Exchange nailing for aseptic tibial shaft nonunion: emphasis on the influence of a concomitant fibulotomy.
BACKGROUND
Exchange nailing is reported to have a high success rate for aseptic tibial nonunions. However, sample sizes in all series in the literature were small, and the influence of a concomitant fibulotomy was not evaluated.


METHODS
Fifty-four aseptic tibial shaft nonunions for 1.2 approximately 4.3 (mean, 2.4) years were treated with exchange nailing. Indications for this technique included an aseptic nonunion of the tibial shaft with an inserted intramedullary nail and < 2 cm of shortening. A fibulotomy was performed in a nonunion with poor shaft alignment, which concomitantly required manipulation to correct. The success rate of exchange nailing was determined, and whether a concomitant fibulotomy affected the success rate was evaluated.


RESULTS
Forty-seven nonunions were followed-up for 1.1 approximately 6.9 (mean, 3.8) years, and all nonunions healed. The union rate was 100% (47/47), and the average period required to achieve union was 4.7 (3.0 approximately 7.5) months. The average union periods between the fibulotomy and non-fibulotomy groups did not statistically differ (4.6 vs. 4.8 months, p = 0.61). There were no significant complications in either group.


CONCLUSIONS
Exchange nailing is an excellent technique to treat aseptic nonunions of the tibia. It can be considered the treatment of choice for all indicated cases. A concomitant fibulotomy has minimal influence on the success rate. It can be performed when the shaft alignment needs correction.
Hsiao
Chih-Wen
CW
Department of Orthopedics, Chang Gung Memorial Hospital, Taipei. mr3507@adm.cgmh.org.tw
Wu
Chi-Chuan
CC
Su
Chun-Yi
CY
Fan
Kuo-Feng
KF
Tseng
I-Chuan
IC
Lee
Po-Chang
PC
D000328:Adult; D000368:Aged; D001858:Bone Nails; D005260:Female; D005360:Fibula / Q000601:surgery*; D005594:Fracture Fixation, Intramedullary / Q000379:methods*; D005599:Fractures, Ununited / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013978:Tibial Fractures / Q000601:surgery*