Challenging Case: Non-Union of Distal Tibia Fracture after IM Nailing – Management Strategies in Sana'a? e446b

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.