title: Infection after reamed intramedullary nailing of the tibia: a case series review.
abstract: OBJECTIVE
  We reviewed those patients who developed a postoperative infection after reamed intramedullary nailing of tibial shaft fractures to investigate the possible causes of infection, its effect on union time, and the requirement for reconstructive surgery.
  
  
  METHODS
  Retrospective review of patients who developed deep infection after reamed tibial nailing during a 15-year period.
  
  
  METHODS
  University Level II Trauma Center.
  
  
  METHODS
  Thirty-five with tibial diaphyseal fractures.
  
  
  METHODS
  All patients were treated with reamed intramedullary nailing.
  
  
  METHODS
  Union, union time, compartment syndrome, requirement for reconstructive procedures, and development of deep infection.
  
  
  RESULTS
  In the closed-fracture group, 43.8% of patients were considered to have developed infection because of inappropriate fasciotomy closure, exchange nailing, and thermal necrosis. In the open-fracture group, 62.5% were considered to have developed infection attributable to late complications of plastic surgery. The most significant problem was marginal necrosis after flap cover.
  
  
  CONCLUSIONS
  A number of deep infections after reamed intramedullary tibial nailing are avoidable. Particular attention must be paid to correct reaming, exchange nailing, and fasciotomy closure in closed fractures. In open fractures, marginal flap necrosis should be actively treated and not left to granulate.
authors.affiliation: Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.
authors.forename: Brad
authors.initials: B
authors.lastname: Petrisor
authors.forename: Stuart
authors.initials: S
authors.lastname: Anderson
authors.forename: Charles M
authors.initials: CM
authors.lastname: Court-Brown
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018483:Diaphyses / Q000293:injuries; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects*; D017102:Fracture Healing; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000209:etiology* / Q000628:therapy; D013977:Tibia / Q000293:injuries*; D016896:Treatment Outcome