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Results of a Systematic Approach to Exchange Nailing for the Treatment of Aseptic Tibial Nonunions

Swanson, Eli A. MD*; Garrard, Eli C. MD*; O'Connor, Daniel P. PhD; Brinker, Mark R. MD*,‡

Journal of Orthopaedic Trauma: January 2015 - Volume 29 - Issue 1 - p 28–35
doi: 10.1097/BOT.0000000000000151
Original Article

Objectives: The purpose of this study was to evaluate the effectiveness of a systematic approach to exchange nailing for the treatment of aseptic tibial nonunion.

Design: Retrospective cohort.

Setting: Tertiary referral center.

Patients: Forty-six aseptic tibial nonunion sites in 40 patients (2 bilateral and 4 segmental) who presented with an intramedullary nail on an average of 16 months after the initial treatment were presented in this study.

Intervention: Insertion of an exchange nail of at least >2-mm diameter than the prior nail using a different manufacturer's nail, static interlocking, partial fibulectomy in a select group of patients, and correction of underlying metabolic and endocrine abnormalities.

Main Outcome Measurements: Union rate, time to union.

Results: Forty-five of 46 tibial nonunion sites (98%) healed at an average of 4.8 months.

Conclusions: Patient selection criteria and a systematic approach to exchange nailing for tibial nonunion is highly successful.

Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

*Department of Orthopaedic Trauma, University of Texas Health Science Center at Houston, Houston, TX;

Department of Health and Human Performance, University of Houston, Houston, TX; and

Fondren Orthopedic Group, Texas Orthopedic Hospital, Houston, TX.

Reprints: Daniel P. O'Connor, PhD, University of Houston, 3855 Holman GAR 104, Houston, TX 77204-6015 (e-mail:

Investigation performed at the Center for Problem Fractures and Limb Restoration, Fondren Orthopedic Group, Texas Orthopedic Hospital, Houston TX.

M. R. Brinker is a consultant for Biomet. D. P. O'Connor is a consultant for Nimbic, and has grants from CDC, NIH, U.S. Department of Education (NIDRR), NASA, and J. W. King Orthopedic Institute. The other authors report no conflict of interest.

Accepted April 29, 2014

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