title: Displaced tibial shaft fractures: a prospective randomized study of closed intramedullary nailing versus cast treatment in 53 patients.
abstract: Of 53 patients with unilateral, displaced and closed or grade 1 open tibial shaft fractures, 27 patients (group I) were randomized to treatment with an intramedullary nail and 26 patients (group II) to treatment with a plaster cast. 12 fractures in the latter group were considered stable enough for treatment with only a cast (group IIa), while 14 fractures in group II showed redisplacement during reduction under anesthesia or at 1 week follow-up. Therefore, these fractures were stabilized with cerclage or screws (group IIb), which was a prerequisite for continuing cast treatment. The mean time-to-union was 19 weeks for group I, and 25 weeks for group II. 6 patients in group I and 16 in group II had delayed union. The Nottingham Health Profile index scores on physical mobility, social isolation, work ability, and sexual life were significantly better in group I than in group II at 3 months after injury. Delayed union, malunion, and restricted range of motion at the ankle joint were common complications when these fractures were treated with a cast. We recommend intramedullary nailing for these fractures.
authors.affiliation: Department of Orthopedics, Sahlgrenska University Hospital, Göteborg University, Sweden.
authors.forename: A H
authors.initials: AH
authors.lastname: Karladani
authors.forename: H
authors.initials: H
authors.lastname: Granhed
authors.forename: B
authors.initials: B
authors.lastname: Edshage
authors.forename: R
authors.initials: R
authors.lastname: Jerre
authors.forename: J
authors.initials: J
authors.lastname: Styf
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D002370:Casts, Surgical / Q000009:adverse effects; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000379:methods; D017102:Fracture Healing; D005596:Fractures, Closed / Q000145:classification / Q000000981:diagnostic imaging / Q000601:surgery*; D005597:Fractures, Open / Q000145:classification / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011446:Prospective Studies; D011859:Radiography; D016059:Range of Motion, Articular; D012720:Severity of Illness Index; D013978:Tibial Fractures / Q000145:classification / Q000000981:diagnostic imaging / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome