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- See:
     - External fixators for tibia frx
     - IM nails for tibial frx

- Indications for Fixator Exchange (for IM nail): (factors for successful exchange:)
     - absence of pin tract infections;
     - short duration of external fixator;
          - it is unclear whether the interval between application of the fixator and the exchange nailing is a factor in postop infection as long as a superficial pin site infection is not present;
     - debridement of pin sites upon fixator removal;

- Pearls:
    - some surgeons will allow a week to pass between external fixator removal and IM nailing, in order to allow epithelialization of the pin sites to occur;
            - Respet, et al noted that about 3 weeks are required to ensure that pin track infections are completely healed (before IM nailing is considered);
            - ref: Pin track infections: a canine model.

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- references:

Delayed intramedullary nailing after failed external fixation of the tibia.

Infection after intramedullary nailing of severe open tibial fractures initially treated with external fixation.

External fixation and delayed intramedullary nailing of open fractures of the tibial shaft. A sequential protocol.

Treatment of open tibial-shaft fractures. External fixation and secondary intramedullary nailing.

External fixation and secondary intramedullary nailing of open tibial fractures. A randomised, prospective trial.

Comparison of reamed and nonreamed solid core nailing of the tibial diaphysis after external fixation: a preliminary report.

Complicated open fractures of the distal tibia treated by secondary interlocking nailing.

Treatment of complex tibial shaft fractures. Arguments for early secondary intramedullary nailing.