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Casting, IM nailing show similar function at 6 months for stable tibial fractures

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DENVER — The first study comparing intramedullary (IM) nailing and casting for stable tibial fractures shows better functional outcomes with nailing at 3 months, but no functional advantages at 6 months.

The research also indicates a greater risk of malalignment with casting, according to a report at the 24th Annual Meeting of the Orthopaedic Trauma Association, here.

In a prospective, multicenter trial, William T. Obremskey, MD, and investigators from the SouthEast Fracture Consortium studied 54 patients who met Sarmiento’s criteria for a stable tibial fracture and were treated with either IM nailing (22 patients) or casting (32 patients) based on surgeon preference. The researchers assessed radiographic and functional results at 6 weeks, 3 months and 6 months.

The investigators discovered that the IM nail group had statistically significantly greater ankle dorsiflexion and plantar flexion than the cast group at 3 months. However, they found no significant differences between the groups at 6 months.

They also found no significant differences between the cohorts for knee pain, and neither group had an infection.

Although significantly more patients in the IM nail group returned to work at 3 months compared to the cast group (76% vs. 39%, respectively), there was no significant difference at 6 months. Radiographic assessment at 6 months also showed more malalignment in the cast group, but the investigators found no statistically significant differences between the groups in union rates at 3 and 6 months.

The investigators also reported that the IM nail group had significantly better scores on nearly all domains of the Short Musculoskeletal Functional Assessment scale at 3 months compared to the cast group, but there were no differences between the groups at 6 months.

“[This] is the first study to look at stable tibia fractures,” Obremskey said. “There is no real difference in ankle range of motion [between the patient groups]. The IM nail group seemed to return to work faster. The IM nail group also had better functional scores at 3 months with no real difference at 6 [months], and malalignment is possibly a slightly greater risk in the casting group.”

For more information:

• Obremskey WT. A prospective multicenter study of intramedullary nailing versus casting of stable tibial fractures. Paper #6. Presented at the 24th Annual Meeting of the Orthopaedic Trauma Association. Oct. 16-18, 2008. Denver.