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01.05.2013 | original article | Ausgabe 9-10/2013

Wiener klinische Wochenschrift 9-10/2013

Exchange reamed nailing compared to augmentation compression plating leaving the inserted nail in situ in the treatment of aseptic tibial non-union: a two-centre study

Wiener klinische Wochenschrift > Ausgabe 9-10/2013
Dr. med. Atesch Ateschrang, Dr. med. Georgios Karavalakis, Dr. med. Christoph Gonser, Prof. Dr. med. Ulrich Liener, Dr. med. Thomas Freude, Prof. Dr. med. Ulrich Stöckle, Dr. med. Matthias Walcher, Dr. med. Derek Zieker
Wichtige Hinweise
This trial gained approval through the appropriate ethics committee of the Eberhard Karls University of Tübingen.



A remarkable number of investigations are available treating tibial non-unions by exchange reamed nailing (ERN). Only few authors reported positive results after augmentation compression plating (ACP) for the same entity. To our knowledge no systematic study is published comparing ERN vs. ACP, so that this trial compares ACP leaving the already inserted un-reamed nail in situ against ERN in the treatment of aseptic tibial non-union, analysing success rate, time for union and operation time.

Patients and methods

Forty-eight patients with aseptic hypertrophic diaphyseal tibial non-union treated previously by un-reamed nailing were included retrospectively in this two-centre study. Group A consisted of 25 patients with ERN and group B of 23 patients with ACP leaving the underlying un-reamed nail in situ.


Mean follow-up was 3.8 years. Union was achieved in 24 out of 25 cases (96 %) for group A and in 22 out of 23 cases (95.6 %) for group B. Time needed for union varied; an average of 29 weeks for group A and 14 weeks for group B. The mean operation time for group A was 99 min, while it was 65 min for group B.


ERN and ACP with remaining pre-existing nail in situ are both safe and straightforward surgical procedures with equivalent high success rates of about 95 %. ACP has the advantage of less time for union and operating time in this series, but is associated with the disadvantage of requiring an additional incision and complaints associated to the plate requiring implant removal.

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