{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T13:36:00Z","timestamp":1786714560773,"version":"build-2736575974"},"reference-count":23,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVES:<\/jats:title>\n                    <jats:p>To quantify deep surgical site infection (SSI) rates after intramedullary nailing of open tibial shaft fractures stratified by Gustilo\u2013Anderson (G-A) classification.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Sources:<\/jats:title>\n                    <jats:p>A systematic review of MEDLINE, Embase, and Scopus screened for English language studies published from January 2000 through May 2025 in accordance with PRISMA guidelines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Selection:<\/jats:title>\n                    <jats:p>Studies included skeletally mature patients with open tibial shaft fractures (OTA\/AO 42) treated with locked intramedullary nailing and reporting deep SSI rates by G-A type.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Extraction:<\/jats:title>\n                    <jats:p>Two independent reviewers screened studies and extracted data, with conflicts resolved through consensus or adjudication by a third independent reviewer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Synthesis:<\/jats:title>\n                    <jats:p>\n                      A single-arm meta-analysis was performed to estimate pooled infection rates using fixed-effects and random-effects models, with between-study heterogeneity assessed using Cochran Q and the\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      statistic.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Seventeen studies composed of 2063 total patients met inclusion criteria. The overall pooled deep SSI rate was 13.2% [95% confidence interval (CI), 11.8%\u201314.8%]. Stratified pooled infection rates were 6.2% (95% CI, 3.7%\u201310.3%) for G-A type I, 7.6% (95% CI, 5.6%\u201310.1%) for type II, 11.9% (95% CI, 9.5%\u201314.6%) for type IIIA, 25.0% (95% CI, 18.6%\u201332.6%) for type IIIB, and 41.8% (95% CI, 21.3%\u201365.5%) for type IIIC fractures. Subgroup analysis demonstrated a significant difference in pooled deep SSI rates across G-A fracture classifications (Q = 104.85, df = 4,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001), indicating substantial heterogeneity attributable to fracture severity. Between-study heterogeneity was low across most analyses, with moderate heterogeneity observed for type IIIB fractures (I\n                      <jats:sup>2<\/jats:sup>\n                      = 50.7%), indicating increased variability in this subgroup.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>Deep SSI rates after intramedullary nailing of open tibial shaft fractures increased with G-A severity. High-grade injuries, particularly G-A types IIIB and IIIC, remain associated with substantial fracture-related infection risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LEVEL OF EVIDENCE:<\/jats:title>\n                    <jats:p>Prognostic, Level III. See Instructions for Authors for a complete description of levels of evidence.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/bot.0000000000003199","type":"journal-article","created":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T16:00:15Z","timestamp":1777392015000},"page":"459-465","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Infection Rate by Gustilo\u2013Anderson Classification in Open Tibial Shaft Fractures Treated With an Intramedullary Nail\u2014A Meta-Analysis"],"prefix":"10.1097","volume":"40","author":[{"given":"Janse T.","family":"Schermerhorn","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD;"},{"name":"Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick J.","family":"McGlone","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD;"},{"name":"Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arissa M.","family":"Torrie","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD;"},{"name":"Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony R.","family":"Carlini","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renan C.","family":"Castillo","sequence":"additional","affiliation":[{"name":"Department of 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NC;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiqiu","family":"Zhang","sequence":"additional","affiliation":[{"name":"Duke-NUS Medical School, Singapore; and"},{"name":"Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tara K.","family":"Mann","sequence":"additional","affiliation":[{"name":"Reselute, Inc, Durham, NC;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cambre","family":"Kelly","sequence":"additional","affiliation":[{"name":"Reselute, Inc, Durham, NC;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert V.","family":"O'Toole","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, 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