Fibulectomy with exchange intramedullary nailing. A, Anteroposterior radiograph of a nonunion 64 months after tibial fracture and 26 months after exchange nailing. Distal interlocking screws are broken, and fibula has significant bowing (arrow). B, Axial loading was sufficient to break the screws. The bowed fibula may have provided a distraction force similar to force a bowed pole provides to lift a pole vaulter, which may have contributed to failure of the fracture to heal. C, Six months after exchange nailing and partial fibulectomy the patient had a solid bony union. Arrows indicate that partial fibulectomy removed the distraction force, allowing compression across the construct.