Introduction: Long bone fracture treatment with interlocking intramedullary nails is associated with long operative procedures, re-operations and long periods of infirmity. We assessed the clinical and economical factors associated with tibial fracture fixation with interlocking nails in comparison to fixation with an expandable stainless steel intramedullary nail.

Methods: Eighty diaphysial tibial fractures were consecutively treated with either an interlocking intramedullary nail (n=53 patients) or an expandable nail (n=27 patients).

Results: The duration of surgery was 139 minutes with interlocking nails and 52.9 minutes with expandable nails (p< 0.001). Re-hospitalization and re-operations were required in 51% and 42% of patients with interlocking nails respectively, compared to one patient (3%) with an expandable nail (p< 0.0001). Complications related to the introduction of interlocking screws (e.g., neurological deficits, screw breakage and delayed or non-union requiring dynamization) occurred in 19 interlocking nail patients and in none of the expandable nail patients. Union was achieved after 17.5 weeks (mean) with the interlocking nails compared to 11.5 weeks for expandable nails (p=0.071). The beneficial economic ramifications of using expandable nails were a 39% reduction in hospital expenses.

Conclusions: The use of an expandable stainless steel intramedullary nail is associated with a substantial reduction in clinical complications and hospital costs. An expandable nail features a unique fixation modality, which has superior mechanical fixation strength and is better adapted to the physiological bone healing process.

Based on these advantages, as well as its simplicity in use and short surgical technique, we recommend it for treatment of long bone fractures.