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Displaced tibial shaft fractures can be treated with intramedullary nailing or, in selected cases, closed reduction and casting. A prospective randomized study compared these approaches in adults with displaced, closed or minimally open fractures. The nailing group achieved faster union and had fewer delayed unions and malunions than the cast group. Early functional measures, including mobility and work-related outcomes, also favoured intramedullary fixation in the early phase. The study supports intramedullary nailing as a reliable strategy for displaced tibial shaft fractures when operative treatment is appropriate. The clinical message is not that every tibial fracture requires a nail: fracture stability, soft-tissue condition and patient factors remain important. Rather, the evidence shows the consequences of relying on cast treatment when a fracture is unstable or repeatedly loses alignment. For HCPs, early assessment of alignment and fracture stability is essential, as is planning for rehabilitation and weight-bearing. Nail insertion also carries risks, including anterior knee symptoms and infection, so the benefits need to be weighed against the patient's injury pattern and functional requirements.
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Displaced tibial shaft fractures can be treated with intramedullary nailing or, in selected cases, closed reduction and casting. A prospective randomized study compared these approaches in adults with displaced, closed or minimally open fractures. The nailing group achieved faster union and had fewer delayed unions and malunions than the cast group. Early functional measures, including mobility and work-related outcomes, also favoured intramedullary fixation in the early phase. The study supports intramedullary nailing as a reliable strategy for displaced tibial shaft fractures when operative treatment is appropriate. The clinical message is not that every tibial fracture requires a nail: fracture stability, soft-tissue condition and patient factors remain important. Rather, the evidence shows the consequences of relying on cast treatment when a fracture is unstable or repeatedly loses alignment. For HCPs, early assessment of alignment and fracture stability is essential, as is planning for rehabilitation and weight-bearing. Nail insertion also carries risks, including anterior knee symptoms and infection, so the benefits need to be weighed against the patient's injury pattern and functional requirements.
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