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<h5 class="section-title" id="d2965596e150">Background</h5>
<p id="d2965596e152">The nonunion of open and closed tibial shaft fractures continues
to be a common complication
of fractures. Tibial nonunions constitute the majority of long bone nonunions seen
by orthopaedic surgeons. In this article, we present our approach to the surgical
treatment of noninfected tibial shaft nonunions.
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<h5 class="section-title" id="d2965596e155">Methods</h5>
<p id="d2965596e157">Between 2008 and 2014, 33 patients with aseptic diaphyseal tibial
nonunion was treated
by reamed intramedullary nailing and were retrospectively reviewed. The initial fracture
management consisted of external fixation (27 patients), plate fixation (2 patients)
and cast treatment (4 patients). All patients, preoperatively, were evaluated for
the signs of the infection, by the same protocol. There were 13 hypertrophic, 16 oligotrophic
(atrophic) and 4 defect nonunions registered in our material. The primary goal was
to perform a closed intramedullary nailing on antegrade manner. An open procedure
was only unavoidable when implants had to be removed or an osteotomy had to be performed
to improve the alignment. Functional rehabilitation was encouraged with the assistance
of a physiotherapist early postoperative. Patients were examined regularly during
followed-up for a minimum of 12 months period for clinical and radiological signs
of union, infection, malunion, malalignment, limb shortening, and implant failure.
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<h5 class="section-title" id="d2965596e160">Results</h5>
<p id="d2965596e162">The time that elapsed from injury to intramedullary nailing ranged
from 9 months to
48 months (mean 17 months).Open intramedullary nailing was unavoidable in 25 cases
(75,75%), while closed nailing was performed in 8 patients (24,25%). Osteotomy or
resection of the fibula was performed in 78,8% of the cases. All patients were followed
up in average period of 2 years postoperative (range 1–4 years), and 31(93,9%) patients
achieved a solid union within the first 8 months. Mean union time was 5±0.8 months.
Complications included 2 (6,06%) patients, one with deep infection and another case
with absence of bone healing. Anatomical alignment has been achieved in the majority
of patients, 28 patients (84,8%). The additionally autogenous bone chips were added
in 4 patients (12,1%) where cortical defect was greater than 50% of the bone circumference.
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<h5 class="section-title" id="d2965596e165">Conclusion</h5>
<p id="d2965596e167">In conclusion, a reamed intramedullary nail provides optimal
conditions for stable
fixation, good rotational control, adequate alignment, early weight-bearing and a
high union rate of tibial non-unions. Reaming of the medullary canal with preservation
of periosteal sleeve create the "breeding ground" for sound healing of tibial shaft
nonunions. Additionally cancellous bone grafting is recommended only in the case of
defect nonunion.
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