Need for Secondary Procedures to Address Delayed Union in Open versus Closed Reduction in Tibia Nailing

Background: Treatment of tibial fractures presents challenges, particularly regarding the choice of reduction technique. Open reduction is linked to higher infection and nonunion rates, while closed reduction techniques are favored for minimizing soft-tissue disruption. Despite the increasing preference for closed reduction with intramedullary nailing, comparative evidence assessing the effectiveness of open versus closed reduction remains limited. This study aims to address this gap by evaluating the need for secondary procedures clinical assessments, radiological union scores, and functional outcomes in patients undergoing tibial nailing. Materials and Methods: This retrospective study evaluated need for secondary procedures and outcomes of open versus closed reduction techniques in tibial nailing from January 2018 to January 2023. We included 80 patients aged 18–60 years with closed tibial shaft fractures. The clinical and radiological assessments were conducted, focusing on weight-bearing ability, range of motion, Radiographic Union Score for Tibial fractures (RUST), and Lower Extremity Functional Scale (LEFS). Follow-up assessments were performed at 2 and 6 weeks postoperatively. Results: The mean age of the participants was 43.2 ± 17.1 years, with 53.8% males and 46.3% females. The majority of injuries (90%) were due to road traffic accidents. Notably, 80% of participants experienced no complications. Both RUST and LEFS scores showed significant improvement from 2 to 6 weeks ( P < 0.001), with no significant association between reduction techniques and clinical outcomes ( P > 0.05). Conclusion: Our study indicates that open reduction internal fixation with tibial nailing yields functional and radiological outcomes comparable to closed reduction, contingent on achieving minimal soft-tissue dissection, absolute reduction, and stable fixation. These findings are significant as they suggest that the choice of reduction technique may not significantly influence the patient outcomes. While concerns regarding intraoperative duration and infection risk are valid, these can be mitigated through proper techniques and postoperative care, thereby reducing the likelihood of delayed union and the necessity for secondary procedures.