Exchange nailing for failure of initially rodded tibial shaft fractures

This retrospective study evaluated 32 patients who underwent exchange nailing for initially rodded nonunited tibial shaft fractures during a 5-year period. High-energy trauma accounted for 22 fractures; 19 fractures were open. An unreamed nail was initially used to stabilize all but 2 fractures. Implant 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 and fibulectomy in 27 cases. Healing occurred an average of 20 weeks (range: 6-47 weeks) after postexchange nailing in 27 (84%) fractures. Four (12.5%) fractures healed after additional procedures. There was 1 persistent nonunion. Factors leading to delay in union time included comminution, healed fibula, and proximal location. Multiple regression analysis using survival data at P<.05 showed a significant 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 stability and stimulation of arrested bone healing may account for the good outcome. The advantages of repeat reamed nailings should be weighed against the possible adverse effect of reaming on bone vascularity.