[Secondary nailing of the tibia in non-unions with septic risk. Indications and results]

Reamed or unreamed intramedullary nailing with or without associated grafting are well established technics for treating tibial non-unions. However, certain cases can present an increased risk of septic complications. The authors propose a classification of these risks into 4 grades based on a review of 25 cases: grade I (14 cases): non-union following open fractures with no history of infection; grade II (5 cases): non-union following fractures treated initially by external fixation; grade III (4 cases): non-union following septic fractures showing no current signs of active infection; grade IV (2 cases): septic non-union. The risks of intramedullary tibial nailing are evaluated. Only one case presented a serious septic complication leading to nail removal and knee arthrodesis. Intramedullary nailing may be indicated in grade I and II non-unions, but should rarely be used in grades III and IV.