Treatment of open tibial shaft fractures by delayed closed intramedullary nailing

Forty-seven open tibial fractures in 43 patients were internally fixed by delayed closed nailing after reaming the medullary canal. The procedure was usually undertaken after complete healing of the wound. Early mobilization was encouraged in all cases. In 37 patients (86%) the fractures were caused by road traffic accidents; 21 patients (49%) had other skeletal and soft tissue injuries. All fractures united with a mean of 19 weeks, but five had delayed union. Most patients had a full range of knee and ankle movements. No infection was encountered in the series.