Intramedullary Nailing for Segmental Tibia Fractures: A Comprehensive Retrospective - Prospective Outcome Analysis in 30 Patients at a Tertiary Care Centre.

INTRODUCTION: Segmental fractures of the tibia (OTA/AO 42-C2) account for 3-13% of all tibial shaft fractures and provide unique complications due to twin fracture lines isolating a vascularly impaired intermediate bone segment. High-energy processes usually cause substantial soft tissue disturbance, increasing the likelihood of non-union, malalignment, infection, and compartment syndrome. The objective of this study is to evaluate the functional and radiological outcome of segmental tibial fractures treated with intramedullary interlocking nailing (IMIL), to assess the rate and time of fracture union following IMIL nailing. To evaluate maintenance of alignment using radiological parameters, such as medial proximal tibial angle (MPTA), lateral distal tibial angle (LDTA), and posterior proximal tibial angle (PPTA). To analyze post-operative functional recovery using the lower extremity functional scale (LEFS). To identify complications, such as torsion, malalignment, infection, shortening, delayed, and malunion rate using IMIL nailing.

MATERIALS AND METHODS: This study was a cross-sectional study design in both retrospective and prospective manners. Examined 30 consecutive patients (>18 years old) with segmental tibial fractures treated with locked intramedullary nailing at a Level I trauma hospital (January 2021-June 2025). The primary objectives were radiographic union rates, time to healing, and LEFS scores. Secondary outcomes included alignment maintenance (MPTA, LDTA, PPTA), complications (malalignment >5°, shortening >1 cm, torsion, discomfort), and prognostic variables (Mann-Whitney U, Fisher's exact, Wilcoxon signed-rank tests, and Spearman's correlation; the Statistical Package for the Social Sciences v25, P < 0.05).

RESULTS: The average age was 44.7 ± 19.0 years (64.3% male), with 78.6% sustaining road traffic accident injuries. Union was accomplished in 78.6% (mean 24 ± 6.8 weeks). The mean LEFS score was 52.5 ± 8.07, indicating moderate to good function. Radiographic angles showed excellent stability: MPTA 89.2° ± 2.1° → 89.1° ± 2.3° (Post-operative Day 2→6 months, P = 0.87). Malalignment (14.3%), shortening (7.1%), torsion (20%), and non-union (21.4%) were among the complications reported. Torsion (P = 0.0027, OR 12.5) and chronic discomfort (P = 0.0027) were independent predictors of non-union. Healing rates for open fractures were comparable to those for closed injuries (P = 0.41).

CONCLUSION: Intramedullary nailing provides predicted stability and satisfactory functional recovery for segmental tibia fractures, even with high-energy injury patterns. Intraoperative torsion control and post-operative pain monitoring are crucial quality markers. These findings support IMN as a first-line treatment while highlighting actionable predictors that require technique refinement.