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Purpose <p>This study aimed to describe the methods and outcomes of primary reamed intramedullary nailing (IMN) of tibial shaft fractures, specifically comparing multifragmentary tibial shaft fractures (MTSFs) with simple (type A) and wedge (type B) fractures in a low-resource setting.</p> Methods <p>The study included 165 fresh tibial shaft fractures, comprising 55 type A, 65 type B, and 45 MTSFs (type C) treated with SIGN nails. Intra-operatively, a surgical support triangle was used to facilitate fracture reduction and alignment. Outcomes included post-operative length of stay (PLOS), ongoing radiographic healing (ORH), full weight-bearing (FWB), squat and smile (S&amp;S), and infection.</p> Results <p>The mean patient age was 42.2 years. The surgical approach was similar across all fracture types. Closed reduction was achieved in 91.1% of MTSFs, 78.2% of type A, and 76.9% of type B fractures. The mean PLOS was 6.6 days. At 12 weeks, ORH was 88.6% for MTSFs (versus 100% for A/B, <i>p</i> = 0.001), FWB was 86.4% (versus 100% A, 92.3% B, <i>p</i> = 0.011), and S&amp;S was 81.8% (versus 100% A, 83.1% B, <i>p</i> = 0.002). The infection rate was 4.3%, with no significant differences between fracture types.</p> Conclusions <p>This study demonstrates that primary reamed IMN can be an effective treatment option for MTSFs in low-resource settings. The palpability of the tibia, early surgical intervention, and utilisation of a surgical support triangle contributed to procedural success despite the absence of intraoperative fluoroscopy. Although marginally lower than rates for types A and B fractures, radiographic and functional recovery at 12 weeks for MTSFs was satisfactory.</p>

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Primary reamed intramedullary nailing of tibial shaft fractures in a low-resource setting: a prospective comparative study of multifragmentary (AO/OTA 42 C) versus simple and wedge (AO/OTA 42 A/B) fractures

  • 期刊论文

  • 发表日期：

    2026年2月16日

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  • Stephen Adesope Adesina,
  • Isaac Olusayo Amole,
  • Imri Goodness Adefokun,
  • Adepeju Olatayo Adegoke,
  • Olusola Tunde Ekunnrin,
  • Dolapo Emmanuel Ajala,
  • Simeon Ayorinde Ojo,
  • Chiwendu Uchechukwu Isiakpona,
  • Innocent Chiedu Ikem,
  • Samuel Uwale Eyesan

摘要

Purpose

This study aimed to describe the methods and outcomes of primary reamed intramedullary nailing (IMN) of tibial shaft fractures, specifically comparing multifragmentary tibial shaft fractures (MTSFs) with simple (type A) and wedge (type B) fractures in a low-resource setting.

Methods

The study included 165 fresh tibial shaft fractures, comprising 55 type A, 65 type B, and 45 MTSFs (type C) treated with SIGN nails. Intra-operatively, a surgical support triangle was used to facilitate fracture reduction and alignment. Outcomes included post-operative length of stay (PLOS), ongoing radiographic healing (ORH), full weight-bearing (FWB), squat and smile (S&S), and infection.

Results

The mean patient age was 42.2 years. The surgical approach was similar across all fracture types. Closed reduction was achieved in 91.1% of MTSFs, 78.2% of type A, and 76.9% of type B fractures. The mean PLOS was 6.6 days. At 12 weeks, ORH was 88.6% for MTSFs (versus 100% for A/B, p = 0.001), FWB was 86.4% (versus 100% A, 92.3% B, p = 0.011), and S&S was 81.8% (versus 100% A, 83.1% B, p = 0.002). The infection rate was 4.3%, with no significant differences between fracture types.

Conclusions

This study demonstrates that primary reamed IMN can be an effective treatment option for MTSFs in low-resource settings. The palpability of the tibia, early surgical intervention, and utilisation of a surgical support triangle contributed to procedural success despite the absence of intraoperative fluoroscopy. Although marginally lower than rates for types A and B fractures, radiographic and functional recovery at 12 weeks for MTSFs was satisfactory.