Distal tibial nonunion treated by intramedullary reaming with external immobilization

Seventeen distal tibial nonunions were treated by a combination of metal removal with closed intramedullary reaming for internal bone graft and application of a long leg cast for aseptic nonunions and an external fixator for quiescent septic nonunions. The nonunions were present for a median of 1.8 years (range, 1.2-3.4 years). All achieved a solid union with a union period of 5.2 +/- 1.6 months. There was one complication of a renewed infection in a septic nonunion. The functional rating score improved from all unsatisfactory before treatment to 13 satisfactory after treatment. The other four (all were infected nonunions) also improved from poor to a fair outcome. In conclusion, the technique described is a simple and effective method to treat some complex distal tibial nonunions.