{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T23:14:37Z","timestamp":1789686877996,"version":"4.0.1"},"reference-count":37,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T00:00:00Z","timestamp":1748304000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T00:00:00Z","timestamp":1748304000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100011104","name":"Universitat Aut\u00f2noma de Barcelona","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100011104","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Orthop Surg Traumatol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      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 (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt; 0.01). This difference was not observed in the tibia. The average time of EF was 12.6 \u00b1\u20097.8 days. PTI occurred in seven cases (5.9%), on average 14.9 \u00b1\u200910.9 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 (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009= 0.03). FRI was more frequent in patients with prior PTI than in those without (57.1% vs. 4.5%, respectively;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt; 0.01).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00590-025-04282-9","type":"journal-article","created":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T00:01:30Z","timestamp":1748304090000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["External fixation to intramedullary nailing for femoral and tibial fractures: an eleven-year cohort study at a level I trauma center"],"prefix":"10.1007","volume":"35","author":[{"given":"Diego","family":"Gonz\u00e1lez-Morgado","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula","family":"Fabado-Tortajada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josep","family":"Nomded\u00e9u","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordi","family":"Teixidor-Serra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordi","family":"Tom\u00e0s-Hern\u00e1ndez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nayana","family":"Joshi-Jubert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joan","family":"Minguell-Monyart","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 Vicente","family":"Andr\u00e9s-Peir\u00f3","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,5,27]]},"reference":[{"key":"4282_CR1","doi-asserted-by":"publisher","first-page":"1355","DOI":"10.1007\/s00264-021-04973-y","volume":"45","author":"A Bekos","year":"2021","unstructured":"Bekos A, Sioutis S, Kostroglou A et al (2021) The history of intramedullary nailing. 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