title: Intramedullary nailing following external fixation in femoral and tibial shaft fractures.
abstract: BACKGROUND
  Intramedullary nailing is the standard of care for the definitive management of lower extremity long bone fractures. Occasionally, temporary external fixation is used in fractures with severe open wounds or vascular injury before definitive intramedullary nailing. Secondary intramedullary nailing following external fixation is somewhat controversial, especially with respect to the duration of external fixation that is allowable before the risk of infection following later nailing becomes too great. Several recent studies have provided further insight into this issue.
  
  
  OBJECTIVE
  The primary objective is to evaluate infection and nonunion rates in patients treated with temporary external fixation and secondary intramedullary nailing for lower extremity long bone fractures. The secondary objective is to evaluate whether the duration of external fixation and the interval time (defined as the time from external fixator removal to intramedullary nailing) influence the risk of infection after intramedullary nailing.
authors.affiliation: Division of Orthopaedic Surgery, Hamilton Health Sciences-General Hospital, 237 Barton Street East. Hamilton, Ontario L8L 2X2, Canada. bhandam@mcmaster.ca
authors.forename: Mohit
authors.initials: M
authors.lastname: Bhandari
authors.forename: Michael
authors.initials: M
authors.lastname: Zlowodzki
authors.forename: Paul
authors.initials: P
authors.lastname: Tornetta
authors.forename: Andrew
authors.initials: A
authors.lastname: Schmidt
authors.forename: David C
authors.initials: DC
authors.lastname: Templeman
mesh_terms: D016267:External Fixators; D005264:Femoral Fractures / Q000601:surgery*; D005592:Fracture Fixation; D005594:Fracture Fixation, Intramedullary; D006801:Humans; D013978:Tibial Fractures / Q000601:surgery*