{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:37:18Z","timestamp":1792787838045,"version":"4.5.0"},"reference-count":51,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e4tsklinikum Halle (Saale)","id":[{"id":"https:\/\/ror.org\/04fe46645","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Orthop Traumatol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Fracture-related infection (FRI) is a devastating complication of intramedullary nailing of tibial and femoral diaphyseal fractures. The present study evaluates the clinical efficacy of an antibacterially coated intramedullary nail in patients with high-risk tibial and femoral diaphyseal fractures. Open fractures, fractures requiring fasciotomy or closed fractures with Tscherne grade II or III soft-tissue damage were considered fractures at high risk of infection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A single-centre observational study was conducted between January 2022 and December 2024, in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Patients who underwent definitive intramedullary nailing with Bactiguard (Bactiguard AB, Tullinge, Sweden)-coated Natural Nail (Zimmer Biomet, Warsaw, IN, USA) for tibial or femoral diaphyseal fractures at high risk of infection were included. The primary outcome was the incidence of FRI, defined according to the internationally validated consensus criteria. Secondary outcomes included time to union, rates of nonunion, malunion, unplanned secondary procedures and functional outcomes at a minimum follow-up of 12\u00a0months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 103 patients were enrolled: 55 with tibial fractures and 48 with femoral fractures. The combined cohort comprised 90 males and 13 females, with a median age of 40\u00a0years (tibial) and 32.5\u00a0years (femoral). Open fractures accounted for 38.2% and 16.7% of tibial and femoral cases, respectively; the remaining patients presented closed fractures with severe soft-tissue involvement (Tscherne grade II\u2013III). FRI was diagnosed in 6 of 103 patients (5.8%): 4 of 55 in the tibial cohort (7.3%) and 2 of 48 in the femoral cohort (4.2%). All FRI cases were successfully managed without sepsis or limb amputation. Fracture union was achieved in 94.5% of tibial and 95.8% of femoral cases, with mean times to union of 9.8 \u00b1 3.2 and 8.4 \u00b1 2.3\u00a0months, respectively. No malunion was recorded in either cohort. Open reduction was significantly associated with FRI in both the tibial (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.001) and femoral (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.03) cohorts; articular extension of the fracture was associated with FRI in femoral fractures (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.01).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Intramedullary nailing with a Bactiguard-coated implant yielded an overall FRI rate of 5.8% in a consecutive series of 103 high-risk tibial and femoral diaphyseal fractures. Open reduction was identified as a significant independent risk factor for FRI in both cohorts. These findings are hypothesis-generating and support the rationale for prospective, controlled studies to establish the efficacy of biofilm-inhibiting coatings in orthopaedic trauma.