Top

Published in:

Open Access 01-08-2017 | Original Paper

Reamed intramedullary exchange nailing in the operative treatment of aseptic tibial shaft nonunion

Authors: Christian Hierholzer, Jan Friederichs, Claudio Glowalla, Alexander Woltmann, Volker Bühren, Christian von Rüden

Published in: International Orthopaedics | Issue 8/2017

Abstract

Purpose

The aim of this study was to evaluate a standardized treatment protocol regarding the rate of secondary bone union, complications, and functional outcome.

Methods

This study was started as a prospective study in a single Level I Trauma Centre between 2003 and 2012. The study group consisted of 188 patients with the diagnosis of an aseptic tibial shaft nonunion. Exchange nailing was performed following a standardized surgical protocol. Long-term follow-up was analyzed for rate of bone healing and functional outcome.

Results

Osseous healing was achieved in 182 out of 188 patients (97 %). In 165 out of 188 patients (88 %), bone healing was observed timely and uneventfully after a single exchange nailing procedure. An open approach was necessary in 32 patients (17 %). Twenty-three patients (12 %) required additional therapy such as extracorporeal shock wave therapy. Post-operative complications were observed in seven patients (4 %). Almost all patients demonstrated osseous healing within 12 months, with the majority of osseous healing occurring within six months. A relevant shortening of the fractured tibia was observed in 20 out of 188 patients (11 %). After a median follow-up of 23 months (range 12–45 months), outcome was evaluated using the assessment system of Friedman/Wyman. In summary, 154 out of 188 patients (82 %) had a good functional long-term result.

Discussion

Reamed intramedullary exchange nailing including correction of axis alignment is a safe and effective treatment of aseptic tibial shaft nonunion with a high rate of bone healing and a good radiological and functional long-term outcome.

Attal R, Blauth M (2010) Unreamed intramedullary nailing. Orthopade 39:182–191. doi:10.1007/s00132-009-1524-5 CrossRefPubMed

Forster MC, Bruce ASW, Aster AS (2005) Should the tibia be reamed when nailing? Injury 36:439–444CrossRefPubMed

Lin J, Hou SM (2001) Unreamed locked tight-fitting nailing for acute tibial fractures. J Orthop Trauma 15(1):40–46CrossRefPubMed

McQueen MM, Christie J, Court-Brown CM (1996) Acute compartment syndrome in tibial diaphyseal fractures. J Bone Joint Surg (Br) 78:95–98

Rodriguez-Merchan EC, Forriol F (2004) General principles and experimental data. Clin Orthop Relat Res 419:4–12CrossRef

Swanson EA, Garrard EC, OʼConnor DP, Brinker MR (2015) Results of a systematic approach to exchange nailing for the treatment of aseptic tibial nonunion. J Orthop Trauma 29(1):28–35. doi:10.1097/BOT.0000000000000151 CrossRefPubMed

Court-Brown CM, Keating JF, Christie J, McQueen MM (1995) Exchange intramedullary nailing: its use in aseptic tibial nonunion. J Bone Joint Surg (Br) 77:407–411

Wu CC, Shih CH, Chen WJ, Tai CL (1999) High success rate with exchange nailing to treat a tibial shaft aseptic nonunion. J Orthop Tauma 13:33–38CrossRef

Zelle BA, Gruen GS, Klatt B, Haemmerle MJ, Rosenblum WJ, Prayson MJ (2004) Exchange reamed nailing for aseptic nonunion of the tibia. J Trauma 57:1053–1059CrossRefPubMed

10.

Mercado EM, Lim EV, Stern P, Aquino NJ (2001) Exchange nailing for failure of initially rodded tibial shaft fractures. Orthopedics 24:757–762PubMed

11.

Templeman D, Thomas M, Varecka T, Kyle R (1995) Exchange reamed intramedullary nailing for delayed union and nonunion of the tibia. Clin Orthop Relat Res 315:169–175

12.

Niu Y, Bai Y, Xu S, Liu X, Wang P, Wu D, Zhang C, Li M (2011) Treatment of lower extremity long bone nonunion with expandable intramedullary nailing and autologous bone grafting. Arch Orthop Trauma Surg 131:885–891. doi:10.1007/s00402-010-1226-9 CrossRefPubMed

13.

Wiss DA, Johnson DL, Miao M (1992) Compression plating for nonunion after failed external fixation of open tibial fractures. J Bone Joint Surg Am 74:1279–1285CrossRefPubMed

14.

Mayo KA, Benirschke SK (1990) Treatment of tibial malunions and nonunion with reamed intramedullary nails. Orthop Clin North Am 21(4):715–724PubMed

15.

Bonnevialle P, Bellumore Y, Foucras L, Hézard L, Mansat M (2000) Tibial fracture with intact fibula treated by reamed nailing. Rev Chir Orthop Reparatrice Appar Mot 86:29–37PubMed

16.

Hsiao CW, Wu CC, Su CY, Fan KF, Tseng IC, Lee PC (2006) Exchange nailing for aseptic tibial shaft nonunion: emphasis on the influence of a concomitant fibulotomy. Chang Gung Med J 29:283–290PubMed

17.

Heckman JD, Ryaby JP, McCabe J, Frey JJ, Kilcoyne RF (1994) Acceleration of tibial fracture-healing by non-invasive, low-intensity pulsed ultrasound. J Bone Joint Surg Am 76:26–34CrossRefPubMed

18.

Penzkofer R, Maier M, Nolte A, von Oldenburg G, Püschel K, Bühren V, Augat P (2009) Influence of intramedullary nail diameter and locking mode on the stability of tibial shaft fracture fixation. Arch Orthop Trauma Surg 129:525–531CrossRefPubMed

19.

