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.