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s10195-026-00967-x","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T20:04:27Z","timestamp":1789589067000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Antibiofilm-coated intramedullary nailing for tibial and femoral diaphyseal fractures at high-risk infection: outcomes of 103 consecutive patients"],"prefix":"10.1186","volume":"27","author":[{"given":"Giovanni","family":"Vicenti","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7220-1221","authenticated-orcid":false,"given":"Filippo","family":"Migliorini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Loiodice","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Scarpino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priscilla","family":"D\u2019attis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luise","family":"Sch\u00e4fer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Colasuonno","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Solarino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,16]]},"reference":[{"issue":"1","key":"967_CR1","doi-asserted-by":"publisher","DOI":"10.1186\/s10195-024-00780-4","volume":"25","author":"V Ponkilainen","year":"2024","unstructured":"Ponkilainen V, Nurmi H (2024) Abandoning the use of tension in tibial fracture nailing is associated with lower rate for acute compartment syndrome? J Orthop Traumatol 25(1):42. https:\/\/doi.org\/10.1186\/s10195-024-00780-4","journal-title":"J Orthop Traumatol"},{"issue":"1","key":"967_CR2","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1186\/s10195-024-00749-3","volume":"25","author":"EE Honkonen","year":"2024","unstructured":"Honkonen EE, Repo JP, Lehtokangas H, Luoma E, Uimonen M, Nurmi S, Ylitalo A, Riuttanen A, Kivela T, Mattila VM, Suomalainen P (2024) Suprapatellar tibial fracture nailing is associated with lower rate for acute compartment syndrome and the need for fasciotomy compared with the infrapatellar approach. J Orthop Traumatol 25(1):5. https:\/\/doi.org\/10.1186\/s10195-024-00749-3","journal-title":"J Orthop Traumatol"},{"issue":"1","key":"967_CR3","doi-asserted-by":"publisher","DOI":"10.1186\/s10195-024-00746-6","volume":"25","author":"Group PS","year":"2024","unstructured":"Group PS (2024) Optimizing periprosthetic fracture management and in-hospital outcome: insights from the PIPPAS multicentric study of 1387 cases in Spain. J Orthop Traumatol 25(1):13. https:\/\/doi.org\/10.1186\/s10195-024-00746-6","journal-title":"J Orthop Traumatol"},{"issue":"1","key":"967_CR4","doi-asserted-by":"publisher","DOI":"10.1186\/s10195-025-00856-9","volume":"26","author":"F Muller","year":"2025","unstructured":"Muller F, Zellner M, Bauml C, Proske A, Fuchtmeier B, Wulbrand C (2025) Risk factors for surgical site infection following treatment of proximal femoral fracture: a matched-pair analysis. J Orthop Traumatol 26(1):35. https:\/\/doi.org\/10.1186\/s10195-025-00856-9","journal-title":"J Orthop Traumatol"},{"issue":"1","key":"967_CR5","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1186\/s10195-025-00836-z","volume":"26","author":"S Yang","year":"2025","unstructured":"Yang S, Lian Y, Yang L, Ma S, Ding C, Huang F, Liu Y, Li H, Mutan Z, Zhong H, Chen H (2025) Fibular head osteotomy: a new technique for better exposure of postero-lateral tibial plateau fracture. J Orthop Traumatol 26(1):19. https:\/\/doi.org\/10.1186\/s10195-025-00836-z","journal-title":"J Orthop Traumatol"},{"issue":"1","key":"967_CR6","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1186\/s10195-025-00825-2","volume":"26","author":"Y Li","year":"2025","unstructured":"Li Y, Wang T, Zhang J, Wang Z, Guo J, Zhang Q (2025) Intra-operative blood transfusions raise the risk of postoperative delirium and impede functional recovery in elderly hip fracture patients: a propensity score-matched