Limited bone loss in the hip and heel after reamed intramedullary fixation and early weight-bearing of tibial fractures

Objective: To determine changes in bone mineral density at the hip and calcaneus in the injured and uninjured sides after surgery for tibial fractures. Design: Prospective, longitudinal study. Setting: University hospital. Patients and Methods: Twenty-six patients with a tibial fracture were treated with a reamed and statically locked intramedullary nail with early weight-bearing. Dual-energy x-ray absorptiometry at the proximal femur and quantitative ultrasonography at the calcaneus were performed bilaterally after surgery and after three, six, and twelve months. Results: At three months, the bone mineral density in the trochanteric region in the injured limb had decreased almost 4 percent (p < 0.007), a reduction still present at twelve months. whereas in the femoral neck, the reduction was approximately speed of sound at the calcaneus on the injured side decreased (p < 0.03 and p < 0.008, respectively) during the first three months, whereas at twelve months, there was no significant difference when compared with those measured directly after surgery. There were no significant changes at any time in the proximal femur or calcaneus of the uninjured limb. Conclusion: Treatment with a reamed statically locked intramedullary nail and early weight-bearing resulted in limited bone loss in the proximal femur and calcancus of the injured limb. After twelve months, the bone properties at the heel were restored, whereas there was still a small reduction at the hip. Compared with previous studies of patients with similar fractures treated with casts and restricted weight-bearing, the loss in bone mineral density was less and not as longstanding.