[Treatment of tibial non-union with a large bone defect with half-tubular fibular graft, centromedullary nailing and bone graft]. / Tratamiento de la no unión tibial con gran defecto oseo con peroné en media caña, clavo centromedular e injerto oseo.

INTRODUCTION: Non-union is most frequent in the tibia. It may occur with bone loss and is most often seen in the mid-third, mainly as a result of high-energy trauma. Our purpose is to present a treatment alternative. MATERIAL AND METHODS: Prospective, longitudinal, experimental trial conducted between 1999 and 2004. Five patients classified according to Judet and Paley were included. A half-tubular fibular graft plus an autologous and/or heterologous iliac crest graft were used with a UTN nail for stabilization purposes; mean follow-up was 24 months. RESULTS: All patients were male. High energy trauma was the cause in 100%; 5 were Gustilo III fractures; Paley B1 type was present in 60%; the mean bone defect was 7.8 cm. Grade III Montoya bone healing was observed on average at 13.6 months. There were two complications; one infection that required removal of the synthesis without disrupting the healing, and one re-fracture which was managed at a different service. CONCLUSIONS: An autologous half-tubular fibular graft, plus autologous and/or heterologous graft, stabilized with a UTN nail, restores the loss caused by the bone defect and allows achieving an appropriate bone healing.