Nonunion of tibial shaft fractures treated with locked intramedullary nailing without bone grafting.

Twenty-five nonunions of tibial fractures were treated with Grosse-Kempf slotted, locked nails in 20 men and 5 women 6 to 54 months after fracture. No bone grafts were performed in connection with nailing. For better alignment, opening of the nonunion site, fibular osteotomy/resection, or both were used. In one patient reoperation with nailing and bone grafting was necessary after the first nail broke. There were three postoperative infections (12%), two with persistent drainage. All nonunions healed. In one patient an external rotatory malalignment was corrected by a later osteotomy. In no case was the function of the ankle or foot impaired by the index operation. Static locking was not unfavorable for healing. We conclude that bone grafting is rarely needed and function is restored early after locked nailing of tibial nonunions.