Treatment Of Segmental Tibial Shaft Fractures: Combination Of External Fixator With Titanium Elastic Nails Versus Locking Intramedullary Nail

Objectives: This study was designed to compare clinical outcomes using external fixator combined with titanium elastic nails (EF + TENs) versus reamed locking intramedullary nail (IM) for the treatment of segmental tibial shaft fractures. Methods: Between February 2010 and September 2013, one hundred and eight patients ranging from 23 to 55 years old (mean age: 37 years old) suffering from segmental tibial shaft fractures (68 women and 40 men) were treated with either EF + TENs or IM, with 54 patients in each group. The duration of operation, radiation times, intraoperative blood loss, peri-operative hidden blood loss, postoperative clinical efficacy, and radiographic evaluation were measured to explore the benefits and drawbacks of these two techniques. Results: All 108 patients were followed up for at least 12 months. The differences in the mean radiation times and duration of operation (P = 0.451 and P = 0.082, respectively) were not statistically significant when comparing the EF + TENs group to the IM group. There was no significant difference in the time to union (P = 0.460), delayed union (P = 0.358) and malunion (P = 0.475) between the two groups. In addition, the rate of ankle pain (P = 0.475) and the total scores as measured by the functional American Orthopaedic Foot and Ankle surgery (AOFAS) score (P = 0.312) was not significantly different. No case of nonunion was observed in both groups. In comparison with IM, patients in group EF + TENs have less blood loss during the operation (P = 0.001), less peri-operative hidden blood loss (P = 0.001) and a lower rate of knee pain (P = 0.001). Moreover, EF + TENs can be used in fractures which have bone subfissures close to the joint, and can promote fracture healing by gradual mobilization as an outpatient. Conclusions: Our results indicated that compared with IM, EF + TENs has potential advantages and benefits, and should be a better technique for the treatment of segmental tibial shaft fractures.