No difference in the long term final functional outcome after nailing or cast bracing of high energy displaced tibial shaft fractures

Sixty-eight consecutive patients were treated alternately with CB and IMN for high energy, displaced, closed and Gustilo Grade 1 open fractures of the tibial shaft, between 1995 and 2001.An average follow up at 4.3？years revealed no statistical difference in the final functional outcome as per Johner and Wruhs' criteria with modification to Indian lifestyle. IMN group had a) slightly shorter time to fracture union (mean 21.3？weeks versus 23.1？weeks for CB, p？>？0.05), (b) lesser time off work (mean 17.6？weeks versus 25.6？weeks for CB, p <0.01), (c) fewer outpatient visits (mean 6.2 versus 9.7 for CB, p？<？0.05), (d) less limb length discrepancy (mean 4.3？mm versus 6.6？mm for CB, p？<？0.05). The difference in residual antero-posterior angulation (mean 3.2 degrees for IMN versus 4.9 degrees for CB, p？=？0.14) and varus-valgus angulation (mean 3.7 degrees for IMN versus 5.1 degrees for CB, p？=？0.7) were not statistically significant. However CB group had no deep infections as compared to two in the IMN group. The average cost of hospital treatment of CB group was less than half incurred by the IMN group (average USD 831 versus USD 2071 for nailed group, p？<？0.05).Treating tibial shaft fracture either with IMN or CB provided equally gratifying results with no statistical difference in final functional outcome. The economic cost to the patient in Indian conditions is significantly less with CB and therefore stands as an equally reliable treatment option, especially in countries with fewer resources.