High Success Rate for Augmentation Compression Plating Leaving the Nail In Situ for Aseptic Diaphyseal Tibial Nonunions

Objectives: To evaluate adjunctive compression plating leaving the previously unreamed inserted intramedullary nail (URIMN) in situ for treating a resultant diaphyseal tibial nonunion. Design: Retrospective study. Setting: Level 1 trauma center (University Hospital). Patients/Participants: Patients treated by URIMN for diaphyseal tibial fractures that developed an aseptic hypertrophic nonunion. Intervention: Dynamization of the nail and compression plating leaving the URIMN in situ. Main Outcome Measurements: Radiographic and clinical parameters. Results: The mean follow-up was 3.8 years (range 2-7 years). Mean time for healing was 15 weeks with a mean operation time of 63 minutes. Union occurred in 27/28 (96.4%). There were no infections. Conclusions: This simple technique seems to have a high success rate and should be considered when a nonunion occurs after URIMN. The need for an additional incision and removal of symptomatic implants remains a disadvantage.