Gold or Dust: A Prospective Study of Tibial Shaft Fractures Treated with Interlock Nail and Percutaneous Injection of Reamed Autologous Cells.

INTRODUCTION: Tibial shaft fractures are unique due to the tibia's subcutaneous position and limited muscular cover, which leads to reduced vascularity. This can result in complications like delayed bone union, wound dehiscence, and infection. Intramedullary nailing (IMN) is the most common method for treating tibial shaft fractures, preserving blood supply by minimizing soft tissue disruption. Several studies have analyzed reamed versus unreamed IMN for tibial shaft fractures, but selection bias may affect results. No meta-analyses or systematic reviews conclusively compare reamed and unreamed IMN in open and closed tibial fractures. This study aimed to compare the functional and radiological outcomes of tibial shaft fractures treated with standard interlocking nails versus interlocking nails combined with percutaneous injection of reamed autologous cells. MATERIALS AND METHODS: A total of 100 patients with tibial shaft fractures underwent IMN with reaming, with 50 patients receiving an injection of reamed autologous cells at the fracture site. Postoperatively, patients were evaluated for tenderness, fracture union duration, and active range of motion. RESULTS: The mean union time in the IMN + Reaming + Autologous Cell Injection group was 14.13 ± 3.5 weeks, significantly faster than 18.07 ± 3.96 weeks in the IMN + Reaming group (P < 0.05). The IMN + Reaming + Autologous Cell Injection group had a significantly higher percentage of patients with excellent and good functional outcomes compared to the IMN + Reaming group. CONCLUSION: The IMN + Reaming + Autologous Cell Injection technique resulted in faster union, earlier weight-bearing, and improved functional outcomes compared to IMN with reaming alone. These findings suggest that this technique is a superior alternative for treating closed tibial shaft fractures.