The incidence of non-union in the long bones varies with each bone and with the methods of treating acute fractures. Several factors have been implicated as the cause of non-union, most of which are inherent in the nature of the fracture. High-velocity open fractures with skin or bone loss, distraction at the fracture site, and an inadequate external or internal fixation increase the incidence of non-union in fractures.

Weber and Cech classify non-unions as two types – hypervascular and avascular. Hypervascular non-unions can be treated by stable fixation of the fragments alone, whereas the avascular type requires decortication and bone grafting for healing. Reamed intramedulary nailing is an effective technique for management of the tibial shaft aseptic non-union for both types.

Twenty tibial non-unions were treated with a reamed intramedullary nail. The initial fracture management consisted of a cast in seven patients (35%), external fixation in four (20%), plate osteosynthesis in four (20%), and unreamed nailing in five (25%). The time from injury to nailing averaged 32 weeks. Patients were followed for an average of 16 months.

All non-unions united uneventfully and functional results were excellent. Contraindications are a history of prior acute infection or excessive shortening due to bone loss.

Reamed intramedullary nailing is an effective, relatively low-risk technique for the management of non-union of the tibia. The closed technique should be used when possible. When necessary, open alignment should be executed with minimal dissection. Osteotomy of the fibula is a necessary component of this technique and bone grafting is indicated in cases of avascular non-union.