Exchange Reamed Nailing for Aseptic Nonunion of the Tibia

Abstract

Exchange reamed nailing for nonunions of the tibia results in a high union rate and is associated with a low complication rate. This technique is recommended as a standard procedure for aseptic tibial nonunions after initial unreamed intramedullary nailing.

Efficacy of minimally invasive techniques for enhancement of fracture healing: evidence today

“…Literature describing conventional approaches using autologous bone grafts have reported a variable success rate. Tibial nonunions heal at a rate of 90-95% [25, 88,119], whereas in femoral nonunions the rate of healing is slightly lower, ranging from 78.3% to 92.3% [43,85,86,117]. Similarly, in humeral nonunions the healing rates vary between 76% and 100% [1,41,48,72].…”

“…The incidence of impaired healing of long bone fractures has been reported to range between 5 and 10% [25,88,94,118,119]. It requires complex and expensive treatment and a variable degree of morbidity is often a common finding.…”

Reamed versus unreamed intramedullary nailing for the treatment of closed tibial fractures-A comparative study

“…Annual reoperation rates following tibial fracture repair with the use of nails had been reported to be between 12% and 44% [14]. Treatment options include dynamization of the interlocked nail, bone grafting, implant exchange, and electrostimulation [15].…”

Nonunion of the tibia following intramedullary nailing treated by Ilizarov external fixator: A case report

“…Nonunion may present itself as a problem, though occasionally, following intramedullary fixation of the tibial fractures (Zelle et al, 2004;Patil and Montgomery, 2006;Sen et al, 2006). Too much or too little motion at the fracture site, excessive space between fracture fragments, inadequate fixation, infection, soft tissue interposition, inadequate blood supply, and many other factors can lead to nonunion (Shuler 1996;Rosen 1998;Audige et al, 2005;Drosos et al, 2006).…”

“…A variety of treatment modalities can be preferred in such a situation including replacement of the nail with a largerdiameter nail, dynamization of replaced nail, open reduction and internal fixation by plates and screws, bone grafting or grafting other materials with osteogenic potential on the fracture site, electrical simulation or low-intensity pulsed ultrasound, and application of external fixator by removing the nail (Shuler 1996;Rosen 1998;Mayr et al, 2000;Zelle et al, 2004;Patil and Montgomery, 2006;Sen et al, 2006). Each of these methods has advantages and disadvantages.…”