Distal tibial nonunions with small distal fragments are difficult to treat. The use of a blade plate improves the quality of the fixation in the distal fragment especially if the blade can be inserted in the subchondral bone. Fixation in the distal fragment is the key to achieving a stable construct that allows early motion. In this case stable fixation allowed early motion and maximized outcome.
The implant alone did not solve this problem. Adherence to well established principles of nonunion care must be followed. Rigid biologic fixation and bone grafting provide a stable microenvironment and stimuli that facilitate bone union.