Results of a systematic approach to exchange nailing for the treatment of aseptic tibial nonunions.
OBJECTIVE
The purpose of this study was to evaluate the effectiveness of a systematic approach to exchange nailing for the treatment of aseptic tibial nonunion.


METHODS
Retrospective cohort.


METHODS
Tertiary referral center.


METHODS
Forty-six aseptic tibial nonunion sites in 40 patients (2 bilateral and 4 segmental) who presented with an intramedullary nail on an average of 16 months after the initial treatment were presented in this study.


METHODS
Insertion of an exchange nail of at least >2-mm diameter than the prior nail using a different manufacturer's nail, static interlocking, partial fibulectomy in a select group of patients, and correction of underlying metabolic and endocrine abnormalities.


METHODS
Union rate, time to union.


RESULTS
Forty-five of 46 tibial nonunion sites (98%) healed at an average of 4.8 months.


CONCLUSIONS
Patient selection criteria and a systematic approach to exchange nailing for tibial nonunion is highly successful.


METHODS
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
*Department of Orthopaedic Trauma, University of Texas Health Science Center at Houston, Houston, TX; †Department of Health and Human Performance, University of Houston, Houston, TX; and ‡Fondren Orthopedic Group, Texas Orthopedic Hospital, Houston, TX.
Eli A
EA
Swanson
Eli C
EC
Garrard
Daniel P
DP
OʼConnor
Mark R
MR
Brinker
D001858:Bone Nails; D020878:Device Removal; D005594:Fracture Fixation, Intramedullary; D017102:Fracture Healing; D005599:Fractures, Ununited / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies; D013977:Tibia / Q000000981:diagnostic imaging / Q000601:surgery*; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome