title: External fixation versus locked intramedullary nailing in tibial shaft fractures: a prospective, randomised study of 78 patients.
abstract: BACKGROUND
  We performed a prospective, randomised study to compare the Ex-fi-re external fixator (EF) with locked intramedullary (IM) nailing in tibial fractures. Only fractures without soft-tissue problems of importance were included.
  
  
  METHODS
  Ex-fi-re is a unilateral, dynamic axial fixator with fracture reduction capabilities. The Grosse-Kempf nail was used for nailing. A total of 78 patients with 79 fractures were entered in the study (41 Ex-fi-re, 38 IM nails).
  
  
  RESULTS
  Time to radiographic union and full weight-bearing did not differ significantly, but unprotected weight-bearing was achieved earlier in the IM group (12 vs 20 weeks; p<0.001). There were more reoperations due to secondary dislocation in the EF group. There were no differences in final angulation or shortening. After 6 months and 1 year there were no differences in knee motion, ankle motion, fracture site pain or ankle pain. Some 64% of the nailed patients complained of anterior knee pain after 1 year.
  
  
  CONCLUSIONS
  The results were comparable in most respects. Unprotected weight-bearing was achieved earlier after IM nailing. Anterior knee pain was frequent after nailing.
authors.affiliation: Department of Orthopedics, University Hospital, 7006, Trondheim, Norway. martinus.braten@medisin.ntnu.no
authors.forename: Martinus
authors.initials: M
authors.lastname: Bråten
authors.forename: Per
authors.initials: P
authors.lastname: Helland
authors.forename: Torbjørn
authors.initials: T
authors.lastname: Grøntvedt
authors.forename: Arild
authors.initials: A
authors.lastname: Aamodt
authors.forename: Pål
authors.initials: P
authors.lastname: Benum
authors.forename: Anders
authors.initials: A
authors.lastname: Mølster
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004867:Equipment Design; D016267:External Fixators; D005594:Fracture Fixation, Intramedullary; D017102:Fracture Healing; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D011446:Prospective Studies; D012086:Reoperation / Q000706:statistics & numerical data; D013978:Tibial Fractures / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D016474:Weight-Bearing / Q000502:physiology