Abstract
Nonunions are a vexing problem for the orthopedic surgeon. Herein, we describe an adjunct to the standard exchange nailing procedure adapted from an established limb lengthening technique in which cortical vents are drilled adjacent to the nonunion site. These transcortical drill tunnels facilitate local dispersion of the osteogenic intramedullary reamings around the nonunion site during the exchange nailing, whereby the extruded reamings serve as autograft for the nonunion. This simple adjunctive technique can increase the likelihood of achieving union when performed with an exchange nailing procedure as demonstrated by our case series of recalcitrant tibia and femoral nonunions successfully treated when this surgical adjunct was implemented.