Abstract
One of the most dreaded complications of fracture management is a nonunion. Nonunions are usually difficult to manage and can be a source of significant mental, physical, and financial distress to the patient. The incidence of nonunion is dependent on multiple factors including degree of comminution, open versus closed, concomitant infection, and vascular status, and therefore the management of such nonunions continues to be an often debated topic. Currently, there is no clear consensus on the role of reamed exchange nailing for tibial shaft nonunions. While reamed exchange nailing for aseptic tibial shaft nonunions has shown promising results, with very high union rates, many surgeons prefer newer novel techniques such as plating along with osteoperiosteal decortication or the use of more conventional compressive plating with bone grafts. The aim of this article is to critically review and understand the available evidence base on reamed exchange nailing in nonunion of tibial shaft fractures and to explore the other options available and their indications.
Highlights
BackgroundOne of the most dreaded complications of fracture management is a nonunion
There is no clear consensus on the role of reamed exchange nailing for tibial shaft nonunions
While reamed exchange nailing for aseptic tibial shaft nonunions has shown promising results, with very high union rates, many surgeons prefer newer novel techniques such as plating along with osteoperiosteal decortication or the use of more conventional compressive plating with bone grafts
Summary
One of the most dreaded complications of fracture management is a nonunion. Nonunions are usually difficult to manage and can be a source of significant mental, physical, and financial distress to the patient. Petrisor et al reported infection rates of 62.5% in patients with open fractures who were treated with reamed intramedullary nailing [35] They went on to treat 18 infected tibial diaphyseal nonunions with reamed exchange nailing and reported osseous union in only 7 out of 18 cases [35]. They suggested a novel approach in the management of such cases by performing a medullary debridement with reaming followed by insertion of antibiotic beads and a staged exchange nailing after three weeks This protocol helped the authors achieve a 100% union rate without the need for any further procedures. Many other exciting options including biologic implants such as platelet gel and recombinant bone morphogenetic protein implant are under investigation and require further research before they can be widely recommended
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