Does timing matter? Impact of early versus delayed intramedullary nailing on healing and complications in isolated tibial shaft fractures


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DOI:

https://doi.org/10.26900/hsq.2838

Keywords:

Tibial shaft fracture, intramedullary nailing, early surgery, delayed surgery, fracture healing, complications

Abstract

This study aimed to compare the effects of early (<48 hours) and delayed (>48 hours) intramedullary nailing on fracture union time and complication rates in patients with isolated tibial shaft fractures. A total of 68 patients who underwent intramedullary nailing for isolated tibial shaft fractures were retrospectively included in the study. Patients were divided into two groups based on the timing of surgery: early surgery group (n=34) and delayed surgery group (n=34). Demographic data, AO classification, time to union, and complication rates were compared between the groups. The mean time to union was significantly shorter in the early surgery group (15.2 ± 3.4 weeks) compared to the delayed group (17.6 ± 4.1 weeks) (p=0.011). There was no statistically significant difference between the groups in terms of complication rates, including superficial/deep infections, nonunion, and implant failure (p>0.05). Fracture types according to the AO classification were evenly distributed between the groups. Early intramedullary nailing significantly shortens the union time in isolated tibial shaft fractures. However, surgical timing does not appear to have a significant effect on complication rates. Therefore, the decision on surgical timing should be individualized based on patient characteristics and soft tissue condition.

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References

Court-Brown CM, Caesar B. Epidemiology of adult fractures: A review. Injury. 2006;37(8):691-7. doi: 10.1016/j.injury.2006.04.130. DOI: https://doi.org/10.1016/j.injury.2006.04.130

Larsen P, Elsoe R, Hansen SH, Graven-Nielsen T, Laessoe U, Rasmussen S. Incidence and epidemiology of tibial shaft fractures. Injury. 2015;46(4):746-50. doi: 10.1016/j.injury.2014.12.027. DOI: https://doi.org/10.1016/j.injury.2014.12.027

Schmidt AH, Finkemeier CG, Tornetta 3rd P. Treatment of closed tibial fractures. Instr Course Lect. 2003;52:607-22. DOI: https://doi.org/10.2106/00004623-200302000-00027

Bhandari M, Tornetta 3rd P, Sprague S, Najibi S, Petrisor B, Griffith L, et al. Predictors of reoperation following operative management of fractures of the tibial shaft. J Orthop Trauma. 2003;17(5):353-61. doi: 10.1097/00005131-200305000-00006. DOI: https://doi.org/10.1097/00005131-200305000-00006

Schemitsch EH, Bhandari M. Tibia fractures. In: Bucholz RW, Heckman JD, Court-Brown CM, Tornetta P III, editors. Rockwood & Green's Fractures in Adults. 8th ed. Philadelphia: Wolters Kluwer Health; 2015. 2415-72 p.

Cannada LK, Anglen JO, Archdeacon MT, Herscovici D Jr, Ostrum RF. Avoiding complications in the care of fractures of the tibia. Instr Course Lect. 2009;58:27-36.

Shao Y, Zou H, Chen S, Shan J. Meta-analysis of reamed versus unreamed intramedullary nailing for open tibial fractures. J Orthop Surg Res. 2014;9:74. doi: 10.1186/s13018-014-0074-7. DOI: https://doi.org/10.1186/s13018-014-0074-7

Vallier HA, Cureton BA, Patterson BM. Randomized, prospective comparison of plate versus intramedullary nail fixation for distal tibia shaft fractures. J Orthop Trauma. 2011;25(12):736-41. doi: 10.1097/BOT.0b013e318213f709. DOI: https://doi.org/10.1097/BOT.0b013e318213f709

Weber CD, Hildebrand F, Kobbe P, Lefering R, Sellei RM, Pape HC, et al. Epidemiology of open tibia fractures in a population-based database: Update on current risk factors and clinical implications. Eur J Trauma Emerg Surg. 2019 Jun;45(3):445-53. doi: 10.1007/s00068-018-0916-9. DOI: https://doi.org/10.1007/s00068-018-0916-9

Pape HC, Giannoudis P, Krettek C. The timing of fracture treatment in polytrauma patients: Relevance of damage control orthopedic surgery. Am J Surg. 2002;183(6):622-9. doi: 10.1016/S0002-9610(02)00865-6. DOI: https://doi.org/10.1016/S0002-9610(02)00865-6

Harwood PJ, Giannoudis PV, Probst C, Krettek C, Pape HC. The risk of local infective complications after damage control procedures for femoral shaft fracture. J Orthop Trauma. 2006;20(3):181-9. doi: 10.1097/00005131-200603000-00004. DOI: https://doi.org/10.1097/00005131-200603000-00004

Olson SA. Early versus delayed stabilization of femoral fractures. J Bone Joint Surg Am. 2003;85(7):1394. doi: 10.2106/00004623-200307000-00039. DOI: https://doi.org/10.2106/00004623-200307000-00039

Nowotarski PJ, Turen CH, Brumback RJ, Scarboro JM. Conversion of external fixation to intramedullary nailing for fractures of the shaft of the femur in multiply injured patients. J Bone Joint Surg Am. 2000;82(6):781-8. DOI: https://doi.org/10.2106/00004623-200006000-00004

Pape HC, Halvachizadeh S, Leenen L, Velmahos GD, Buckley R, Giannoudis PV. Timing of major fracture care in polytrauma patients - An update on principles, parameters and strategies for 2020. Injury. 2019;50(10):1656-70. doi: 10.1016/j.injury.2019.09.021. DOI: https://doi.org/10.1016/j.injury.2019.09.021

