Comparison of Results of Conservative and Operative (Interlocking Nail) Treatment of Closed Isolated Diaphyseal Tibial Fracture in Adult

The aim of this prospective study is to compare the result of treatment in two groups , one group closed intramedullary nailing after reaming with the other group closed reduction followed by plaster casting in the patient having isolated closed diaphyseal tibial fracture in adult. Materials & Methods: All patients with an isolated closed unilateral fracture of the tibial diaphysis, , were evaluated for inclusion in the present study. Inclusion criteria were displaced closed fractures. The fractures of type A and B, according to the AO-classification system, were considered suitable for the study Patients who agreed to participate in the study were randomized using the technique of stratified randomization by minimization. This method ensures that the treatment groups are similar as regards the percentage of patient factors that are considered of major prognostic importance. The aim is to balance the marginal treatment totals for each level of each patient factor. Patients in each stratum were randomly allocated for treatment by reamed intramedullary nailing or plaster cast . 17 patients were randomized to have reamed intramedullary nail (group I), and 17 patients were randomized to have a plaster cast (group II). All fractures were unilateral. 19 involved the right leg. 4 patients were injured by falling accidents. Traffic accidents caused the injuries in 26 patients, 11 of them were pedestrians, 2 was an automobile driver, and 13 was a motorcycle driver. 2 patients were injured in sporting accidents and 2 others were injured at work. Results: The mean time to radiographic union was nineteen weeks for the 17 patients who had been managed with a cast compared with thirteen weeks for the 17 patients who had been managed with nailing (p <0.05). A non-union occurred in two patients who had been managed with a cast and in one patient who had nailing. Two patients who had a non-union after management with a cast had intact fibula. These differences were significant (p < 0.05, chi-square test). For the matched pairs of patients, the mean time to union was nineteen weeks after management with a cast and thirteen weeks after management with nailing (p <0.05) (Table 3The differences between the two groups were significant (p < 0.05).