INTRAMEDULLARY NAILING OF ASEPTIC TIBIAL NONUNIONS WITHOUT THE USE OFTHE FRACTURE TABLE

Twenty-seven patients with 28 aseptic nonunions were treated with ream ed intramedullary (IM) nailing of the tibia and were followed for at l east 1 year postoperatively. The management protocol called for a radi olucent operating room table with the limb draped free and manual mani pulation of the nonunion with a preference for closed nailing. Nail in terlocking was used when residual axial or rotational instability was observed after nail insertion. Iliac crest bone grafting was performed on all patients requiring open nailing. Closed nailing, using the des cribed technique, was accomplished in 20 cases; open nailing was neces sary in eight. Although operative time and total blood loss were signi ficantly increased with open nailing, time to union was similar in the two groups. Twenty-seven nonunions healed. The lone persistent nonuni on responded to bone grafting, leaving the nail in situ. One infection occurred, which responded to debridement, drainage, and long-term ant ibiotic therapy without requiring nail removal. Acceptable bony alignm ent was attained in all patients. Functional results were excellent. T his method is recommended for all tibial nonunions amenable to IM nail stabilization. A history of prior acute infection and/or excessive sh ortening due to bone loss constitute the relative contraindications.