DOI: https://doi.org/10.36347/sasjs.2026.v12i05.019

Pages: 435-441

Background: Open tibial fractures are associated with a high risk of nonunion, particularly when prolonged external fixation is employed as the primary stabilization method. The pathophysiology involves a combined mechanical and biological failure at the fracture site, including cortical devascularization, axial instability, and impaired osteogenic stimulation. Methods: We present a series of three patients with aseptic diaphyseal tibial nonunion, all of whom sustained open tibial fractures initially managed with external fixation. Time from initial injury to definitive surgical treatment ranged from 8 to 12 months. All three underwent surgical treatment combining reamed, locked intramedullary nailing with biological stimulation through cortical decortication, medullary preparation, and autologous cancellous bone grafting from the iliac crest. Results: All three patients achieved complete radiological consolidation with satisfactory functional recovery. No postoperative infectious complications were recorded. The outcomes are consistent with published literature reporting union rates of 76–96% with reamed intramedullary nailing for aseptic tibial nonunion. Conclusion: This case series reinforces the efficacy of combined biomechanical and biological treatment in aseptic tibial nonunion following open fracture and prolonged external fixation. Reamed, interlocked intramedullary nailing combined with autologous bone grafting represents the gold-standard approach in this setting.