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Newly Published Peer-Reviewed Case Series on the Apex Tibial Nail

Despite major advances in fracture fixation, delayed healing and nonunion of tibial fractures continue to challenge orthopaedic surgeons worldwide. Tibial shaft fracture nonunions are a common and costly occurrence1 with patients out of work for long periods time, having reduced mobility and in many cases resulting in amputation. In a newly published clinical case series, in the Journal of Orthopaedic Reports, patients who developed a nonunion after primary intramedullary nail treatment were followed up, having received the Apex Tibial Nail with micromotion technology during their revision surgery. This subsequent revision surgery to an Apex micromotion nail with torsional stability, resulted in the fracture healing.

Background

While reamed exchange nailing and augmentative plating remain the standard treatments for tibial nonunion, failure rates persist – particularly in atrophic, non-isthmal, or high-energy injuries2. Traditional rigid fixation limits beneficial axial movement across the fracture site, potentially reducing biological stimulation essential for bone repair. The Apex Nail featuring micromotion technology, introduces a new paradigm, by generating controlled axial micromotion while maintaining high torsional stability through a gliding proximal insert mechanism.

Case Series Overview

This case series discusses three cases of tibial shaft nonunion treated with Apex micromotion intramedullary nails following failed conventional fixation. Patients presented with complex risk profiles including, smoking, and immunosuppression.

All three patients achieved radiographic union (RUST ≥11) and full clinical recovery following revision surgery to the Apex micromotion nail – despite their high-risk profile and persistent nonunion.

Key Findings

Clinical Implications

The findings suggest that surgeons should consider micromotion fixation for the treatment of nonunion fractures. Despite co-morbidities such as smoking and immunosuppression, revision patients experienced successful healing with the Apex axial micromotion nail. All patients in this case series healed, demonstrating the benefits of micromotion for these complex surgeries. The results also agree with recent feedback from surgeons on the OTA Podcast3, with the Apex Tibial Nail their go-to option for tibia shaft primary treatment and nonunion treatment.

Further multicentre studies are underway across the United States to compare micromotion fixation directly against conventional rigid nailing in both acute and chronic tibial and femoral fractures.

References

  1. Dailey HL, Wu KA, Wu P-S, McQueen MM, Court-Brown CM. Tibial fracture nonunion and time to healing following reamed intramedullary nailing: Risk factors based on a single-centre review of 1003 patients. J Orthop Trauma. 2018;32(7):e263-269.
  2. Fu C-X, Gao H, Ren J, Wang H, Lu S-K,Wang G-L, Zhu Z-F, Liu Y-Y, Luo W, Zhang Y, Zhang Y-F. Effectiveness and safety of augmentative plating technique in managing nonunion following intramedullary nailing of long bones in the lower extremity: a systematic review and meta-analysis. Chinese Journal of Traumatology. 2025;28(3):164–174. doi:10.1016/j.cjtee.2024.04.004.
  3. Dailey HL., Campbell S., Saiz A., Industry Session Podcast: Healing in Motion: Innovations in Orthopedic Trauma with Apex Nailing Systems. Sponsored by OrthoXel. The OTA Podcast. Spotify Podcasts; 2025 Sep 18. Accessed December 01, 2025. Available from: https://open.spotify.com/episode/7e4OBOJ6li2X7nDccICULx

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