Arsalan Haider Bukhari.
Results of only using reamed bone graft obtained during interlocking nailing as an osteo-inducer, while treating tibial shaft aseptic nonunion after plating.
J Surg Pak Jan ;12(2):67-9.

Objective: To analyze the outcome of only using cancellous bone graft as an osteo-inducer, obtained during reaming, for intramedullary nail stabilization in treating tibial shaft aseptic nonunion after plating. Design: An analytical study Place and Duration of study: Combined Military Hospital Peshawar, during a period of 20 months, between March 2005 to October 2006. Patients & Methods: This study included a total of 21 patients with tibial shaft aseptic nonunion after plating. Of the total patients nineteen were males and two females. All were treated initially with bone plating for their diaphysial tibial fractures in various peripheral hospitals. Reamed interlocking nailing was carried out in all these patients in the second stage. Following the first stage operation of plate removal, no additional iliac bone grafting was used. Results: Twenty one patients were followed up between 7 to 15 months postoperatively. Eight patients were lost to follow up after 7 months. All the tibial nonunion healed uneventfully. The median union period was 4.5 months (range, 3.0-7.5 months). Knee range of motion showed evident improvement after operation. The ankle range of motion also had some improvement and all the patients could walk without aid postoperatively. There were no deep infections, rotational (>10º) or angular (>10º) deformity, or shortening (>2 cm). Conclusions: We recommend the use of reamed intramedullary nails without additional bone grafting in all suitable cases, so as to achieve a high success rate in management of tibial shaft aseptic nonunion after failed plating.

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