title: The role of intramedullary nailing in treatment of open fractures.
abstract: The management of open fractures remains one of the greatest challenges to orthopedic trauma surgeons. Damage to the soft tissue envelope together with periosteal stripping are the most important factors making open fractures prone to complications such as nonunion and infection. Urgent and thorough soft tissue debridement, proper surgical fracture stabilization as well as the administration of intravenous and local antibiotics as adjunctive therapy are mandatory to reduce the risk of infection. Intramedullary nail osteosynthesis has become an accepted treatment method of open long bone fractures. Especially at sites of sparse soft tissue coverage like the proximal and distal tibia, early intramedullary stabilization proved advantageous for its superior biomechanical stability, the chance of early soft tissue reconstruction, shorter healing times, and quicker rehabilitation. However, due to a potential risk of deep infection, especially when a reamed technique is applied, nailing of open fractures remains contentious. In this review, we focus on the current evidence of nail osteosynthesis in open fractures and delineate its value with respect to other possible treatment options.
authors.affiliation: Department of Orthopedics and Traumatology, University Medical Centre, Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany, hofmann.trauma-surgery@gmx.net.
authors.forename: A
authors.initials: A
authors.lastname: Hofmann
authors.forename: S-O
authors.initials: SO
authors.lastname: Dietz
authors.forename: P
authors.initials: P
authors.lastname: Pairon
authors.forename: P M
authors.initials: PM
authors.lastname: Rommens
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001858:Bone Nails; D003646:Debridement / Q000379:methods*; D005594:Fracture Fixation, Intramedullary; D017102:Fracture Healing; D005597:Fractures, Open / Q000150:complications / Q000473:pathology / Q000601:surgery*; D006801:Humans; D017410:Practice Guidelines as Topic; D017695:Soft Tissue Injuries / Q000150:complications / Q000473:pathology / Q000601:surgery*; D013530:Surgical Wound Infection / Q000473:pathology / Q000517:prevention & control*; D013978:Tibial Fractures / Q000150:complications / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents