Fifty patients suffering from aseptic tibial nonunion underwent reamed intr
amedullary nailing (I.N.) and were retrospectively reviewed. Thirty-six pat
ients were initially treated with external fixation, six with plate and scr
ews, one with a static I.N., and seven with plaster of Paris. Eighteen of t
he fractures were initially open (A: 5, B: 6, and C: 7 according to the Gus
tilo classification). In 34 cases a closed procedure was performed, whereas
in sixteen, an opening at the nonunion site was unavoidable either to remo
ve metalwork or realign the fragments. Following failed external fixation,
secondary I.N. was performed at least 10 days after removal of the device.
Bone grafts from the iliac crest were used in three cases, and a fibular os
teotomy was performed in 33. Patients were followed up for an average of 2.
5 years after nailing, ranging from 10 months to 7 years. A solid union was
achieved in all patients within a period of 6 months. One patient develope
d late infection, which settled after nail removal and one patient develope
d impending compartment syndrome which was detected on the first post-opera
tive day and was treated with a fasciotomy. Transient peroneal nerve palsy
occurred in one patient and this recovered in 3 months, whereas in nine pat
ients a clinically acceptable deformity was noticed. In conclusion, we beli
eve that reamed intramedullary nailing is a highly effective treatment for
aseptic tibial nonunions. Early and late complications are rare and bone gr
aft is rarely needed. The method allows early weight bearing even before so
lid union occurs, short hospitalisation time and early return to work witho
ut external support. (C) 2001 Elsevier Science Ltd. All rights reserved.