Comparative study between interlocking nail and V-nail in management of fracture shaft tibia


  • Ritesh Pathak Department of Orthopedics, Indian Institute of Medical Sciences and Research, Warudi, Jalna, Maharashtra, India
  • M. A. Naser Department of Orthopedics, Indian Institute of Medical Sciences and Research, Warudi, Jalna, Maharashtra, India



Diaphyseal fracture tibia, Interlocked nail, V-Nail, Ekland grading, AO classification


Background: Tibia is the most commonly fractured long bone in the body. Interlocked nails, either reamed or unreamed, has become the established method of treatment of closed and Grade I, II and III A open fractures of diaphysis of tibia. The cephalo-medullary nail like V-nail, has advantages of less surgical time and cost effectiveness while disadvantage of rotational instability. The present study was undertaken to compare the short-term as well as long-term results of treatment of diaphyseal fractures of tibia with interlocked nail and V-nail.

Methods: Forty patients with fracture of shaft tibia were treated with either interlocked nail or V-nail. Twenty patients were treated with interlocked nail while remaining twenty were treated with V-nail. The follow-up period ranged from 14 weeks to 10 months. The results were assessed according to Ekland grading.

Results: In interlocking series, 85% patients had excellent and good result while 15% patients had fair and poor results. In V-nail series, 30% patients had excellent result, 70% patients had good and fair results while no patient had poor result.

Conclusions: From our study we conclude that closed interlocked nailing is the most ideal method of management of fracture shaft tibia of all types, allowing early mobilization. Closed V-nail is a simple and short procedure with satisfactory results, when used in simple and unifocal fracture types.


Court-Brown CM, Christie J, McQueen MM. Closed intramedullary tibial nailing. Its use in closed and type I open fractures. J Bone Joint Surg Br. 1990;72:605-11.

Hooper GJ, Keddell RG, Penny JD. Conservative management or closed nailing for tibial shaft fractures. A randomized prospective trial. J Bone Joint Surg Br. 1991;73:83-5.

Alho A, Benterud JG, Hogevold HE, Ekeland A, Stromsoe K. Comparison of functional bracing and locked intramedullary nailing in the treatment of displaced tibial shaft fractures. Clin Orthop Relat Res. 1992;277:243-50.

Whittle AP, Russell TA, Taylor JC, Lavelle DG. Treatment of open fractures of the tibial shaft with the use of interlocking nailing without reaming. J Bone Joint Surg Am. 1992;74:1162-71.

Gregory P, Sanders R. The treatment of closed, unstable tibial shaft fractures with unreamed interlocking nails. Clin Orthop Relat Res. 1995;315:48-55.

Bone LB, Sucato D, Stegemann PM, Rohrbacher BJ. Displaced isolated fractures of the tibial shaft treated with either a cast or intramedullary nailing. An outcome analysis of matched pairs of patients. J Bone Joint Surg Am. 1997;79:1336-441.

Karladani AH, Granhed H, Edshage B, Jerre R, Styf J. Displaced tibial shaft fractures: a prospective randomized study of closed intramedullary nailing versus cast treatment in 53 patients. Acta Orthop Scand. 2000;71:160-7.

Riemer BL, DiChristina DG, Cooper A, Sagiv S, Butterfield SL, Burke CJ 3rd, et al. Nonreamed nailing of tibial diaphyseal fractures in blunt polytrauma patients. J Orthop Trauma. 1995;9:66-75.

Koval KJ, Clapper MF, Brumback RJ. Complications of reamed intramedullary nailing of the tibia. J Orthop Trauma. 1991;5:184-9.

Court-Brown CM, Gustilo T, Shaw AD. Knee pain after intramedullary tibial nailing: its incidence, etiology, and outcome. J Orthop Trauma. 1997;11:103-5.

Toivanen JA, Vaisto O, Kannus P, Latvala K, Honkonen SE, Jarvinen MJ. Anterior knee pain after intramedullary nailing of fractures of the tibial shaft. A prospective, randomized study comparing two different nailinsertion techniques. J Bone Joint Surg Am. 2002;84:580-5.

Court-Brown CM, Will E, McQueen MM. Reamed or unreamed nailing for closed tibial fractures. A prospective study in Tscherne C1 fractures. J Bone Joint Surg Br. 1996;78:580-3.

Chiu FY, Lo WH, Chen CM, Chen TH, Huang CK. Treatment of unstable tibial fractures with interlocking nail versus Ender nail: a prospective evaluation. Zhonghua Yi Xue Za Zhi (Taipei). 1996;57:124-33.

Donald G, Salingston D. Treatment of tibial shaft fractures by percutaneous Kuntscher nailing. CORR. 178:64;1983.

Arne Ekland, Bjorn O, Thoresen E. Interlocking intramedullary nailing in the treatment of tibial fracture. Clin Ortho. 1988;205:231-8.

Whittle AP. Fracture of lower extremity. Chapter-47 In: Canale ST, Ed. Campbell’s operative orthopaedics, 9th Edn. New York: Mosby; 1998: 2067-2094.

Bonatus T, Olson SA Lees, Champman MW. Nonreamed locking intrameduallary nailing for open fracture of the tibia. Clin Orthop. 1997;339:58-64.

Duwelius PJ, Schmidt AH, Rubinstein RA, Green JM. Non reamed interlocked intramedullary tibial nailing one community’s experience. Clin Orthop. 1995;315:104- 13.

Singer RW, Kellam JF. Open tibial diaphyseal fractures: Results of undreamed locked intramedullary nailing. Clin Orthop. 1995;315:114-8.

Lang GJ, Cohen BE, Bosse MJ, Kellam JF. Proximal third tibial shaft fractures. Should they be nailed? Clin Orthop. 1995;(315):64-74.

Pankovich AM, Tarabishy IE, Yelda S. Flexible intramedullary nailing of tibial-shaft fractures. Clin Orthop. 1981;(160):185-95.

Christian K, Haral SPT. Nonreamed Interlocking Nailing of Closed Tibial Fractures With Severe Soft Tissue Injury. Clin Orthop Related Res. 1995;315:34–47.






Original Research Articles