Impact of Surgical Timing on Fracture Healing in Tibial Shaft Injuries: A Comparative Review of Intramedullary Nailing Techniques.

Abstract

Tibial shaft fractures are a prevalent and challenging orthopedic injury, often resulting from high-energy trauma. Optimal management of these fractures is crucial to prevent complications such as nonunion, malunion, and prolonged functional impairment. Intramedullary nailing (IMN) is widely regarded as the gold standard for treating these injuries due to its ability to provide stable fixation, preserve soft tissues, and enable early mobilization. However, the timing of surgical intervention remains a topic of ongoing debate. Early surgical intervention, defined as surgery within 24-48 hours of injury, is advocated for its potential to reduce hospital stay, facilitate early mobilization, and decrease the risk of secondary complications such as compartment syndrome. Conversely, delayed intervention allows for patient stabilization and reduction of soft tissue swelling, potentially lowering the risk of infection and other complications. This comprehensive review aims to evaluate the impact of surgical timing on fracture healing outcomes in tibial shaft fractures treated with IMN. It explores the benefits and limitations of early versus delayed surgery, emphasizing their influence on union rates, healing time, and complication rates. Furthermore, the review examines different IMN techniques, including reamed versus unreamed and static versus dynamic nailing, to determine their role in optimizing fracture healing. By synthesizing current evidence, this review provides critical insights into the optimal timing and technique for IMN in tibial shaft fractures, ultimately aiming to guide clinical decision-making and improve patient outcomes. Future research should focus on randomized controlled trials to establish standardized surgical timing and technique selection guidelines in this patient population.