title: Intramedullary nailing after external fixation of the femur and tibia: a review of advantages and limits.
abstract: OBJECTIVE
  External fixation is a safe option for stabilisation of extremity lesions in the polytraumatised patient as well as in fractures with severe soft tissue damage. Nevertheless, long-term-complications are to be expected when external fixation is chosen as a definitive treatment. The purpose of this review article is twofold: primarily, to define the rationale of a procedural change from an external fixator to an intramedullary nail; secondarily, to assess the possible advantages and pitfalls of a single- or two-staged procedure.
  
  
  CONCLUSIONS
  External fixation of the femur is recommended in multiply injured patients who are critically ill to avoid an additional inflammatory response caused by the surgical trauma of primary nailing. The conversion towards nailing must be done as soon as the clinical condition of the patient has been stabilised. Stable polytraumatised patients do not benefit from initial stabilisation with an external fixator and should immediately be treated with a definitive osteosynthesis. In tibial fractures, external fixation followed by intramedullary nailing is recommendable in fractures with severe soft tissue injuries. Conversion should be done as soon as the soft tissues allow before pin-tract infections occur and performed in a one-staged procedure.
authors.affiliation: Department of Orthopaedics and Traumatology, University Medical Center of the Johannes Gutenberg-University, Langenbeckstrasse 1, 55131, Mainz, Germany, philip.pairon@unimedizin-mainz.de.
authors.forename: P
authors.initials: P
authors.lastname: Pairon
authors.forename: C
authors.initials: C
authors.lastname: Ossendorf
authors.forename: S
authors.initials: S
authors.lastname: Kuhn
authors.forename: A
authors.initials: A
authors.lastname: Hofmann
authors.forename: P M
authors.initials: PM
authors.lastname: Rommens
mesh_terms: D016267:External Fixators; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005594:Fracture Fixation, Intramedullary; D017102:Fracture Healing; D006801:Humans; D009104:Multiple Trauma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000382:microbiology / Q000473:pathology / Q000601:surgery*; D011859:Radiography; D017695:Soft Tissue Injuries / Q000150:complications / Q000473:pathology / Q000601:surgery*; D013530:Surgical Wound Infection / Q000382:microbiology / Q000473:pathology / Q000517:prevention & control*; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*