Hoffmann S, Gerber C, von Oldenburg G, Kessler M, Stephan D, Augat P (2015) Effect of angular stability and other locking parameters on the mechanical performance of intramedullary nails. Biomed Tech (Berl) 60(2):157–164. doi:10.1515/bmt-2014-0100 CrossRef

20.

Friedman RJ, Wyman ET (1986) Ipsilateral hip and femoral shaft fractures. Clin Orthop Relat Res 208:188–194

21.

Högel F, Gerber C, Bühren V, Augat P (2013) Reamed intramedullary nailing of diaphyseal tibial fractures: comparison of compression and non-compression nailing. Eur J Trauma Emerg Surg 39:73–77. doi:10.1007/s00068-012-0237-3 CrossRefPubMed

22.

Piątkowski K, Piekarczyk P, Kwiatkowski K, Przybycień M, Chwedczuk B (2015) Comparison of different locking plate fixation methods in distal tibia fractures. Int Orthop 39(11):2245–2251. doi:10.1007/s00264-015-2906-4 CrossRefPubMed

23.

Fadel M, Ahmed MA, Al-Dars AM, Maabed MA, Shawki H (2015) Ilizarov external fixation versus plate osteosynthesis in the management of extra-articular fractures of the distal tibia. Int Orthop 39(3):513–519. doi:10.1007/s00264-014-2607-4 CrossRefPubMed

24.

Sathiyakumar V, Thakore RV, Ihejirika RC, Obremskey WT, Sethi MK (2014) Distal tibia fractures and medial plating: factors influencing re-operation. Int Orthop 38(7):1483–1488. doi:10.1007/s00264-014-2345-7 CrossRefPubMedPubMedCentral

25.

Xia L, Zhou J, Zhang Y, Mei G, Jin D (2014) A meta-analysis of reamed versus unreamed intramedullary nailing for the treatment of closed tibial fractures. Orthopedics 37(4):e332–e338. doi:10.3928/01477447-20140401-52 CrossRefPubMed

26.

Xue D, Zheng Q, Li H, Qian S, Zhang B, Pan Z (2010) Reamed and unreamed intramedullary nailing for the treatment of open and closed tibial fractures: a subgroup analysis of randomised trials. Int Orthop 34(8):1307–1313. doi:10.1007/s00264-009-0895-x CrossRefPubMed

27.

Augat P, Bühren V (2015) Intramedullary nailing of the distal tibia. Does angular stable locking make a difference? Unfallchirurg 118(4):311–317CrossRefPubMed

28.

Wu CC (2007) Exchange nailing for aseptic nonunion of femoral shaft: a retrospective cohort study for effect of reaming size. J Trauma 63:859–865CrossRefPubMed

29.

Guimarães JA, Duarte ME, Fernandes MB, Vianna VF, Rocha TH, Bonfim DC, Casado PL, do Val Guimarães IC, Velarde LG, Dutra HS, Giannoudis PV (2014) The effect of autologous concentrated bone-marrow grafting on the healing of femoral shaft non-unions after locked intramedullary nailing. Injury 45 Suppl 5:S7–S13CrossRefPubMed

30.

Frölke JP, Bakker FC, Patka P, Haarman HJ (2001) Reaming debris in osteotomized sheep tibiae. J Trauma 50:65–69CrossRefPubMed

31.

Kuzyk PR, Li R, Zdero R, Davies JE, Schemitsch EH (2011) The effect of intramedullary reaming on a diaphyseal bone defect of the tibia. J Trauma 70:1248–1256. doi:10.1097/TA.0b013e3181e985bd CrossRefPubMed

32.

Reichert IL, McCarthy ID, Hughes SP (1995) The acute vascular response to intramedullary reaming. Microsphere estimation of blood flow in the intact ovine tibia. J Bone Joint Surg (Br) 77:490–493

33.

Schemitsch EH, Kowalski MJ, Swiontkowski MF (1996) Soft-tissue blood flow following reamed versus undreamed locked intramedullary nailing: a fractured sheep tibia model. Ann Plast Surg 36:70–75CrossRefPubMed

34.

Haffner N, Antonic V, Smolen D, Slezak P, Schaden W, Mittermayr R, Stojadinovic A (2016) Extracorporeal shockwave therapy (ESWT) ameliorates healing of tibial fracture non-union unresponsive to conventional therapy. Injury 47(7):1506–1513. doi:10.1016/j.injury.2016.04.010 CrossRefPubMed

Title: Reamed intramedullary exchange nailing in the operative treatment of aseptic tibial shaft nonunion
Authors: Christian Hierholzer
Jan Friederichs
Claudio Glowalla
Alexander Woltmann
Volker Bühren
Christian von Rüden
Publication date: 01-08-2017
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 8/2017
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-016-3317-x

At a glance: The STEP trials

Springer Medicine

Reamed intramedullary exchange nailing in the operative treatment of aseptic tibial shaft nonunion

Abstract

Purpose

Methods

Results

Discussion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Discussion

Please log in to get access to this content

Other articles of this Issue 8/2017

Painful stress reaction in the posterior subtalar joint after resection of os trigonum or posterior talar process

How effective is embolization with N-2-butyl-cyanoacrylate for aneurysmal bone cysts?

Complications during removal of conventional versus locked compression plates: is there a difference?

Segmental acetabular rim defects, bone loss, oversizing, and press fit cup in total hip arthroplasty evaluated with a probabilistic finite element analysis

INFIX versus plating for pelvic fractures with disruption of the symphysis pubis

Multimodal nerve monitoring during periacetabular osteotomy identifies surgical steps associated with risk of injury