Intramedullary nailing of tibial nonunions

Fifteen tibial nonunions, ranging nine months to 19 years after original injury, were treated with the Brooker intramedullary nail (IMN). The average number of previous failed surgeries was two. The fracture location ranged from several centimeters below the tubercle to 3 cm above the plafond. Twelve of 15 had bone grafting, and all 15 had fibular osteotomy at the time of the IMN procedure. Thirteen of 15 were reamed, and 11 of 15 were nailed open. Patients required an average of five postoperative days in the hospital, and 14 of 15 tibial nonunions healed uneventfully at an average of eight months after the IMN procedure. Weight bearing in a removable patellar-tendon-bearing (PTB) brace was encouraged in most cases by two to four weeks postoperative. One nonunion patent, traumatically refractured after rod removal, was treated at another hospital with dynamic compression plating and iliac crest bone graft; the fracture healed three months later but was considered an IMN treatment failure. There were no other significant complications. The IMN procedure encourages early return to function and reliably promotes union in even the most challenging and complex of tibial healing problems.