Delayed union and nonunion of the tibia: experience in a community teaching hospital.

Delayed union and nonunion are frequent sequelae of high-energy tibial fractures, particularly compound ones. The authors studied 45 such cases; of these, 20 fractures were compound. The authors analysed the initial management but found no apparent correlation between the initial management of these fractures and subsequent delayed union or nonunion. The Phemister bone-grafting technique was used to achieve union and was considered a safe, efficacious method. Aggressive initial management of the soft-tissue component of tibial fractures is recommended to minimize the possible development of chronic osteomyelitis, a serious complication that occurred in eight patients and necessitated below-knee amputation in three.