ArticleEuropean journal of trauma and emergency surgery : official publication of the European Trauma Society2026
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.
Article in European journal of trauma and emergency surgery : official publication of the European Trauma Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeThis 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.
methodsThe 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.
resultsThe 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.
conclusionsThis 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.
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