title: Reamed intramedullary exchange nailing in the operative treatment of aseptic tibial shaft nonunion.
abstract: The aim of this study was to evaluate a standardized treatment protocol regarding the rate of secondary bone union, complications, and functional outcome.
  
  
  
  This study was started as a prospective study in a single Level I Trauma Centre between 2003 and 2012. The study group consisted of 188 patients with the diagnosis of an aseptic tibial shaft nonunion. Exchange nailing was performed following a standardized surgical protocol. Long-term follow-up was analyzed for rate of bone healing and functional outcome.
  
  
  
  Osseous healing was achieved in 182 out of 188 patients (97 %). In 165 out of 188 patients (88 %), bone healing was observed timely and uneventfully after a single exchange nailing procedure. An open approach was necessary in 32 patients (17 %). Twenty-three patients (12 %) required additional therapy such as extracorporeal shock wave therapy. Post-operative complications were observed in seven patients (4 %). Almost all patients demonstrated osseous healing within 12 months, with the majority of osseous healing occurring within six months. A relevant shortening of the fractured tibia was observed in 20 out of 188 patients (11 %). After a median follow-up of 23 months (range 12-45 months), outcome was evaluated using the assessment system of Friedman/Wyman. In summary, 154 out of 188 patients (82 %) had a good functional long-term result.
  
  
  
  Reamed intramedullary exchange nailing including correction of axis alignment is a safe and effective treatment of aseptic tibial shaft nonunion with a high rate of bone healing and a good radiological and functional long-term outcome.
authors: Department of Trauma Surgery, University Hospital Zurich, Zurich, Switzerland.
authors: Christian
authors: C
authors: Hierholzer
authors: Department of Trauma Surgery, Trauma Center Murnau, Professor Küntscher Str. 8, 82418 Murnau, Germany.
authors: Jan
authors: J
authors: Friederichs
authors: Clinic of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
authors: Claudio
authors: C
authors: Glowalla
authors: Department of Trauma Surgery, Trauma Center Murnau, Professor Küntscher Str. 8, 82418 Murnau, Germany.
authors: Alexander
authors: A
authors: Woltmann
authors: Department of Trauma Surgery, Trauma Center Murnau, Professor Küntscher Str. 8, 82418 Murnau, Germany.
authors: Volker
authors: V
authors: Bühren
authors: Department of Trauma Surgery, Trauma Center Murnau, Professor Küntscher Str. 8, 82418 Murnau, Germany. christian.vonrueden@bgu-murnau.de.|Institute of Biomechanics, Paracelsus Medical University, Salzburg, Austria. christian.vonrueden@bgu-murnau.de.
authors: Christian
authors: C
authors: von Rüden
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001858:Bone Nails; D002985:Clinical Protocols / Q000592:standards; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000379:methods*; D017102:Fracture Healing; D005599:Fractures, Ununited / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020127:Recovery of Function; D012086:Reoperation; D013977:Tibia / Q000601:surgery; D013978:Tibial Fractures / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Long-term outcome; Nonunion; Reamed intramedullary exchange nailing; Tibia