Nonunion and Delayed Union of The Tibia Treated by Closed Intramedullary Nailing

Abstract

From January 1988 to March 1993, in the Department of Orthopaedic Surgery and Traumatology of Ege University Medical School, 13 nonunions and 5 delayed unions of the tibia were treated with reamed intramedullary nailing with the Kuntscher nail. Seven nonunions and five delayed unions were treated originally with either cast, lag screws, or plates. The remaining 6 nonunions, all open fractures, were treated initially by external fixation. The average number of previous failed surgeries was two. In 8 (44%) patients the operation was open and in ten (56%) it was closed although two also had open removal of a tibial plate. The mean interval between fracture and secondary surgery was 11 (min. 5, max. 43) months. Supplemantary bone grafting was essential only for major dejects. Weight bearing in a patellar-tendon bearing (PTB) brace was encouraged in all cases by two weeks postoperatively. Union was obtained all of the patients. Follow up average of 26 (min. 9, max. 48) months, on all patients showed a 100% rate of union. The mean interval between surgery and radiographic union was 3 (min. 2, max. 4) months. Functional results were assessed with the modified knee-rating system of the hospital for special surgery. There were excellent results in 7 (39%), good results in 9 (50%), and fair results in 2 (11%). It appears that closed intramedullary nailing with reaming of the medullary cavity of nonunion and delayed union of the tibia offers the best approach for achieving optimum results.