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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.