The Effect of timing of conversion from external fixation to secondary intramedullary nailing in experimental tibial fractures

Abstract

Diaphyseal tibial fractures with initial temporary external fixation (EF) are usually converted to intramedullary nailing (IMN) within 2 weeks, and no consensus on the optimal conversion time point exists. Current clinical practice is mainly based on estimation of the risk of postoperative infection. This is the first investigation of the effect of timing of such conversion on fracture healing. Forty male rats received a standardized tibial shaft osteotomy and EF. The animals were then randomly assigned to conversion to IMN at either 7 (group A, N = 10), 14 (group B, N = 10), or 30 (group C, N = 10) days after initial fixation. Group D (N = 10) served as a control group without conversion. Evaluation at 60 days included X-ray, DXA, and mechanical testing. Group A had significantly increased bone mineral content and callus area compared to the control group. Groups B and C showed significantly inferior mechanical bending strength and rigidity compared to both group A and the control group (D). The timing of the conversion procedure has a significant effect on fracture healing. Early conversion procedure did not improve healing compared to control, but was advantageous compared to late conversion (at 2 or 4 weeks) with higher mineralization and superior biomechanical properties.