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

Authors

• Ashraf Ahmed Alhusseini, Dept. of Surgery, Hammurabi College of Medicine, University of Babylon, Hilla, IraqFollow

Corresponding Author

Ashraf Ahmed Alhusseini

Authors ORCID

Ashraf Ahmed Alhusseini: https://orcid.org/0009-0004-2253-9848

Document Type

Original Study

Keywords

Exchange, Nailing, Augmented, Plating, Nonunion

Abstract

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.

How to Cite This Article

Alhusseini, Ashraf Ahmed (2026) "Exchange Nailing Versus Augmented Plating for Aseptic Tibial Shaft Nonunion after Complicated Intramedullary Nailing: A Comparative Outcome Study," Hilla University College Journal For Medical Science: Vol. 4: Iss. 3, Article 10.
DOI: https://doi.org/10.62445/2958-4515.1129

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