NAILING OF OPEN FRACTURES

The goal of treatment of open fractures is to prevent infection, promo te fracture healing, and restore normal limb alignment and function. T he initial treatment of these fractures includes: debridement, soft ti ssue coverage, antibiotic therapy, and fracture stabilization. Four di fferent techniques for intramedullary nailing for the fixation of open fractures have been employed: (1) unreamed, unlocked nails (i. e., En der and Lottes, which have low infection rates, but are mechanically i nsufficient); (2) reamed unlocked nailing (which relies on overreaming to provide stability through bone-nail surface contact, but is associ ated with high infection rates); (3) reamed locked nailing (which may rely on limited reaming because of the interlocking screws); and (4) u nreamed nailing (which always relies on interlocking screws and is ass ociated with function better than and infection rates similar to those with external fixation, but has an increased incidence of screw break age). In contrast to the biological problems in the tibia, those probl ems encountered in the femur are more predominantly mechanical in orig in. For humeral shaft fractures, shoulder problems associated with the antegrade approach are frequent, and bypassing the rotator cuff with a retrograde approach appears advantageous.