EXCHANGE REAMED INTRAMEDULLARY NAILING FOR DELAYED UNION AND NONUNIONOF THE TIBIA

Twenty-eight tibial fractures, initially treated with nonreamed interl ocking nails, were exchanged to reamed intramedullary nails to promote union. Initially, there were 8 closed fractures with compartment synd romes; 5 Type 2 open fractures; 6 Type 3 A injuries; and 6 Type 3B inj uries. Exchange nailing was performed if followup radiographs did not show callus formation between 3 and 5 months after injury. Originally, 16 of the 28 nailings were statically locked. Twenty-five of 27 fract ures united after exchange nailing. In 2 patients with bone loss, addi tional bone grafting was required. Infection developed in 3 patients a fter exchange nailing (11%). Exchange nailing is a useful method to pr omote union of tibial fractures when dow consolidation occurs after in itial treatment with a nonreamed nail. This method should be combined with autogenous bone grafting in patients with bone loss. The procedur e is safe and effective in closed and minor open fractures; however, c aution should be exercised in patients with prior Grade 3B open fractu res because of the risk of infection.