Infection after reamed intramedullary nailing of the tibia: a case series review

OBJECTIVE: We reviewed those patients who developed a postoperative infection after reamed intramedullary nailing of tibial shaft fractures to investigate the possible causes of infection, its effect on union time, and the requirement for reconstructive surgery. DESIGN: Retrospective review of patients who developed deep infection after reamed tibial nailing during a 15-year period. SETTING: University Level II Trauma Center. PATIENTS: Thirty-five with tibial diaphyseal fractures. INTERVENTION: All patients were treated with reamed intramedullary nailing. OUTCOME MEASURES: Union, union time, compartment syndrome, requirement for reconstructive procedures, and development of deep infection. RESULTS: In the closed-fracture group, 43.8% of patients were considered to have developed infection because of inappropriate fasciotomy closure, exchange nailing, and thermal necrosis. In the open-fracture group, 62.5% were considered to have developed infection attributable to late complications of plastic surgery. The most significant problem was marginal necrosis after flap cover. CONCLUSIONS: A number of deep infections after reamed intramedullary tibial nailing are avoidable. Particular attention must be paid to correct reaming, exchange nailing, and fasciotomy closure in closed fractures. In open fractures, marginal flap necrosis should be actively treated and not left to granulate.