The Journal of Bone and Joint Surgery (American). 2007;89:177-188.
doi:10.2106/JBJS.F.00742
© 2007 The Journal of Bone and Joint Surgery, Inc.
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Current Concepts Review

Exchange Nailing of Ununited Fractures

Mark R. Brinker, MD1 and Daniel P. O'Connor, PhD1

1 Fondren Orthopedic Group (M.R.B.) and Joe W. King Orthopedic Institute (D.P.O'C.), Texas Orthopedic Hospital, 7401 South Main Street, Houston, TX 77030-4509

Investigation performed at the Fondren Orthopedic Group, Texas Orthopedic Hospital, Houston, Texas

Disclosure: The authors did not receive grants or outside funding in support of their research for or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Exchange nailing is most appropriate for a nonunion without substantial bone loss.

There is no clear consensus regarding the use of exchange nailing in the presence of active, purulent infection.

The exchange nail should be at least 1 mm larger in diameter than the nail being removed, and it has been recommended that it be up to 4 mm larger when the nail being removed was greatly undersized. Canal reaming should progress until osseous tissue is observed in the reaming flutes.

Exchange nailing is an excellent choice for aseptic nonunions of noncomminuted diaphyseal femoral fractures, with union rates reported to range from 72% to 100%. On the basis of the available literature, exchange nailing cannot be recommended for distal femoral nonunions at this time.

Exchange nailing is an excellent choice for aseptic nonunions of noncomminuted diaphyseal tibial fractures, with union rates reported to range from 76% to 96%.

On the basis of the available literature, exchange nailing is generally not indicated for humeral nonunions.


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Use of Ilizarov Frame with Exchange Nailing
Subir L. Bali
JBJS Online, 18 Jan 2007 [Full text]