The Journal of Bone and Joint Surgery, Vol 71, Issue 7 1004-1019, Copyright © 1989 by Journal of Bone and Joint Surgery, Inc
Intramedullary nailing with reaming to treat non-union of the tibia
SL Sledge, KD Johnson, MB Henley and JT Watson
Division of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas 75235-9031.
The records of fifty-one patients who were treated by intramedullary
nailing with reaming for non-union of the tibia were retrospectively
reviewed. The fractures had been treated initially by closed reduction and
immobilization in a cast, external fixation followed by immobilization in a
cast, fixation by pins incorporated in a plaster cast, minimum internal
fixation and immobilization in a cast, dynamic compression plating, or
intramedullary nailing with or without reaming. After the initial treatment
had failed, intramedullary nailing with reaming was done to gain union.
Although closed nailing of the tibia was preferred, in thirty-three
patients, the site of the non-union was opened to improve alignment by
performing an osteotomy or to remove failed hardware. Bone grafts from the
iliac crest were used in ten patients, and a fibular ostectomy or osteotomy
was done in thirty-three. Of thirty-four open fractures (fourteen grade I,
seven grade II, and thirteen grade III), eight were infected at the time of
intramedullary nailing. The average time of the diagnosis of a non-union
was 9.6 months; the average length of follow-up after nailing was twenty
months. In forty-nine (96 per cent) of the fifty-one patients, tibial union
occurred at an average of seven months postoperatively. Complications
included persistent infection (three patients), acquired infection after
intramedullary nailing with reaming (three patients), fracture of the nail
that necessitated an additional operation (two patients), shortening of
more than one centimeter (two patients), malrotation of more than 15
degrees (one patient), peroneal palsy (one patient), and amputation (one
patient). When used to treat non-union of the tibia, intramedullary nailing
with reaming can produce union as effectively as other alternatives, while
enabling the patient to function more normally without external
immobilization or walking aids.
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