Quiescent infected nonunion of a tibia treated by intramedullary reaming with external fixation

21 consecutive adult quiescent infected nonunions of tibiae were prospectively treated by intramedullary reaming with external fixation. The indications for this technique were tibial infected nonunions without acute systemic or local infection manifestations, without large bony defect, and less than 1 cm shortening. The marrow cavity was reamed as widely as possible and a stable external fixation was inserted. 18 cases were followed up for at least one year (range, 1-3 years) and all healed uneventfully. The union rate was 100% (18/18) with a median union period of 5 months (range, 4-7 months). Two cases had flare-up of deep infection which subsided after systemic intravenous antibiotic treatment. One case had valgus deformity of 15°; however the gait was satisfactory. Clinically, all cases had a satisfactory outcome. In conclusion, this simple technique could provide sufficient internal cancellous bone graft and adequate local stability, spare a new harvest wound, and concomitantly avoid internal fixation. Therefore, it might be considered for all indicated cases.