Rates of union and risk factors for continued nonunion following exchange nailing of tibial nonunion

Authors

• Julia C. Mastracci, Atrium Health Musculoskeletal Institute, Charlotte, NC
• Benjamin Averkamp, Atrium Health Musculoskeletal Institute, Charlotte, NC
• Matthew Braswell, Atrium Health Musculoskeletal Institute, Charlotte, NC
• Ziqing Yu, Atrium Health Musculoskeletal Institute, Charlotte, NC
• Andrew T. Chen, University of North Carolina, Chapel Hill, NC
• Roman M. Natoli, Indiana University, Indianapolis, IN
• Hassan Farooq, Indiana University, Indianapolis, IN
• Hassan Mir, Florida Orthopaedic Institute, Tampa, FL
• Jessica Rivera, LSU Health Sciences Center - New OrleansFollow
• Rachel B. Seymour, Atrium Health Musculoskeletal Institute, Charlotte, NC
• Joseph R. Hsu, Atrium Health Musculoskeletal Institute, Charlotte, NC
• Evidence-Based Musculoskeletal Injury & Trauma Collaborative (EMIT)

Document Type

Article

Publication Date

5-9-2026

Publication Title

Archives of Orthopaedic and Trauma Surgery

Abstract

INTRODUCTION: The objective of this study was to evaluate the rate of nonunion repair success in tibia nonunions treated with exchange nailing. This retrospective cohort study was conducted across five academic Level 1 trauma centers and included 63 patients with tibia nonunions. MATERIALS AND METHODS: Patients who sustained a tibia fracture (AO/OTA 42) treated with intramedullary fixation that developed a nonunion and were subsequently treated with exchange nailing were retrospectively reviewed. The primary outcome measure was nonunion repair success based on osseous union. Additional analyses included union rate by AO/OTA classification, nonunion type, implant(s) used, graft used, time from initial procedure, and infection status. RESULTS: All patients sustained an AO/OTA type 42 fracture. Out of 63 patients, 47 tibias (75%) achieved osseous union after the index exchange nail procedure. The rates of nonunion revision success were similar across nonunion types and time from initial procedure until exchange nailing. There was no significant difference in union rate when infection was present. Complications included re-operation, readmission, infection, and implant failure. CONCLUSIONS: This large, multicenter study with contemporary implants, instruments, and techniques for exchange nailing tibia nonunions demonstrates a nonunion repair success rate of 75%, consistent with the lower end of reported data in previous literature. No identifiable risk factors for failure of exchange nailing in tibia nonunions were found. LEVEL OF EVIDENCE: Level III Evidence.

PubMed ID

42126445

Volume

146

Comments

See article for full author list.

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License

Recommended Citation

Mastracci, Julia C.; Averkamp, Benjamin; Braswell, Matthew; Yu, Ziqing; Chen, Andrew T.; Natoli, Roman M.; Farooq, Hassan; Mir, Hassan; Rivera, Jessica; Seymour, Rachel B.; Hsu, Joseph R.; and (EMIT), Evidence-Based Musculoskeletal Injury & Trauma Collaborative, "Rates of union and risk factors for continued nonunion following exchange nailing of tibial nonunion" (2026). School of Medicine Faculty Publications. 4694.
https://digitalscholar.lsuhsc.edu/som_facpubs/4694
10.1007/s00402-026-06208-4