[Secondary locked nailing of the leg after external fixation. 25 cases]

Twenty-five tibial shaft fractures were treated by primary Hoffman external fixation and secondary locked nailing with reaming. The indications were: aseptic non union (12 cases) and the original plan of treatment (13 cases) (early delayed nailing). The septic risk factors were the initial opening of the fracture site (19 sites) and, in all cases, the pin-tracts with, in 5 cases, an intolerance to pins marked by a drainage or an osteolysis. Union was achieved in the 25 cases in an average time of 3.3 months. The restoration of alignment was anatomic in 19 cases. The risk of infection was confirmed with the onset of 4 deep infections which occurred each time when risk factors existed: prolonged bone exposure and intolerance to pins. Infection was treated by a selected antibiotherapy with the nail kept in place and union was obtained primarily: secondary removal of the nail was necessary in 2 cases to obtain drying up. The risk of infection after secondary nailing has thus been confirmed but its frequency and severity didn't appear excessive when compared to the advantages of locked intramedullary nailing.