study. J Orthop Traumatol 26(1):12. https:\/\/doi.org\/10.1186\/s10195-025-00825-2","journal-title":"J Orthop Traumatol"},{"issue":"1","key":"967_CR7","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1186\/s10195-025-00819-0","volume":"26","author":"L Xiao","year":"2025","unstructured":"Xiao L, Tang P, Yang S, Su J, Ma W, Tan H, Zhu Y, Xiao W, Wen T, Li Y, Liu S, Deng Z (2025) Comparing the efficacy of 3D-printing-assisted surgery with traditional surgical treatment of fracture: an umbrella review. J Orthop Traumatol 26(1):3. https:\/\/doi.org\/10.1186\/s10195-025-00819-0","journal-title":"J Orthop Traumatol"},{"issue":"10","key":"967_CR8","doi-asserted-by":"publisher","first-page":"1905","DOI":"10.1016\/j.injury.2018.07.024","volume":"49","author":"PR Oliveira","year":"2018","unstructured":"Oliveira PR, Leonhardt MC, Carvalho VC, Kojima KE, Silva JS, Rossi F, Lima ALL (2018) Incidence and risk factors associated with infection after intramedullary nailing of femoral and tibial diaphyseal fractures: prospective study. Injury 49(10):1905\u20131911. https:\/\/doi.org\/10.1016\/j.injury.2018.07.024","journal-title":"Injury"},{"issue":"1","key":"967_CR9","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1007\/s00402-023-05073-9","volume":"144","author":"LC Marais","year":"2024","unstructured":"Marais LC, Hungerer S, Eckardt H, Zalavras C, Obremskey WT, Ramsden A, McNally MA, Morgenstern M, Metsemakers W-J, Obremskey WT, McNally MA, Atkins BL, Borens O, Depypere M, Egol KA, Fragomen AT, Onsea J, Govaert GAM, Kates SL, Kuehl R, McFadyen I, Fintan Moriarty T, Raschke M, Richards RG, Sancineto C, Senneville E, Trampuz A, Verhofstad MHJ, Zimmerli W, the FRICG (2024) Key aspects of soft tissue management in fracture-related infection: recommendations from an international expert group. Arch Orthop Trauma Surg 144(1):259\u2013268. https:\/\/doi.org\/10.1007\/s00402-023-05073-9","journal-title":"Arch Orthop Trauma Surg"},{"issue":"4","key":"967_CR10","doi-asserted-by":"publisher","first-page":"453","DOI":"10.2106\/00004623-197658040-00004","volume":"58","author":"RB Gustilo","year":"1976","unstructured":"Gustilo RB, Anderson JT (1976) Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am 58(4):453\u2013458","journal-title":"J Bone Joint Surg Am"},{"issue":"3","key":"967_CR11","first-page":"111","volume":"85","author":"H Tscherne","year":"1982","unstructured":"Tscherne H, Oestern HJ (1982) A new classification of soft-tissue damage in open and closed fractures (author\u2019s transl). Unfallheilkunde 85(3):111\u2013115","journal-title":"Unfallheilkunde"},{"issue":"1","key":"967_CR12","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD008241.pub2","volume":"1","author":"X Duan","year":"2012","unstructured":"Duan X, Al-Qwbani M, Zeng Y, Zhang W, Xiang Z (2012) Intramedullary nailing for tibial shaft fractures in adults. Cochrane Database Syst Rev 1(1):CD008241. https:\/\/doi.org\/10.1002\/14651858.CD008241.pub2","journal-title":"Cochrane Database Syst Rev"},{"key":"967_CR13","doi-asserted-by":"publisher","DOI":"10.3390\/life15040540","author":"FL Rodrigues","year":"2025","unstructured":"Rodrigues FL, Ferrari ALM, Faria FF, Pinto RLE, Lopes MF, Santos MEA, Varela EC, Filho MJL, Cecyn MN, Oliveira NHC (2025) Intramedullary nailing in femoral diaphyseal fractures: a retrospective multicenter cohort study. Life. https:\/\/doi.org\/10.3390\/life15040540","journal-title":"Life"},{"issue":"5","key":"967_CR14","doi-asserted-by":"publisher","first-page":"296","DOI":"10.5435\/00124635-200905000-00004","volume":"17","author":"WM