Secondary intramedullary nailing of complicated fractures of lower extremities

Between 1984 and 1991, 16 patients with 23 fractures of the lower extremities were treated with external skeletal fixation and subsequent intramedullary nailing. There were 7 closed fractures, 1 closed fracture with vascular injury, 2 Grade I, 3 Grade II and 10 Grade III injuries, sansistiny of 5 Grade IIIA, 2 Grade IIIB and 3 Grade IIIC fractures. The fractures were maintained in external fixation for an average of 14 days (range 4 to 32 days) after which the fixateur was removed and an intramedullary nail placed during the same procedure in all cases. Two of the twenty-three fractures, 9%, subsequently developed deep infections involving the intramedullary canal, both of which resolved with antibiotics while retaining the nail. Thus we were able to place intramedullary fixation in these difficult and often contaminated injuries in less than one month with a relatively low incidence of complications.