The issue of selecting the thickness of intramedullary nails for the long tubular bones of the lower limbs.

Intramedullary nailing is the gold standard for the surgical treatment of diaphyseal fractures of the long tubular bones in the lower limbs. It offers advantages such as minimal surgical trauma and high biomechanical strength, making it most commonly used in tibial, femoral, and humeral shaft fractures. Clinically, the selection of intramedullary nail diameter often favors the thickest possible nail that can be inserted with moderate reaming, to ensure greater stability. However, whether the thickness of the intramedullary nail directly affects the fracture prognosis remains inconclusive.

In a previous article, we discussed a study examining the impact of intramedullary nail diameter on bone healing in patients over 50 with intertrochanteric fractures. The results indicated no statistical difference in fracture healing rates and reoperation rates between the 10mm group and the group with nails thicker than 10mm.

A paper published in 2022 by scholars from Taiwan Province also reached a similar conclusion:

A study involving 257 patients, who were fixed with intramedullary nails of diameters 10mm, 11mm, 12mm, and 13mm, divided the patients into four groups based on the nail diameter. It was found that there was no statistical difference in the fracture healing rates among the four groups.

So, is this also the case for simple tibial shaft fractures?

In a prospective case-control study involving 60 patients, the researchers divided the 60 patients equally into two groups of 30 each. Group A was fixed with thin intramedullary nails (9mm for women and 10mm for men), while Group B was fixed with thick intramedullary nails (11mm for women and 12mm for men):

The results indicated that there were no significant differences in clinical outcomes or imaging between the thin and thick intramedullary nails. Additionally, the thin intramedullary nails were associated with shorter surgical and fluoroscopy times. Regardless of whether a thick or thin diameter nail was used, moderate reaming was performed prior to nail insertion. The authors suggest that for simple tibial shaft fractures, thin diameter intramedullary nails can be used for fixation.