Ricci","year":"2009","unstructured":"Ricci WM, Gallagher B, Haidukewych GJ (2009) Intramedullary nailing of femoral shaft fractures: current concepts. J Am Acad Orthop Surg 17(5):296\u2013305. https:\/\/doi.org\/10.5435\/00124635-200905000-00004","journal-title":"J Am Acad Orthop Surg"},{"key":"967_CR15","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1186\/s13037-015-0086-1","volume":"9","author":"BA Zelle","year":"2015","unstructured":"Zelle BA, Boni G (2015) Safe surgical technique: intramedullary nail fixation of tibial shaft fractures. Patient Saf Surg 9:40. https:\/\/doi.org\/10.1186\/s13037-015-0086-1","journal-title":"Patient Saf Surg"},{"issue":"11","key":"967_CR16","doi-asserted-by":"publisher","first-page":"2093","DOI":"10.2106\/00004623-200311000-00005","volume":"85","author":"Canadian Orthopaedic Trauma Society","year":"2003","unstructured":"Canadian Orthopaedic Trauma Society (2003) Nonunion following intramedullary nailing of the femur with and without reaming. J Bone Joint Surg Am 85(11):2093\u20132096","journal-title":"J Bone Joint Surg Am"},{"issue":"29","key":"967_CR17","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000004248","volume":"95","author":"AB Li","year":"2016","unstructured":"Li AB, Zhang WJ, Guo WJ, Wang XH, Jin HM, Zhao YM (2016) Reamed versus unreamed intramedullary nailing for the treatment of femoral fractures: a meta-analysis of prospective randomized controlled trials. Medicine 95(29):e4248. https:\/\/doi.org\/10.1097\/MD.0000000000004248","journal-title":"Medicine"},{"issue":"12","key":"967_CR18","doi-asserted-by":"publisher","first-page":"1686","DOI":"10.1007\/s43465-024-01205-4","volume":"58","author":"F Migliorini","year":"2024","unstructured":"Migliorini F, Schafer L, Simeone F, Vaish A, Bhadani JS, Vaishya R (2024) Management of distal femoral non-union: a systematic review. Indian J Orthop 58(12):1686\u20131723. https:\/\/doi.org\/10.1007\/s43465-024-01205-4","journal-title":"Indian J Orthop"},{"issue":"9","key":"967_CR19","doi-asserted-by":"publisher","first-page":"1085","DOI":"10.1016\/j.injury.2004.09.012","volume":"36","author":"T Noumi","year":"2005","unstructured":"Noumi T, Yokoyama K, Ohtsuka H, Nakamura K, Itoman M (2005) Intramedullary nailing for open fractures of the femoral shaft: evaluation of contributing factors on deep infection and nonunion using multivariate analysis. Injury 36(9):1085\u20131093. https:\/\/doi.org\/10.1016\/j.injury.2004.09.012","journal-title":"Injury"},{"issue":"5","key":"967_CR20","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1016\/j.surge.2018.08.003","volume":"17","author":"H Saleeb","year":"2019","unstructured":"Saleeb H, Tosounidis T, Papakostidis C, Giannoudis PV (2019) Incidence of deep infection, union and malunion for open diaphyseal femoral shaft fractures treated with IM nailing: a systematic review. Surgeon 17(5):257\u2013269. https:\/\/doi.org\/10.1016\/j.surge.2018.08.003","journal-title":"Surgeon"},{"issue":"8","key":"967_CR21","doi-asserted-by":"publisher","first-page":"e326","DOI":"10.1097\/BOT.0000000000002602","volume":"37","author":"IA Castillo","year":"2023","unstructured":"Castillo IA, Heiner JA, Meremikwu RI, Kellam J, Warner SJ (2023) Where are we in 2022? A summary of 11,000 open tibia fractures over 4 decades. J Orthop Trauma 37(8):e326\u2013e334. https:\/\/doi.org\/10.1097\/BOT.0000000000002602","journal-title":"J Orthop Trauma"},{"issue":"7","key":"967_CR22","doi-asserted-by":"publisher","first-page":"e263","DOI":"10.1097\/BOT.0000000000001173","volume":"32","author":"HL