title: Exchange reamed nailing compared to augmentation compression plating leaving the inserted nail in situ in the treatment of aseptic tibial non-union: a two-centre study.
abstract: BACKGROUND
  A remarkable number of investigations are available treating tibial non-unions by exchange reamed nailing (ERN). Only few authors reported positive results after augmentation compression plating (ACP) for the same entity. To our knowledge no systematic study is published comparing ERN vs. ACP, so that this trial compares ACP leaving the already inserted un-reamed nail in situ against ERN in the treatment of aseptic tibial non-union, analysing success rate, time for union and operation time.
  
  
  METHODS
  Forty-eight patients with aseptic hypertrophic diaphyseal tibial non-union treated previously by un-reamed nailing were included retrospectively in this two-centre study. Group A consisted of 25 patients with ERN and group B of 23 patients with ACP leaving the underlying un-reamed nail in situ.
  
  
  RESULTS
  Mean follow-up was 3.8 years. Union was achieved in 24 out of 25 cases (96 %) for group A and in 22 out of 23 cases (95.6 %) for group B. Time needed for union varied; an average of 29 weeks for group A and 14 weeks for group B. The mean operation time for group A was 99 min, while it was 65 min for group B.
  
  
  CONCLUSIONS
  ERN and ACP with remaining pre-existing nail in situ are both safe and straightforward surgical procedures with equivalent high success rates of about 95 %. ACP has the advantage of less time for union and operating time in this series, but is associated with the disadvantage of requiring an additional incision and complaints associated to the plate requiring implant removal.
authors.affiliation: Department of Traumatology and Reconstructive Surgery, Berufsgenossenschaftliche Unfallklinik Tübingen, University Hospital, Eberhard Karls Universität Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Germany.
authors.forename: Atesch
authors.initials: A
authors.lastname: Ateschrang
authors.forename: Georgios
authors.initials: G
authors.lastname: Karavalakis
authors.forename: Christoph
authors.initials: C
authors.lastname: Gonser
authors.forename: Ulrich
authors.initials: U
authors.lastname: Liener
authors.forename: Thomas
authors.initials: T
authors.lastname: Freude
authors.forename: Ulrich
authors.initials: U
authors.lastname: Stöckle
authors.forename: Matthias
authors.initials: M
authors.lastname: Walcher
authors.forename: Derek
authors.initials: D
authors.lastname: Zieker
mesh_terms: D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000601:surgery; D001858:Bone Nails / Q000009:adverse effects*; D001860:Bone Plates; D003131:Combined Modality Therapy; D020878:Device Removal; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods; D017759:Fractures, Malunited / Q000601:surgery*; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000209:etiology* / Q000601:surgery*; D012086:Reoperation; D013978:Tibial Fractures / Q000601:surgery*; D016896:Treatment Outcome