Twenty-four patients had a severe open fracture of the tibia that was
initially treated by external fixation and subsequently by reamed
intramedullary nailing. The external fixation had been maintained for an
average of fifty-two days (range, seven to 230 days). The mean interval
between removal of the external fixator and intramedullary nailing was
sixty-five days (range, three to 360 days). In five of the seven patients
who had had an infection at one or more of the pin sites, an infection
later developed around the intramedullary nail. In comparison, only one of
the seventeen patients who had not had a pin-site infection had an
infection later around the nail (p = 0.003). An analysis of other
variables, including the duration of external fixation, wound coverage,
other injuries, and the type of fracture, showed that none was a predictor
of infection either at the pin sites or around the intramedullary nail. We
concluded that a pin-site infection that develops during external fixation
is a contraindication to the subsequent use of reamed intramedullary
nailing in patients who have a fracture of the tibia.