Management of closed isolated tibial shaft fracture: A dilemma in a rural set up of a developing country

Abstract

Background: Better results are reported with internal fixation of displaced tibial shaft fractures than nonoperative treatment. Objectives: Effective screening of nonunion risk to decrease the morbidity and subsequent healthcare resource use and cost. Materials and Methods: This pilot project was conducted in a tertiary care hospital of a developing country on 68 patients in a time period of one year. Thirty-four patients were treated with intramedullary nailing (Group I) in the tertiary care hospital while 34 patients received closed manipulation (Group II) in a rural hospital. Johner and Wruh′s criteria were used to assess the final outcome. Results: The mean time to union was 19 weeks after management with a cast and 13 weeks after management with nailing (P < 0.05). Excellent result found in 13 cases, good in 6, fair in 2 in Group I and excellent result found in 8 cases, good in 16, fair in 6, poor in four in Group II. The mean time to radiographic union was 19 weeks for Group II compared with 13 weeks for Group I (P < 0.05). Six patients in Group II had shortening of more than 1.5 cms. No patient had shortening of more than 1.5 cms in Group I (P < 0.05). Group I returned to work significantly earlier than the other group. Conclusion: Though results with treatment of isolated, closed tibial shaft fracture with intramedullary nailing is a better option, closed manipulation still remains an alternative method of treatment in a developing country and there is urgent need to upgrade rural centers for improvement of mode of treatment.