COMPARISON BETWEEN INTERLOCKED INTRAMEDULLARY NAILING VERSUS MIPO IN TIBIA SHAFT FRACTURE IN TERMS OF POSTOPERATIVE PAIN AND NON-UNION

Background: Tibial shaft fractures are among the most frequent long bone fractures, resulting from both low- and high-energy trauma. Due to the tibia’s subcutaneous position and limited soft tissue coverage, these fractures are prone to complications such as infection and non-union. Various fixation methods exist, with interlocked intramedullary nailing (IMN) and minimally invasive plate osteosynthesis (MIPO) being the most widely used. However, the optimal fixation technique remains debated. Objective: To compare IMN and MIPO in patients with closed tibial shaft fractures regarding postoperative pain and non-union frequency. Methods: A non-randomized controlled study was conducted at the Department of Orthopedic Surgery, PAEC General Hospital, Islamabad, over 6–9 months. A total of 240 patients aged 18–60 years were included, with 120 treated using IMN (Group A) and 120 using MIPO (Group B). Postoperative pain was assessed using the Visual Analogue Scale (VAS) at immediate post-op, 3 weeks, and 3 months, while non-union was evaluated radiographically at 6 months. Data were analyzed using SPSS version 21. Independent t-tests compared mean VAS scores, and chi-square tests assessed categorical variables, with statistical significance set at p ≤ 0.05. Results: The mean age was 38.5 ± 12.3 years in the IMN group and 40.2 ± 11.8 years in the MIPO group. MIPO demonstrated significantly lower pain scores at 3 weeks (4.9 ± 0.8) compared to IMN (5.4 ± 0.9, p = 0.02), though pain levels were similar at 3 months (p = 0.15). Non-union was more frequent with IMN (8.3%) than MIPO (3.3%, p = 0.04). Operative time was slightly longer for MIPO (95 ± 20 minutes) than IMN (85 ± 15 minutes, p = 0.12), with no significant difference in infection rates (p > 0.05). Stratified analysis revealed higher non-union among patients aged >50 years undergoing IMN (12.5% vs. 5.0%, p = 0.03). Conclusion: MIPO provided superior early postoperative pain relief and lower non-union rates, particularly in elderly patients, while IMN remained a reliable option for simple diaphyseal fractures requiring shorter surgical time. These findings underscore the need for patient-specific fixation strategies to enhance recovery and functional outcomes.