Dailey","year":"2018","unstructured":"Dailey HL, Wu KA, Wu PS, McQueen MM, Court-Brown CM (2018) Tibial fracture nonunion and time to healing after reamed intramedullary nailing: risk factors based on a single-center review of 1003 patients. J Orthop Trauma 32(7):e263\u2013e269. https:\/\/doi.org\/10.1097\/BOT.0000000000001173","journal-title":"J Orthop Trauma"},{"issue":"3","key":"967_CR23","doi-asserted-by":"publisher","first-page":"505","DOI":"10.1016\/j.injury.2017.08.040","volume":"49","author":"WJ Metsemakers","year":"2018","unstructured":"Metsemakers WJ, Morgenstern M, McNally MA, Moriarty TF, McFadyen I, Scarborough M, Athanasou NA, Ochsner PE, Kuehl R, Raschke M, Borens O, Xie Z, Velkes S, Hungerer S, Kates SL, Zalavras C, Giannoudis PV, Richards RG, Verhofstad MHJ (2018) Fracture-related infection: a consensus on definition from an international expert group. Injury 49(3):505\u2013510. https:\/\/doi.org\/10.1016\/j.injury.2017.08.040","journal-title":"Injury"},{"issue":"8","key":"967_CR24","doi-asserted-by":"publisher","first-page":"1013","DOI":"10.1007\/s00402-019-03287-4","volume":"140","author":"WJ Metsemakers","year":"2020","unstructured":"Metsemakers WJ, Morgenstern M, Senneville E, Borens O, Govaert GAM, Onsea J, Depypere M, Richards RG, Trampuz A, Verhofstad MHJ, Kates SL, Raschke M, McNally MA, Obremskey WT, Fracture-Related Infection group (2020) General treatment principles for fracture-related infection: recommendations from an international expert group. Arch Orthop Trauma Surg 140(8):1013\u20131027. https:\/\/doi.org\/10.1007\/s00402-019-03287-4","journal-title":"Arch Orthop Trauma Surg"},{"issue":"1","key":"967_CR25","doi-asserted-by":"publisher","DOI":"10.1186\/s40001-021-00593-9","volume":"26","author":"F Migliorini","year":"2021","unstructured":"Migliorini F, La Padula G, Torsiello E, Spiezia F, Oliva F, Maffulli N (2021) Strategies for large bone defect reconstruction after trauma, infections or tumour excision: a comprehensive review of the literature. Eur J Med Res 26(1):118. https:\/\/doi.org\/10.1186\/s40001-021-00593-9","journal-title":"Eur J Med Res"},{"key":"967_CR26","doi-asserted-by":"publisher","DOI":"10.1155\/2023\/4839701","author":"SY He","year":"2023","unstructured":"He SY, Yu B, Jiang N (2023) Current concepts of fracture-related infection. Int J Clin Pract. https:\/\/doi.org\/10.1155\/2023\/4839701","journal-title":"Int J Clin Pract"},{"issue":"3","key":"967_CR27","doi-asserted-by":"publisher","first-page":"511","DOI":"10.1016\/j.injury.2016.09.019","volume":"49","author":"WJ Metsemakers","year":"2018","unstructured":"Metsemakers WJ, Kuehl R, Moriarty TF, Richards RG, Verhofstad MHJ, Borens O, Kates S, Morgenstern M (2018) Infection after fracture fixation: current surgical and microbiological concepts. Injury 49(3):511\u2013522. https:\/\/doi.org\/10.1016\/j.injury.2016.09.019","journal-title":"Injury"},{"issue":"1","key":"967_CR28","doi-asserted-by":"publisher","DOI":"10.1186\/s10195-025-00892-5","volume":"26","author":"F Migliorini","year":"2025","unstructured":"Migliorini F, Rivera F, Eschweiler J (2025) Editorial: bacteriophage therapy in orthopedics \u2013 key questions and emerging answers. J Orthop Traumatol 26(1):70. https:\/\/doi.org\/10.1186\/s10195-025-00892-5","journal-title":"J Orthop Traumatol"},{"issue":"4","key":"967_CR29","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1016\/j.jclinepi.2007.11.008","volume":"61","author":"E von Elm","year":"2008","unstructured":"von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP, Initiative S (2008) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 