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.