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Eighteen patients with proximal tibial shaft non-union and shortening were treated. In each patient, the non-union area was débrided, realigned and stabilised with an Ilizarov lengthening frame. The tibia was gradually lengthened by 1-1.5 mm per day. After achieving the desired length, external fixation was converted to an angled blade plate and packed with cancellous bone graft. Follow-up of 16 patients for a median of 2.4 (1.2-4.5) years revealed satisfactory outcomes in all. No wound infections were noted. The described technique has a high success rate, a short treatment course and reduces patient discomfort. This method may be considered preferential treatment for all patients with the specified indications.

We followed 12 patients with nailed femoral shaft fractures in which breakage of the static locked nail occurred during fracture treatment. Only two fractures united. The remaining ten fractures had to be treated with exchange nailing after a median of 10 (4-14) months. Nine fractures healed after a median of 5 (4-7) months and one was lost to follow-up. Although breakage of a proximal static reamed femoral locked nail may imitate the effect of dynamisation, the success rate is low. Early exchange nailing is a more successful option to achieve fracture union.