We evaluated the efficacy of using the expandable nail for treating non-union and malunion of the tibial and femoral shafts. Records of 20 patients were retrospectively reviewed: 12 had femoral non-union, 7 had tibial non-union, and one had tibial malunion. The bones underwent reaming and the largest possible nail sizes were inserted during reoperation.

The mean age of the patients was 35 years (26-49) in the tibia group and 53 years (23-85) in the femur group. The fractures were defined according to AO/OTA classification and divided between open and closed. The initial treatment was 6 interlocking intramedullary nails and 2 external fixation in the tibia group, and 6 interlocking intramedullary nails, 3 plates and screws and 2 proximal femoral nails in the femoral group. The respective intervals between the original trauma and re-operation were 12 months and 15 months and the respective operation times were 59 minutes (35-70) and 68 minutes (20-120).

All fractures healed satisfactorily without the need for an additional procedure. Healing time was 26 weeks (6-52) and 14 weeks (6-26) in the tibia and femur group, respectively. Limb shortenings of 10cm and 4cm were recorded in one patient each in the tibia group and of 3cm in one patient in the femur group.

Using the expandable nail system permitted us to ream the bone and expand the nail to its maximal diameter, i.e. up to 16mm in the tibia and 19mm in the femur. We believe that using a bigger nail diameter contributes to better stabilisation of the fracture and promotes better and faster bone healing.

Based on our experience, we recommend the use of the expandable nail system to treat tibia and femur shaft non-unions and malunions.