{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T16:55:23Z","timestamp":1755795323835,"version":"3.44.0"},"reference-count":26,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Trauma Surg Acute Care Open"],"accepted":{"date-parts":[[2016,8,17]]},"published-print":{"date-parts":[[2016,9]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The optimal method of skeletal stabilization is still controversial. Therefore, we examined the clinical outcomes associated with late (L) versus immediate intramedullary nailing (IMN).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This was a retrospective comparative study of trauma registry data from an emergency medical care center (university hospital). We examined 85 open tibial shaft fractures (85 patients) treated with L or immediate (I) IMN from January 2004 to December 2010. The L and I groups comprised 37 (33 men, 4 women) and 48 (44 men, 4 women) patients, respectively. The postoperative infection rate, time to bone union, and delayed union\/non-union were evaluated.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The mean ages at the time of trauma in the L and I groups were 41.8 (18\u201379) and 42.0 (18\u201371) years, respectively; the mean follow-up periods were 15.0 (6\u201339) and 18.3 (8\u201336) months, respectively. A higher rate of postoperative infection was found in the L group than in the I group (p=0.004). Superficial\/deep infection developed at a higher rate in the L group than in the I group (p=0.042 and 0.045, respectively). Among patients with Gustilo grade IIIA fractures, postoperative infection occurred at a higher rate in the L group than in the I group (p=0.008). However, the delayed union rate, non-union rate, and time to bone union were not significantly different between the groups.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Gustilo grade IIIA fractures had a high infection rate, which is likely due to various factors, including pin-site infection after external fixation. We think that I IMN is safer than L IMN, and it should be the treatment of choice.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Level of evidence<\/jats:title>\n                  <jats:p>Retrospective comparative study, level III.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/tsaco-2016-000035","type":"journal-article","created":{"date-parts":[[2016,9,8]],"date-time":"2016-09-08T10:20:18Z","timestamp":1473330018000},"page":"e000035","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Retrospective comparison of postoperative infection and bone union between late and immediate intramedullary nailing of Gustilo grades I, II, and IIIA open tibial shaft fractures"],"prefix":"10.1136","volume":"1","author":[{"given":"Yoshiyasu","family":"Uchiyama","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Surgical Science, Tokai University School of Medicine, Kanagawa, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuka","family":"Kobayashi","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Surgical Science, Tokai University School of Medicine, Kanagawa, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gro","family":"Ebihara","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Surgical Science, Tokai University School of Medicine, Kanagawa, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kosuke","family":"Hamahashi","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Surgical Science, Tokai University School of Medicine, Kanagawa, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masahiko","family":"Watanabe","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Surgical Science, Tokai University School of Medicine, Kanagawa, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2016,9,6]]},"reference":[{"key":"2025081711050515000_1.1.e000035.1","doi-asserted-by":"crossref","first-page":"453","DOI":"10.2106\/00004623-197658040-00004","article-title":"Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses","volume":"58","author":"Gustilo","year":"1976","journal-title":"J Bone Joint Surg Am"},{"key":"2025081711050515000_1.1.e000035.2","doi-asserted-by":"crossref","unstructured":"Nicoll EA . 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