SECONDARY INTERNAL OSTEOSYNTHESIS WITH LOCKING PLATES FOR RECENT OR OLD OPEN FRACTURE OF THE TIBIA, OVERLAPPING PROVISIONAL EXTERNAL FIXATOR PIN SITES: IS THE INFECTION RISK INCREASED?

Twenty-two patients had a severe open fracture of the tibia that was initially treated by external fixation and subsequently by locking plate. The external fixation had been maintained for an average of fifty-nine days (range, 15 to 240 days). The mean interval between removal of the external fixator and plating was twenty-six days (range, 10 to 44 days). five out of twelve patients who had an infection at one or more of the pin sites, developed one superficial and four deep infection. In comparison, only one of the ten patients who had not had a pin-site infection had a superficial infection. An analysis of other variables, including the duration of external fixation, wound coverage, other injuries, and the type of fracture, showed that none was a predictor of infection either at the pin sites or around the plate. We concluded that a pin-site infection that develops during external fixation is a contraindication to the subsequent plating in patients who have a fracture of the tibia.

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