We present a case of 35 years old man presented with aseptic distal tibial nonunion without bone defect. Previous unsuccessful surgical attempt, consisting on revision of the internal fixation and iliac crest bone grafting, was performed. After studying the different treatment options, we suggested him to carry out an endomedular nail stabilization of the nonunion site in combination with a descending genicular corticoperiosteal free flap to provide osteogenetic enhancement, as described by Sakai. Discussion: The treatment protocol of the distal tibial nonunion still remains controversial. When other surgical attempts are unsuccessful, the combination of endomedular nailing and descending genicular corticoperiosteal free flap, may be useful. This surgical technique may require a coordinated work between orthopaedic and plastic surgeons.

We present a case of 35 years old man presented with aseptic distal tibial nonunion without bone defect. Previous unsuccessful surgical attempt, consisting on revision of the internal fixation and iliac crest bone grafting, was performed. After studying the different treatment options, we suggested him to carry out an endomedular nail stabilization of the nonunion site in combination with a descending genicular corticoperiosteal free flap to provide osteogenetic enhancement, as described by Sakai. Discussion: The treatment protocol of the distal tibial nonunion still remains controversial. When other surgical attempts are unsuccessful, the combination of endomedular nailing and descending genicular corticoperiosteal free flap, may be useful. This surgical technique may require a coordinated work between orthopaedic and plastic surgeons.