Exchange reamed nailing for aseptic nonunion of the tibia

Background: Exchange reamed nailing of the tibia is a common procedure in the treatment of an aseptic tibial nonunion. However, reports in the literature supporting this technique are limited. Methods: Forty patients with a tibial nonunion after initial unreamed intramedullary nailing were retrospectively assessed after an exchange reamed nailing. The main outcome measurements included radiographic and clinical union as well as time from exchange reamed nailing to union. Results: Thirty-eight patients achieved union of their fracture (95%). The average time from exchange nailing to union was 29 ± 21 weeks. Complications included one deep vein thrombosis (2.5%) and two hardware failures (5%). Conclusion: Exchange reamed nailing for nonunions of the tibia results in a high union rate and is associated with a low complication rate. This technique is recommended as a standard procedure for aseptic tibial nonunions after initial unreamed intramedullary nailing.