Intramedullary nailing has been the gold standard for treating tibial but nonunions sometimes occur. Various techniques for the treatment of tibial nonunions after intramedullary nail fixation.
They include exchanging nail with a larger sized nail, dynamizing a locked nail and replacing a intramedullary nail with a compression plate or external
fixation.An additional autogenous bone graft is usually required in atrophic nonunion to promote bone healing.
I share with you this case of treatment of tibial atrophic nonunions after intramedullary nail internal fixation with the augmentation plating procedure, refreshing bone edges, fibular osteotomy and autogenous iliac corticocancellous bone graft.
In Ueng concluded that augmentation plate fixation is a useful treatment for the nonunion of tibial shaft fracture after intramedullary nail fixation,in his study of 12 cases. The technique is simple, facilitates very early weight bearing, and provides a good recovery from nonunion.
Reference
Ueng SW, Liu HT, Wang IC. Augmentation plate fixation for the management of tibial nonunion after intramedullary nailing. Journal of Trauma and Acute Care Surgery. 2002 Sep 1;53(3):588-92.