D. Templeman et al., EXCHANGE REAMED INTRAMEDULLARY NAILING FOR DELAYED UNION AND NONUNIONOF THE TIBIA, Clinical orthopaedics and related research, (315), 1995, pp. 169-175
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.