title: External fixation and delayed intramedullary nailing of open fractures of the tibial shaft. A sequential protocol.
abstract: Between 1983 and 1989, forty-one open fractures of the tibial shaft were treated with débridement and provisional external fixation, followed by delayed soft-tissue closure and subsequent intramedullary nailing with reaming. The average duration of external fixation was seventeen days (range, six to fifty-two days). The average time between removal of the fixator and intramedullary nailing was nine days (range, zero to twenty-four days). Of thirty-nine patients who had adequate follow-up, two (5 per cent) subsequently had a deep infection. Both infections healed, with retention of the nail and without chronic osteomyelitis. There were two nonunions and one delayed union. Satisfactory alignment was achieved in thirty-seven patients (95 per cent). This sequential protocol for treatment, which involved a short period of external fixation and thus minimized colonization of the pin tracks, yielded excellent results and a low rate of infection.
authors.affiliation: Department of Orthopaedics, University of British Columbia, Vancouver General Hospital, Canada.
authors.forename: P A
authors.initials: PA
authors.lastname: Blachut
authors.forename: R N
authors.initials: RN
authors.lastname: Meek
authors.forename: P J
authors.initials: PJ
authors.lastname: O'Brien
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001858:Bone Nails; D005260:Female; D005592:Fracture Fixation / Q000379:methods*; D005594:Fracture Fixation, Intramedullary / Q000379:methods; D005597:Fractures, Open / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011859:Radiography; D013530:Surgical Wound Infection; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D013997:Time Factors; D014945:Wound Healing