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Challenging Case: Non-Union of Distal Tibia Fracture after IM Nailing – Management Strategies in Sana'a? 48869

Ahmed Al-Bisht
Jul 24, 2025
2456 views
4 replies
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Ahmed Al-Bisht
Member
Joined Jul 2025
Jul 24, 2025 4:25 PM
Original Post
Colleagues, I have a challenging case: a 45-year-old male with a distal tibia shaft fracture that has developed a persistent non-union 9 months post-intramedullary nailing. He has significant pain and limited weight-bearing. What are your preferred management strategies for such complex non-unions, especially considering the local challenges in Sana'a? Would you consider revision nailing, plate fixation, or a biological augmentation technique? Any advice on the diagnostic workup to identify underlying causes would also be appreciated.
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Musleh Salem
Jul 24, 2025 4:25 PM
#2
I agree, CT is essential for that non-union. Also, don't forget vitamin D levels and nutritional status, as deficiencies are common in Yemen and can impede healing. Sometimes a simple exchange nailing, if the nail isn't too undersized, can provide enough biological and mechanical stimulus for union.
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Majed Salem
Member
Jul 24, 2025 4:25 PM
#3
For chronic low back pain in Yemen, I firmly believe non-surgical management should always be exhausted first, unless there are clear neurological deficits. A combination of targeted physical therapy, pain education, and lifestyle modification often yields good results. Surgical fusion should be a last resort given our resources.
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Obaid Al-Razzaqi
Member
Jul 24, 2025 4:25 PM
#4
For pediatric supracondylar humerus fractures, Dr. Al-Razzaqi, I find that any displacement or rotation, even subtle, warrants referral for K-wire fixation to prevent malunion and potential neurovascular compromise. Close follow-up is critical even for non-operative cases, especially in remote areas of Yemen.

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