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Can Tibial Shaft Fractures Bear Weight After Intramedullary Nailing? A Randomized Controlled Trial

Gross, Steven C. MD; Galos, David K. MD; Taormina, David P. MD; Crespo, Alexander BS; Egol, Kenneth A. MD; Tejwani, Nirmal C. MD

Journal of Orthopaedic Trauma: July 2016 - Volume 30 - Issue 7 - p 370–375
doi: 10.1097/BOT.0000000000000598
Original Article
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Objective: To examine the potential benefits and risks associated with weight-bearing after intramedullary (IM) nailing of unstable tibial shaft fractures.

Design: Randomized controlled trial.

Setting: Two New York State level 1 trauma centers, one level 2 trauma center, and 1 tertiary care orthopaedic hospital in a large urban center in New York City.

Patients/Participants: Eighty-eight patients with 90 tibial shaft fractures were enrolled. The following were used as inclusion criteria: (1) skeletally mature adult patients 18 years of age or older, (2) displaced fractures of tibial diaphysis (OTA type 42) treated with operative intervention, and (3) radiographs, including injury, operative, and completion of follow-up. Sixty-eight patients with 70 tibial shaft fractures completed follow-up.

Intervention: All patients were treated with locked IM nailing. Patients were randomized to 1 of 2 groups: immediate weight-bearing-as-tolerated (WBAT) or non–weight-bearing for the first 6 postoperative weeks (NWB).

Main Outcome Measures: Fracture union or treatment failure/revision surgery.

Results: There was no statistical difference in the observed time to union between groups (WBAT = 22.1 ± 11.7 weeks vs. NWB = 21.3 ± 9.9 weeks; P = 0.76). Rates of complications did not statistically differ between groups. No fracture loss of reduction leading to malunion was encountered. Short Musculoskeletal Function Assessment scores for all domains did not statistically differ between groups.

Conclusions: Immediate weight-bearing after IM nailing of tibial shaft fractures is safe and is not associated with an increase in adverse events or complications. Patients should be allowed to bear weight as tolerated after IM nailing of OTA subtype 42-A and 42-B tibial shaft fractures.

Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Supplemental Digital Content is Available in the Text.

*Department of Orthopaedics, NYU Hospital for Joint Diseases, New York, NY;

Department of Orthopaedics, Jamaica Hospital Medical Center, Jamaica, NY; and

Department of Orthopaedics, Bellevue Hospital Center, New York, NY.

Reprints: Nirmal C. Tejwani, MD, 301 East 17th St, Suite 1402, New York, NY 10003 (e-mail: Nirmal.Tejwani@nyumc.org).

Presented, in part, at the 29th Annual Meeting of the Orthopaedic Trauma Association, October 9–12, 2013, Phoenix, AZ; the 44th Annual Meeting of the Eastern Orthopaedic Association, October 30, 2013–November 2, 2013, Miami, FL; and the Annual Meeting of the American Academy of Orthopaedic Surgeons, March 11–15, 2014, New Orleans, LA.

K. A. Egol is a consultant to, and receives royalties from, Exactech. He also receives grant support from OMEGA, OTA, and OREF. N. C. Tejwani is a consultant for Zimmer and Stryker. The remaining authors report no conflict of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jorthotrauma.com).

This study was approved by the NYU School of Medicine Institutional Review Board as well as the Jamaica Hospital Medical Center Institutional Review Board.

Accepted March 25, 2016

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