Exchange nailing for failure of initially rodded tibial shaft fractures

This retrospective study evaluated 32 patients who underwent exchange naili ng for initially rodded nonunited tibial shaft fractures during a 5-year pe riod. High-energy trauma accounted for 22 fractures; 19 fractures were open . An unreamed nail was initially used to stabilize all but 2 fractures. Imp lant failure occurred in 31% of fractures, mostly in distal-third fractures , with a failure rate of 34%. Average time from injury to exchange nailing was 36 weeks (range: 6-148 weeks) and consisted of closed reamed nailing an d fibulectomy in 27 cases. Healing occurred an average of 20 weeks (range: 6-47 weeks) after postexcha nge nailing in 27 (84%) fractures. Four (12.5%) fractures healed after addi tional procedures. There was 1 persistent nonunion. Factors leading to dela y in union time included comminution, healed fibula, and proximal location. Multiple regression analysis using survival data at P<.05 showed a signifi cant correlation between fracture configuration and fixation method (locked , dynamic, and unlocked) on time to union. Exchange nailing with closed reaming and fibulectomy is a viable option for treating failures of primarily nailed tibial fractures. Increased stabilit y and stimulation of arrested bone healing may account for the good outcome . The advantages of repeat reamed nailings should be weighed against the po ssible adverse effect of reaming on bone vascularity.