Surgical management of delayed union and nonunion of the tibia

A review of 163 patients seen between 1963 and 1975 with tibial nonunion revealed that operative treatment of the fracture, soft tissue injury, infection, and comminution appeared to have a role in the nonunion. The patients usually were seen between five and 12 months after injury. Multiple methods, involving both soft tissue and bone, were used to treat the nonunion. Phemister grafting was both the most frequent (21%) and the most successful (83%) procedure. Plate with graft and external compression with graft were both used with success (73% and 83%, respectively) in smaller patient populations. Infection tended to decrease the rate of successful union. The need to individualize treatment is important.