Reamed intramedullary nailing of diaphyseal tibial fractures: comparison of compression and non-compression nailing

Modern intramedullary implants provide the option to perform compression at the fracture gap in long bone fractures via a compression screw mechanism. The aim of this study was to assess if the application of interfragmentary compression in the intramedullary nailing of tibia fractures could increase the union rate and speed of fracture healing.

Sixty-three patients who suffered from an AO-type 42-A3 or 42-B2 fracture that was treated by reamed intramedullary nailing between 2003 and 2008 were included in this retrospective study. Twenty-five patients were treated with dynamic interlocking without compression while 38 were treated with compression nailing. The compression load of the dynamic proximal screw was calculated by postoperative X-ray and radiographs taken four weeks after operation. Healing was assessed by radiological evaluation until the completion of bony healing or the disappearance of clinical symptoms. Nonunion was defined as the absence of radiological union and the persistence of clinical symptoms after six months.

Postoperative compression was applied at a mean load of 1,852 N, and 980 N remained after four weeks. In the compression group, 19 open and 19 closed fractures occurred. In the non-compression group, 25 patients were included (14 closed and 11 open cases). Active compression decreased healing time significantly. Nonunion occurred in one compression patient and three non-compression patients.

The results show that additional compression of the fracture gap can improve healing outcome in simple transverse tibial shaft fractures treated with reamed nailing.