title: Infection Rate of Intramedullary Nailing in Closed Fractures of the Femoral Diaphysis After Temporizing External Fixation in an Austere Environment.
abstract: OBJECTIVE
  To determine the infection rate of intramedullary (IM) nailing of closed diaphyseal femur fractures after temporary stabilization with external fixation in an austere combat environment.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Iraq and Afghanistan Theater and Military Medical Treatment Centers in the United States and Landstuhl, Germany.
  
  
  METHODS
  Military personnel who underwent temporizing external fixation of a closed diaphyseal femur fracture (OTA 32) with later conversion to an IM nail between 2003 and 2012.
  
  
  METHODS
  Patients were identified from the Joint Theater Trauma Registry and Department of Defense electronic medical record, and a retrospective review was performed.
  
  
  METHODS
  Variables measured included age, gender, mechanism of injury, Injury Severity Score, associated injuries (to include thoracic and abdominal injuries), base deficit, history of massive transfusion, date of injury, date and place of external and IM fixations, time to conversion procedure, report of superficial or deep infection, report of fracture union, and date of last follow-up.
  
  
  RESULTS
  One hundred twenty-two patients, mean age 25 (18-43) years, sustained 125 closed femoral diaphyseal fractures from May 2003 to July 2012. External fixation was performed at a mean of 0.2 days (median of the day of injury) and a range of 0-3 days. Mean time to IM nail conversion procedure was 6.9 (1-20) days. Infection rate was 2.5%, with a P of 0.188. Average follow-up was 41.4 (12-119) months.
  
  
  CONCLUSIONS
  Acceptable low infection rates can be achieved after IM nailing of closed diaphyseal femur fractures treated with initial external fixation in an austere combat environment.
  
  
  METHODS
  Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: *Orthopaedic Surgery Service, Department of Surgery, Madigan Army Medical Center, Tacoma, WA; †Department of Orthopaedics and Rehabilitation, San Antonio Military Medical Center, San Antonio, TX; and ‡G&T Orthopedics and Sports Medicine, Elmhurst, IL.
authors.forename: Joseph W
authors.initials: JW
authors.lastname: Galvin
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Dannenbaum
authors.forename: Creighton C
authors.initials: CC
authors.lastname: Tubb
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Poepping
authors.forename: Jason A
authors.initials: JA
authors.lastname: Grassbaugh
authors.forename: Edward D
authors.initials: ED
authors.lastname: Arrington
mesh_terms: D000293:Adolescent; D000328:Adult; D000346:Afghanistan / Q000453:epidemiology; D017677:Age Distribution; D015984:Causality; D003131:Combined Modality Therapy / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data; D015897:Comorbidity; D018483:Diaphyses / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery; D016267:External Fixators / Q000706:statistics & numerical data*; D005260:Female; D005264:Femoral Fractures / Q000453:epidemiology* / Q000601:surgery*; D005594:Fracture Fixation, Intramedullary / Q000706:statistics & numerical data*; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007493:Iraq / Q000453:epidemiology; D008297:Male; D008889:Military Personnel / Q000706:statistics & numerical data; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000453:epidemiology*; D011859:Radiography; D012307:Risk Factors; D017678:Sex Distribution; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult