Results of a Systematic Approach to Exchange Nailing for the Treatment of Aseptic Tibial Nonunions

OBJECTIVES: The purpose of this study was to evaluate the effectiveness of a systematic approach to exchange nailing for the treatment of aseptic tibial nonunion. DESIGN: Retrospective cohort. SETTING: Tertiary referral center. PATIENTS: 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. INTERVENTION: 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. MAIN OUTCOME MEASUREMENTS: 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. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.