A Comparison between Unreamed Locked Intramedullary Nailing and Plate-Screw Fixation in the Treatment of Tibial Diaphyseal Fractures

Background: Tibial diaphyseal fracture is the most common fracture of long bones. In Iran plating and undreamed tibial nailing (UTN) are the most commonly used methods and because of paucity of equipments such as c-arm and reaming sets, the reamed method is rarely used. This study compares these two methods. Methods: In a randomized clinical trial study including 100 patients (78 males, 22 females; mean age=24 years; range=16-50 years) undergoing UTN and plate-screw in the treatment of uncomminuted closed tibial shaft fractures (50 patients in each group) were compared regarding the union time and complications after a mean follow up of 16 months (1220 months). Results: the mean time to union was 16 weeks with UTN and 14.3 weeks with plate-screw fixation. There was 4 (8%) and 3 (6%) non unions after UTN and plating respectively. Plain radiographs in both groups showed angulation in 3 patients; all in distal third and in varus (6%). There was not any infection after UTN but one case of superficial and one case of deep infection were noticed after osteosynthesis with plate and screw (4%). Four patients after UTN and 4 patients after fixation with plate-screw required reoperation (8%). Conclusion: plate-screw osteosynthesis yielded satisfactory results in uncomminuted closed fractures of the tibial shaft comparable with UTN results.