Exchange reamed nailing for tibial non union

ABSTRACT

Ninety acute tibial shaft fractures were managed by un-reamed tibial nailing. Seventeen cases in 15 patients ended in nonunion. Eight cases showed evidence of implant failure. Exchange nailing was carried out at an average of 9.5 months. After removing the original implants, the modularly canal was reamed until cortical chatter was encountered. The new nail 1-2 mm of larger diameter was introduced either unlocked or dynamically locked. Fibular osteotomy was added in one case and closed intramedullary autogenous graft was needed in three cases. Early full weight bearing was encouraged postoperatively. Follow-up interval of the 17 cases averaged 27 months from the time of injury and 17.5 months after exchange nailing. All cases united at an average of 15.5 weeks. Two wound infections were encountered at the proximal nail insertion site. Exchange nailing is a relatively simple procedure with low morbidity. It is an effective method of treatment for delayed union of closed and grades I and II open tibial shaft fractures that fail to unit after un-reamed nailing. Each case should be individually assessed for the need of adjunctive procedures at the same time, e.g. fibular osteotomy and closed intramedullary grafting. In view of the high incidence of implant failure encountered, surgical intervention should be undertaken as soon as the diagnosis of delayed union is established