• OBJECTIVES
    • The purpose of this study was to evaluate the effectiveness of a systematic approach to exchange nailing for the treatment of aseptic tibial nonunion.
  • DESIGN
    • Retrospective cohort.
  • SETTING
    • Tertiary referral center.
  • PATIENTS
    • Forty-six aseptic tibial nonunion sites in 40 patients (2 bilateral and 4 segmental) who presented with an intramedullary nail on an average of 16 months after the initial treatment were presented in this study.
  • INTERVENTION
    • Insertion of an exchange nail of at least >2-mm diameter than the prior nail using a different manufacturer's nail, static interlocking, partial fibulectomy in a select group of patients, and correction of underlying metabolic and endocrine abnormalities.
  • MAIN OUTCOME MEASUREMENTS
    • Union rate, time to union.
  • RESULTS
    • Forty-five of 46 tibial nonunion sites (98%) healed at an average of 4.8 months.
  • CONCLUSIONS
    • Patient selection criteria and a systematic approach to exchange nailing for tibial nonunion is highly successful.
  • LEVEL OF EVIDENCE
    • Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.