External fixation to intramedullary nailing for femoral and tibial fractures : an eleven-year cohort study at a level I trauma center
González-Morgado, Diego (Hospital Universitari Vall d'Hebron)
Fabado-Tortajada, Paula (Hospital Universitari Vall d'Hebron)
Nomdedéu Sancho, Josep (Universitat Autònoma de Barcelona. Departament de Cirurgia)
Teixidor Serra, Jordi (Hospital Universitari Vall d'Hebron)
Tomas-Hernandez, Jordi (Hospital Universitari Vall d'Hebron)
Joshi Jubert, Nayana (Hospital Universitari Vall d'Hebron)
Minguell-Monyart, Joan (Hospital Universitari Vall d'Hebron)
Andrés Peiró, José Vicente (Hospital Universitari Vall d'Hebron)

Date:	2025
Abstract:	Purpose: To identify factors that contribute to the incidence of postoperative complications following staged treatment of femoral and tibial fractures with external fixation (EF) and intramedullary nailing (IMN). Methods: This retrospective cohort study involved patients with tibial and/or femoral fractures temporarily immobilized using EF, followed by IMN. Patient characteristics, types of injury, treatments, and outcomes were recorded. Primary outcomes were pin tract infection (PTI) and fracture-related infection (FRI). Results: The study had 103 patients involving 119 fractures: 73 tibial (61. 3%) and 46 femoral (38. 7%). Of these, 44. 5% were open. 31. 1% of the EFs were implanted by an orthopedic trauma (OT) specialist. In femoral fractures, OT specialists placed the pins a mean 78. 2 mm from the fracture site, versus just 37. 3 mm by non-OT surgeons (p < 0. 01). This difference was not observed in the tibia. The average time of EF was 12. 6 ± 7. 8 days. PTI occurred in seven cases (5. 9%), on average 14. 9 ± 10. 9 days after EF placement. FRI occurred in nine patients (7. 6%): two in the femur (4. 5%) and seven in the tibia (10. 6%). All FRIs occurred in cases where the EF had been implanted by a surgeon without specialization in OT (p = 0. 03). FRI was more frequent in patients with prior PTI than in those without (57. 1% vs. 4. 5%, respectively; p < 0. 01). Conclusion: PTI was a risk factor for FRI after IMN of tibial and femoral fractures. Surgeon specialization in OT was a protective factor against FRI, probably related to pin placement further from the fracture site.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Intramedullary nailing ; External fixation ; Femur fracture ; Tibia fracture ; Pin tract infection ; Fracture-related infection
Published in:	European journal of orthopaedic surgery & traumatology, Vol. 35 Núm. 1 (december 2025) , p. 219, ISSN 1432-1068

DOI: 10.1007/s00590-025-04282-9
PMID: 40423840

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