61(4):344\u2013349. https:\/\/doi.org\/10.1016\/j.jclinepi.2007.11.008","journal-title":"J Clin Epidemiol"},{"issue":"3","key":"967_CR30","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1097\/00005373-197403000-00001","volume":"14","author":"SP Baker","year":"1974","unstructured":"Baker SP, O\u2019Neill B, Haddon W Jr, Long WB (1974) The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 14(3):187\u2013196","journal-title":"J Trauma"},{"issue":"2","key":"967_CR31","doi-asserted-by":"publisher","first-page":"174","DOI":"10.1016\/j.injury.2019.12.034","volume":"51","author":"British Orthopaedic Association Trauma Committee and others","year":"2020","unstructured":"British Orthopaedic Association Trauma Committee and others (2020) British orthopaedic association standard for trauma (BOAST): open fracture management. Injury 51(2):174\u2013177. https:\/\/doi.org\/10.1016\/j.injury.2019.12.034","journal-title":"Injury"},{"issue":"4","key":"967_CR32","doi-asserted-by":"publisher","first-page":"136","DOI":"10.1302\/2058-5241.3.170018","volume":"3","author":"DA Flevas","year":"2018","unstructured":"Flevas DA, Megaloikonomos PD, Dimopoulos L, Mitsiokapa E, Koulouvaris P, Mavrogenis AF (2018) Thromboembolism prophylaxis in orthopaedics: an update. EFORT Open Rev 3(4):136\u2013148. https:\/\/doi.org\/10.1302\/2058-5241.3.170018","journal-title":"EFORT Open Rev"},{"issue":"11","key":"967_CR33","doi-asserted-by":"publisher","first-page":"516","DOI":"10.1097\/BOT.0000000000000390","volume":"29","author":"J Litrenta","year":"2015","unstructured":"Litrenta J, Tornetta P 3rd, Mehta S, Jones C, O\u2019Toole RV, Bhandari M, Kottmeier S, Ostrum R, Egol K, Ricci W, Schemitsch E, Horwitz D (2015) Determination of radiographic healing: an assessment of consistency using RUST and modified RUST in metadiaphyseal fractures. J Orthop Trauma 29(11):516\u2013520. https:\/\/doi.org\/10.1097\/BOT.0000000000000390","journal-title":"J Orthop Trauma"},{"issue":"3","key":"967_CR34","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1097\/TA.0b013e3181a7c16d","volume":"68","author":"DB Whelan","year":"2010","unstructured":"Whelan DB, Bhandari M, Stephen D, Kreder H, McKee MD, Zdero R, Schemitsch EH (2010) Development of the radiographic union score for tibial fractures for the assessment of tibial fracture healing after intramedullary fixation. J Trauma 68(3):629\u2013632. https:\/\/doi.org\/10.1097\/TA.0b013e3181a7c16d","journal-title":"J Trauma"},{"issue":"10","key":"967_CR35","doi-asserted-by":"publisher","first-page":"796","DOI":"10.1302\/2633-1462.210.BJO-2021-0071.R1","volume":"2","author":"Y Plumarom","year":"2021","unstructured":"Plumarom Y, Wilkinson BG, Willey MC, An Q, Marsh L, Karam MD (2021) Sensitivity and specificity of modified RUST score using clinical and radiographic findings as a gold standard. Bone Jt Open 2(10):796\u2013805. https:\/\/doi.org\/10.1302\/2633-1462.210.BJO-2021-0071.R1","journal-title":"Bone Jt Open"},{"issue":"6","key":"967_CR36","doi-asserted-by":"publisher","first-page":"1867","DOI":"10.1016\/j.injury.2022.03.024","volume":"53","author":"J Onsea","year":"2022","unstructured":"Onsea J, Van Lieshout EM, Zalavras C, Sliepen J, Depypere M, Noppe N, Ferguson J, Verhofstad MH, Govaert GA, IJpma FF, McNally MA (2022) Validation of the diagnostic criteria of the consensus definition of fracture-related infection. Injury 53(6):1867\u20131879. https:\/\/doi.org\/10.1016\/j.injury.2022.03.024","journal-title":"Injury"},{"issue":"2","key":"967_CR37","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2025.112943","volume":"57","author":"A