Exchange nailing for aseptic tibial shaft nonunion: emphasis on the influence of a concomitant fibulotomy.

BACKGROUND Exchange nailing is reported to have a high success rate for aseptic tibial nonunions. However, sample sizes in all series in the literature were small, and the influence of a concomitant fibulotomy was not evaluated. METHODS Fifty-four aseptic tibial shaft nonunions for 1.2 approximately 4.3 (mean, 2.4) years were treated with exchange nailing. Indications for this technique included an aseptic nonunion of the tibial shaft with an inserted intramedullary nail and < 2 cm of shortening. A fibulotomy was performed in a nonunion with poor shaft alignment, which concomitantly required manipulation to correct. The success rate of exchange nailing was determined, and whether a concomitant fibulotomy affected the success rate was evaluated. RESULTS Forty-seven nonunions were followed-up for 1.1 approximately 6.9 (mean, 3.8) years, and all nonunions healed. The union rate was 100% (47/47), and the average period required to achieve union was 4.7 (3.0 approximately 7.5) months. The average union periods between the fibulotomy and non-fibulotomy groups did not statistically differ (4.6 vs. 4.8 months, p = 0.61). There were no significant complications in either group. CONCLUSIONS Exchange nailing is an excellent technique to treat aseptic nonunions of the tibia. It can be considered the treatment of choice for all indicated cases. A concomitant fibulotomy has minimal influence on the success rate. It can be performed when the shaft alignment needs correction.