The role of bone grafting in the treatment of delayed unions and nonunions of the tibia.

From 1972 to 1984, 53 delayed unions or non-unions of the tibia were successfully treated by either posterolateral or local bone grafting techniques. There were 40 initially open fractures, 19 of which became infected nonunions. The average time from injury to surgery was 10.9 months. Clinical union was achieved in 5.6 months in the posterolateral bone graft group and in 5.4 months in the local bone graft group. There were no refractures or amputations and only one patient continued to drain following bony union. The combination of these surgical techniques allows for an approach to bone grafting of the entire tibia and remains the most effective and reliable form of treatment of the tibial delayed union or nonunion.