Reamed intramedullary exchange nailing in the operative treatment of aseptic tibial shaft nonunion

Abstract

Purpose The aim of this study was to evaluate a standardized treatment protocol regarding the rate of secondary bone union, complications, and functional outcome. Methods 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 followup was analyzed for rate of bone healing and functional outcome. Results 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. Discussion 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.

Reamed Exchange Nailing in Nonunion of Tibial Shaft Fractures: A Review of the Current Evidence

“…The authors suggested that owing to the high union rates with exchange nailing, it can be recommended as the first line of treatment for all kinds of aseptic tibial diaphyseal nonunions. Another prospective study consisting of 188 patients demonstrated osseous healing through a single exchange nail in 182 out of 188 aseptic tibial diaphyseal nonunions [30]. A systematic review of seven randomized control trials by Lam et al suggested that reamed intramedullary nailing is superior to nonreamed intramedullary nailing, as reamed nailing had a superior union rate with reduced chances of postoperative infection [31].…”

Acute correction and intramedullary nailing of aseptic oligotrophic and atrophic tibial nonunions with deformity

“…Adequate fixation provides biomechanically stable construct, eliminates disturbing forces, and promotes healing. [ 19 , 20 ] Blocking screws may be necessary to correct the deformity or enhance the mechanical stability. Osteotomy shape, site, technique, grafting of the nonunion site, appropriate nail length and thickness, reaming amount, correction degree, and lengthening should be calculated preoperatively.…”

“…Unfortunately, nonunion was the most prevalent complication of tibial shaft fractures due to insufficient soft tissue cover and high incidence of open fractures independent of the surgical fixation methods such as IMN, locking compression plating, or external fixation. [ 20 ] Intramedullary nailing provides more mechanical stability, enhances biological environment by autografting due to reaming, and supplies dynamic compression in the nonunion site.…”

Double plating with autogenous bone grafting as a salvage procedure for recalcitrant humeral shaft nonunion

“…Interlocking intramedullary nails have been widely used in acute humeral fractures, pathologic fractures and nonunions of the tibia or femur shaft, as for humerus xation, they have the advantages over plates of fewer tissue traumas, fewer circulatory impairments and lower risk of radial nerve injury [3]. Nailing or exchange nailing for humeral shaft nonunion had been successfully reported by some authors, the concept of this technology is improving nonunion segments biomechanical stability by using of a nail being at least one millimeter thicker than its diameter and fostering healing environment by transporting mesenchymal stem cells into the nonunion sites during reaming procedure [2,21]. However, the heal rates varied differently.…”