External fixation and delayed intramedullary nailing of open fractures of

---

the tibial shaft. A sequential protocol. Blachut-PA; Meek-RN; O'Brien-PJ J-Bone-Joint-Surg-Am. 1990 Jun; 72(5): 729-35 Between 1983 and 1989, forty-one open fractures of the tibial shaft were treated with debridement and provisional external fixation, followed by delayed soft-tissue closure and subsequent intramedullary nailing with reaming. The average duration of external fixation was seventeen days (range, six to fifty-two days). The average time between removal of the fixator and intramedullary nailing was nine days (range, zero to twenty-four days). Of thirty-nine patients who had adequate follow-up, two (5 per cent) subsequently had a deep infection. Both infections healed, with retention of the nail and without chronic osteomyelitis. There were two nonunions and one delayed union. Satisfactory alignment was achieved in thirty-seven patients (95 per cent). This sequential protocol for treatment, which involved a short period of external fixation and thus minimized colonization of the pin tracks, yielded excellent results and a low rate of infection.