Kawasaki N, Takegami Y, Sakai R, Todoroki K, Uemi R, Imagama S. Hospitals of Trauma Research of Nagoya (TRON) group. Prediction of delayed union of tibial shaft fracture treated with intramedullary nailing: Multicenter-study analysis and literature review -the TRON study. Eur J Orthop Surg Traumatol. 2022;32(1):129-35. doi: 10.1007/s00590-021-02939-9. DOI: https://doi.org/10.1007/s00590-021-02939-9

Alsharef JF, Ghaddaf AA, AlQuhaibi MS, Shaheen EA, AboAljadiel LH, Alharbi AS, et al. External fixation versus intramedullary nailing for the management of open tibial fracture: Meta-analysis of randomized controlled trials. Int Orthop. 2023;47(12):3077-97. doi: 10.1007/s00264-023-05879-7. DOI: https://doi.org/10.1007/s00264-023-05879-7

Schaffer NE, Wilson JL, Yee MA, Hake ME. Intramedullary nail for a distal tibia fracture. J Orthop Trauma. 2020;34(Suppl 2):S37-8. doi: 10.1097/BOT.0000000000001837.

Faul F, Erdfelder E, Buchner A, Lang AG. Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses. Behav Res Methods. 2009;41(4):1149-60. doi: 10.3758/BRM.41.4.1149. DOI: https://doi.org/10.3758/BRM.41.4.1149

Corrales LA, Morshed S, Bhandari M, Miclau 3rd T. Variability in the assessment of fracture-healing in orthopaedic trauma studies. J Bone Joint Surg Am. 2008;90(9):1862-8. doi: 10.2106/JBJS.G.01580. DOI: https://doi.org/10.2106/JBJS.G.01580

Lashgari AM, Esper G, Ganta A, Egol KA, Konda S. Factors associated with decline in ambulatory ability following intramedullary nailing of 42A-C diaphyseal tibia fractures. J Clin Orthop Trauma. 2025;68:103117. doi: 10.1016/j.jcot.2025.103117. DOI: https://doi.org/10.1016/j.jcot.2025.103117

Donegan DJ, Akinleye S, Taylor RM, Baldwin K, Mehta S. Intramedullary nailing of tibial shaft fractures: size matters. J Orthop Trauma. 2016;30(7):377-80. doi: 10.1097/BOT.0000000000000555. DOI: https://doi.org/10.1097/BOT.0000000000000555

Ebrahimpour A, Rad SB, Ghamari BT, Pourmahmoudian M, Sadighi M, Sabaghzadeh A, Biglari F, Kafiabadi MJ, Razzaghi Z. Comparison of transverse and longitudinal incisions in tibia intramedullary nailing: Implications for pain, numbness, and functional recovery. Injury. 2025;56(7):112342. doi: 10.1016/j.injury.2025.112342. DOI: https://doi.org/10.1016/j.injury.2025.112342

Hak DJ, Toker S, Yi C, Toreson J. The influence of fracture fixation biomechanics on fracture healing. Orthopedics. 2010;33(10):752-5. doi: 10.3928/01477447-20100826-20. DOI: https://doi.org/10.3928/01477447-20100826-20

Upfill-Brown A, Hwang R, Clarkson S, Brodke D, Devana S, Mayer E, et al. Rates and timing of short-term complications following operative treatment of tibial shaft fractures. OTA Int. 2021;4(4):e158. doi: 10.1097/OI9.0000000000000158. DOI: https://doi.org/10.1097/OI9.0000000000000158

Giannoudis PV, Papakostidis C, Roberts C. A review of the management of open fractures of the tibia and femur. J Bone Joint Surg Br. 2006;88(3):281-9. doi: 10.1302/0301-620X.88B3.16465. DOI: https://doi.org/10.1302/0301-620X.88B3.16465

Schaffer NE, Wilson JL, Yee MA, Hake ME. Intramedullary nail for a distal tibia fracture. J Orthop Trauma. 2020;34(2):S37-8. doi: 10.1097/BOT.0000000000001837. DOI: https://doi.org/10.1097/BOT.0000000000001837

Vallier HA. Current evidence: Plate versus intramedullary nail for fixation of distal tibia fractures in 2016. J Orthop Trauma. 2016;30(4):S2-6. doi: 10.1097/BOT.0000000000000692. DOI: https://doi.org/10.1097/BOT.0000000000000692

Li F, Gao L, Zuo J, Wei J. Efficacy of damage control orthopedics strategy in the management of lower limb trauma. Surg Open Sci. 2024;26;19:101-4. doi: 10.1016/j.sopen.2024.03.008. DOI: https://doi.org/10.1016/j.sopen.2024.03.008

Chen SH, Lien PH, Lan CY, Hsu CC, Lin CH, Lin YT, et al. Predicting union, osteomyelitis, and amputation outcomes of Gustilo IIIC open tibial fractures: A retrospective study. Orthop Surg. 2024;16(1):94-103. doi: 10.1111/os.13940. DOI: https://doi.org/10.1111/os.13940

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Published

2025-10-04

How to Cite

Güzel, İsmail, Ulusoy, İbrahim, & Tantekin, M. F. (2025). Does timing matter? Impact of early versus delayed intramedullary nailing on healing and complications in isolated tibial shaft fractures. Health Sciences Quarterly, 5(4), 511–7. https://doi.org/10.26900/hsq.2838

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