Background

Fracture management primarily involves either conservative immobilization using plaster casts or surgical internal fixation with plates, screws, or intramedullary nails. The optimal choice depends on fracture type, patient characteristics, resource availability, and anticipated functional outcome.

Objective

To compare clinical and functional outcomes, complication rates, time to union, return to normal activity, and cost-effectiveness of plaster cast immobilization versus internal fixation in diaphyseal fractures of long bones.

Methods

A prospective comparative study was conducted on 120 patients with closed diaphyseal fractures of the tibia or forearm (radius/ulna). Based on shared decision-making and surgical fitness, patients were allocated into two groups:

Group P (Plaster Cast): 60 patients treated with closed reduction and cast immobilization.

Group I (Internal Fixation): 60 patients treated with open reduction and internal fixation (ORIF) or intramedullary nailing.

Patients were followed up for 12 months. Primary outcomes included time to radiological union, functional scores (Tegner/OMAS for tibia, DASH for forearm), and complication rates (malunion, nonunion, infection). Secondary outcomes were hospital stay, time to return to work, and direct treatment cost. Statistical significance was set at p < 0.05.

Results

Mean time to union:

Group I: 14.2 ± 3.6 weeks

Group P: 16.8 ± 4.9 weeks (p = 0.002)

Functional score (DASH at 6 months):

Group I: 12.4

Group P: 18.7 (p = 0.01)

Complications:

Malunion: 3.3% (Group I) vs 15% (Group P) – p = 0.03

Nonunion: 1.7% vs 5.0% – p = 0.31

Superficial infection: 6.7% in Group I

Cast-related complications (pressure sores/stiffness): 13.3% in Group P

Return to work:

Group I: 9.1 ± 2.8 weeks

Group P: 14.5 ± 4.1 weeks (p < 0.001)

Cost: Internal fixation incurred higher treatment cost.

Conclusion

Internal fixation demonstrated faster union, better early functional recovery, lower malunion rates, and earlier resumption of work, albeit with higher cost and surgical complications. Plaster casting remains a cost-effective option for stable fractures and patients unfit for surgery. Treatment must be individualized, considering fracture pattern, patient occupation, comorbidities, and resource constraints.