Exchange Nailing Versus Augmented Plating for Aseptic Tibial Shaft Nonunion after Complicated Intramedullary Nailing: A Comparative Outcome Study

Background: Aseptic tibial shaft nonunion following unsuccessful treatment by intramedullary (IM) nailing is a challenging orthopedic complication.Objectives: To compare the efficacy of exchange nailing with augmented plating in aseptic tibial shaft nonunion.Materials and Methods: This was a prospective comparative study conducted at Hilla Teaching Hospital. Forty patients (45-65 years) with aseptic tibial shaft nonunion (greater than or equal to 9 months old) secondary to intramedullary rod fixation were included. The patients were grouped at random for exchange nailing (n = 20) or augmented plating using a 4.5-mm LC-DCP over the retained nail (n = 20). Bone grafting and fibular osteotomy were performed on a limited basis. Union rate and time to union were the main outcome measures. (Smoking and diabetes mellitus were also evaluated as risk factors.)Results: The ages of the two groups (56.15 ± 6.33 vs. 55.20 ± 6.30 years; p = 0.6), and both had the same proportion of smoking and diabetes (p = 1.000). In those who progressed to union, the time to union was significantly shorter for augmented plating (4.83 ± 0.79 months) compared to exchange nailing (7.71 ± 0.91 months; p = 0.0001). Complete union was obtained in 90% of augmented plates and 70% of exchange-nailing patients overall. Nonunion occurred three times as often following exchange nailing (30%) than after augmented plating (10%).Conclusion: Augmented plating over a retained intramedullary nail unites aseptic tibial shaft nonunion faster and more reliably than exchange nailing. Better healing may be due to mechanical stability and intramedullary biology.