Treatment of femoral and tibial diaphyseal nonunions using reamed intramedullary nailing without bone graft

Introduction: Intramedullary nailing has long been used successfully in the treatment of aseptic nonunions of the femur and tibia. However, recently the efficacy of reamed intramedullary nailing in the treatment of nonunions of the femur has been questioned by some publications reporting unfavourable results. The purpose of this study is to evaluate the treatment results of femoral and tibial diaphyseal nonunions with intramedullary nailing. Patients and methods: We retrospectively reviewed thirty-two patients with femoral or tibial diaphyseal nonunions who were treated with reamed intramedullary nailing between May 2002 and April 2006. Fixation status at the time of treatment were nail in twenty-eight patients (12 femurs, 16 tibiae), plate in three cases (2 femurs, 1 tibia), no implant in one femur. We used a dynamically locked, reamed intramedullary nailing. Only in bone defects greater than 50% of the cortical diameter and more than 2 cm in length was open bone grafting performed. Results: Solid union was achieved in 93% (fourteen of fifteen) of femoral nonunions and 94% (sixteen of seventeen) of tibial nonunoins. Conclusions: Our protocol with a dynamically locked, reamed nailing with the use of an oval hole and no open bone grafting for a defect less than 50% of the diameter and immediate weight bearing was successful in the treatment of femoral and tibial diaphyseal nonunions.