Outcomes of Intramedullary Fibular Strut Grafting Combined With Locking Plate Fixation for Aseptic Distal Tibial Nonunion

Background:Aseptic distal-third tibial diaphyseal nonunion after failed intramedullary nailing remains challenging because of inadequate distal fixation and mechanical instability.This study evaluated revision surgery using an intramedullary nonvascularized autologous fibular strut graft combined with an anterolateral locking plate. Material/Methods:This retrospective case series included patients who underwent revision surgery for aseptic distal-third tibial diaphyseal nonunion between January 2020 and December 2024.Inclusion criteria were symptomatic nonunion after primary intramedullary nailing, a Radiographic Union Scale for Tibial fractures (RUST) score of 10 or lower, and a minimum postoperative follow-up of 9 months.Patients with infection, pathological fractures, or incomplete follow-up were excluded.Revision consisted of debridement, intramedullary placement of a nonvascularized autologous fibular strut graft, and anterolateral locking plate fixation.The primary outcome was fracture union based on clinical and radiographic criteria. Results:Eleven patients (9 men, 2 women; mean age, 50.9 years) were included.Four had atrophic and 7 had hypertrophic nonunion.Mean follow-up was 16 months (range, 9-27 months).Union was achieved in 10 patients (90.9%).The only failure occurred in a patient with atrophic nonunion, with no evidence of union after 11 months.No microbiological evidence of infection was detected during follow-up. Conclusions:This revision technique achieved a high union rate in patients with aseptic distal-third tibial diaphyseal nonunion after failed intramedullary nailing.It may be particularly useful when exchange nailing alone is unlikely to provide adequate distal stability.Larger comparative studies are warranted.