Abstract
BACKGROUND: Recent research indicates that atrophic nonunions are biologically active and may heal in the optimal biomechanical environment. METHODS: Thirty-three patients with mobile atrophic and oligotrophic tibial nonunions were treated with circular external fixation and functional rehabilitation. Seven patients required autogenous bone graft procedures. RESULTS: Bony union was achieved after the initial surgery in 31/33 (93.9%) tibias. Two persistent nonunions were successfully treated with repeat circular external fixation without bone graft. This resulted in final bony union in 33/33 (100%) patients. CONCLUSION: Mechanobiological stimulation of tibial nonunions can produce union even if the biological activity appears to be low.