Bulletin (Hospital for Joint Diseases (New York, N.Y.))
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Review Case Reports
Intramedullary nailing after external fixation of the tibia.
Intramedullary nailing after external fixation of fractures of the tibia has high complication rates including nonunion and infection. The authors review the literature regarding this technique and refine the indications for secondary IM nailing. The report distinguishes between sequential secondary nailing and reconstructive secondary nailing. ⋯ The authors conclude that when done by protocol sequential IM nailing is safe and effective. Reconstructive IM nailing, however, has strict contraindications that include: a history of or an active infection of the pin tract, wound, or bone; the presence of an open wound or pin tract; and the presence of a ring or halo sequestrum. Yet reconstructive secondary procedures can be effective in healthy individuals if the soft tissue envelope is completely reestablished, if antibiotics are administered preoperatively, and the nail is placed without reaming.