title: Sequential intramedullary nailing of open tibial shaft fractures after external fixation.
abstract: We reviewed 32 tibial shaft fractures in 31 patients treated with sequential intramedullary nailing after primary external fixation. There were 30 open fractures and 2 closed injuries with severe blunt trauma requiring fasciotomy. Fifty per cent of the fractures were classified as Gustilo type III A and B injuries. The mean external fixation treatment averaged 6.6 weeks, and secondary intramedullary nailing was done on average 7.4 weeks after injury. In 50% of the fractures, secondary nailing was done at the same procedure as removal of the external fixation. Overall, the incidence of osteomyelitis and non-union was 3.1% each and of malunion 19%. The time to full weight-bearing averaged 31.2 weeks. The results were separately analyzed according to Gustilo types and subtypes. In the Gustilo type III B injuries, the incidence of osteomyelitis and non-union was 11%, while malunion occurred in 33%. The time to full weight-bearing averaged 53 weeks. These results support the conclusion that this treatment modality is a valid alternative to other treatment options. However, previous pintract infections should be regarded as a contraindication for secondary nailing.
authors.affiliation: Department of Orthopaedic Surgery, Inselspital, University of Bern, Switzerland.
authors.forename: K A
authors.initials: KA
authors.lastname: Siebenrock
authors.forename: T
authors.initials: T
authors.lastname: Gerich
authors.forename: R P
authors.initials: RP
authors.lastname: Jakob
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005592:Fracture Fixation; D005594:Fracture Fixation, Intramedullary; D005596:Fractures, Closed / Q000601:surgery; D005597:Fractures, Open / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D010019:Osteomyelitis / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D013978:Tibial Fractures / Q000601:surgery*; D013997:Time Factors