CONCLUSION: Intramedullary nailing for tibial shaft fractures caused by low-energy gunshot injuries provides clinical and radiological outcomes comparable to those observed in Gustilo-Anderson type I open fractures. Nevertheless, these injuries appear to be associated with a higher risk of infection, warranting careful perioperative management and closer postoperative surveillance.