{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T06:04:30Z","timestamp":1781071470075,"version":"3.54.1"},"reference-count":15,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T00:00:00Z","timestamp":1780963200000},"content-version":"vor","delay-in-days":159,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Case Reports in Orthopedics"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Open tibial shaft fractures require timely management of both skeletal instability and soft\u2010tissue injury. Temporary external fixation is useful for early stabilization, but prolonged retention without progression to definitive fixation may increase the risk of delayed union and other complications. This case illustrates a patient\u2010driven delay from the preferred staged pathway and subsequent salvage after restoration of mechanical stability and biological support.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A 40\u2010year\u2010old man sustained a Gustilo\u2013Anderson Type II open fracture of the right tibial shaft with an associated fibular fracture following a road traffic accident. He presented approximately 40\u2009min after injury with a clean 2\u2009cm wound over the anteromedial midleg and intact distal neurovascular status. Immediate preoperative radiographs before initial stabilization were unavailable because the case was reviewed retrospectively. After resuscitation and optimization, irrigation, debridement, primary wound closure, drain placement, and monolateral external fixation were performed on November 22, 2024. Serial follow\u2010up radiographs showed maintained alignment but limited progression toward union. Early conversion to intramedullary nailing was advised, but the patient initially declined further surgery for personal and socioeconomic reasons. On February 12, 2025, the external fixator was removed and intramedullary interlocking nailing with autogenous bone grafting was performed as a salvage procedure. Follow\u2010up radiographs showed progressive callus formation and solid union at late follow\u2010up on March 27, 2026. No postoperative wound complication or deep infection occurred.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This case should not be interpreted as supporting delayed conversion as routine practice. Rather, it illustrates a cautionary salvage scenario in which patient\u2010driven delay disrupted the preferred staged pathway, and union was achieved only after definitive restoration of stability and selective biological support.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1155\/cro\/1572775","type":"journal-article","created":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T05:34:02Z","timestamp":1781069642000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Salvage After Patient\u2010Driven Delayed Conversion From External Fixation to Intramedullary Nailing in an Open Tibial Shaft Fracture: A Case Report"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-6232-5288","authenticated-orcid":false,"given":"Md","family":"Sulaiman","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,9]]},"reference":[{"key":"e_1_2_9_1_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-197658040-00004"},{"key":"e_1_2_9_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-198408000-00009"},{"key":"e_1_2_9_3_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-198870060-00015"},{"key":"e_1_2_9_4_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-199072050-00013"},{"key":"e_1_2_9_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/0020-1383(92)90010-P"},{"key":"e_1_2_9_6_2","first-page":"709","article-title":"Secondary Nailing After External Fixation for Tibial Shaft Fracture: Risk Factors for Union and Infection. A 55-Case Series","volume":"101","author":"Roussignol X.","year":"2015","journal-title":"Orthopaedics and Traumatology: Surgery and Research"},{"key":"e_1_2_9_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.otsr.2022.103391"},{"key":"e_1_2_9_8_2","doi-asserted-by":"publisher","DOI":"10.5435\/JAAOS-D-21-00857"},{"key":"e_1_2_9_9_2","first-page":"1231","article-title":"Treatment of Open Fractures of the Tibial Shaft: Ender Nailing Versus External Fixation. A Randomized, Prospective Comparison","volume":"71","author":"Holbrook J. L.","year":"1989","journal-title":"Journal of Bone and Joint Surgery-American"},{"key":"e_1_2_9_10_2","doi-asserted-by":"crossref","first-page":"e292","DOI":"10.1097\/BOT.0000000000002362","article-title":"Unreamed Intramedullary Nailing Versus External Fixation for the Treatment of Open Tibial Shaft Fractures in Uganda: A Randomized Clinical Trial","volume":"36","author":"Kisitu D. K.","year":"2022","journal-title":"Journal of Orthopaedic Trauma"},{"key":"e_1_2_9_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2017.08.040"},{"key":"e_1_2_9_12_2","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0000000000001614"},{"key":"e_1_2_9_13_2","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0000000000000460"},{"key":"e_1_2_9_14_2","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-199505000-00012"},{"key":"e_1_2_9_15_2","doi-asserted-by":"publisher","DOI":"10.3928\/01477447-20081201-27"}],"container-title":["Case Reports in Orthopedics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/cro\/1572775","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1155\/cro\/1572775","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/cro\/1572775","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T05:34:09Z","timestamp":1781069649000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1155\/cro\/1572775"}},"subtitle":[],"editor":[{"given":"Shashank","family":"Kaushik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":15,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1155\/cro\/1572775"],"URL":"https:\/\/doi.org\/10.1155\/cro\/1572775","archive":["Portico"],"relation":{},"ISSN":["2090-6749","2090-6757"],"issn-type":[{"value":"2090-6749","type":"print"},{"value":"2090-6757","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"2026-04-22","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-03","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-09","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"1572775"}}