title: Reaming bone grafting to treat tibial shaft aseptic nonunion after plating.
abstract: OBJECTIVE
  To investigate the effects of using intramedullary reaming to provide cancellous bone graft, and reamed intramedullary nail stabilisation to provide fragment stability on treating tibial shaft aseptic nonunions after plating.
  
  
  METHODS
  31 consecutive patients with tibial shaft aseptic nonunions after plating were prospectively treated. Indications for this technique included a tibial shaft nonunion with an inserted plate, a fracture level fit for traditional or locked nail stabilisation, absence of suspected infection and segmental bony defect at the time, and shortening of less than 2 cm. The plate was removed and the marrow cavity was reamed as widely as possible. A stable unlocked or locked intramedullary nail was then inserted. No extra cancellous bone graft was supplemented.
  
  
  RESULTS
  28 patients were followed up for a median period of 2.2 years (range, 1.0-5.2 years). All patients achieved solid union. The median union period was 4.5 months (range, 3.0-7.5 months). There were no significant complications.
  
  
  CONCLUSIONS
  When reamed intramedullary nails are used to treat tibial shaft aseptic nonunions after plating, supplemented cancellous bone grafting can be spared. Despite the technique being simplified, the success rate is high. We therefore recommend its wide use to treat all suitable cases.
authors.affiliation: Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chang Gung Institute of Technology, Taoyuan, Taiwan. ccwu@mail.cgu.edu.tw
authors.forename: C C
authors.initials: CC
authors.lastname: Wu
mesh_terms: D000328:Adult; D001858:Bone Nails; D001860:Bone Plates; D016025:Bone Transplantation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000379:methods*; D005599:Fractures, Ununited / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012086:Reoperation; D013978:Tibial Fractures / Q000601:surgery*; D016896:Treatment Outcome