Schiefer","year":"2026","unstructured":"Schiefer A, Renz N, Steiner G, Mardian S, Stockle U, Trampuz A, Meller S (2026) Infection after intramedullary nailing for femur and tibia fractures \u2013 characteristics and outcome analysis. Injury 57(2):112943. https:\/\/doi.org\/10.1016\/j.injury.2025.112943","journal-title":"Injury"},{"key":"967_CR38","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare12131306","author":"G Vicenti","year":"2024","unstructured":"Vicenti G, Buono C, Albano F, Ladogana T, Pesare E, Colasuonno G, Passarelli AC, Solarino G (2024) Early management for fracture-related infection: a literature review. Healthcare. https:\/\/doi.org\/10.3390\/healthcare12131306","journal-title":"Healthcare"},{"issue":"Suppl 6","key":"967_CR39","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2024.111902","volume":"55","author":"N Walter","year":"2024","unstructured":"Walter N, Bartl S, Alt V, Rupp M (2024) Recent advancements and future directions in fracture related infections: a scoping review. Injury 55(Suppl 6):111902. https:\/\/doi.org\/10.1016\/j.injury.2024.111902","journal-title":"Injury"},{"key":"967_CR40","doi-asserted-by":"publisher","DOI":"10.3390\/medsci14010009","author":"F Migliorini","year":"2025","unstructured":"Migliorini F, Schafer L, Vaishya R, Eschweiler J, Oliva F, Driessen A, Pipino G, Maffulli N (2025) Bacteriophages in hip and knee periprosthetic joint infections: a promising tool in the era of antibiotic resistance. Med Sci. https:\/\/doi.org\/10.3390\/medsci14010009","journal-title":"Med Sci"},{"issue":"Suppl 6","key":"967_CR41","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2023.110857","volume":"54","author":"JS Vargas-Hernandez","year":"2023","unstructured":"Vargas-Hernandez JS, Sanchez CA, Renza S, Leal JA (2023) Effectiveness of antibiotic-coated intramedullary nails for open tibia fracture infection prevention. A systematic review and meta-analysis. Injury 54(Suppl 6):110857. https:\/\/doi.org\/10.1016\/j.injury.2023.110857","journal-title":"Injury"},{"key":"967_CR42","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.OA.25.00183","author":"NK Kanakaris","year":"2025","unstructured":"Kanakaris NK, Giannoudis VP, Strain RG, Giannoudis PV (2025) Tibial fractures at high risk of infection treated with intramedullary nailing: do nails with antibacterial coatings make a difference? JBJS Open Access. https:\/\/doi.org\/10.2106\/JBJS.OA.25.00183","journal-title":"JBJS Open Access"},{"issue":"11S","key":"967_CR43","doi-asserted-by":"publisher","first-page":"S12","DOI":"10.1097\/BOT.0000000000002688","volume":"37","author":"G Kotsarinis","year":"2023","unstructured":"Kotsarinis G, Wakefield SM, Kanakaris NK, Giannoudis PV (2023) Stabilization of tibial fractures at risk of complications with the Bactiguard intramedullary nail: early to medium results with a novel metal-coated device. J Orthop Trauma 37(11S):S12\u2013S17. https:\/\/doi.org\/10.1097\/BOT.0000000000002688","journal-title":"J Orthop Trauma"},{"issue":"1","key":"967_CR44","doi-asserted-by":"publisher","first-page":"86","DOI":"10.1007\/s00068-025-02763-4","volume":"51","author":"SK Rai","year":"2025","unstructured":"Rai SK, Gupta TP, Kashid M, Sirohi B, Kale A, Sharma R, Gandotra A (2025) Does a gentamicin-coated intramedullary nail prevent postoperative infection in Gustilo type I and II tibial open fractures? A comparative study and retrospective analysis. Eur J Trauma Emerg Surg 51(1):86. https:\/\/doi.org\/10.1007\/s00068-025-02763-4","journal-title":"Eur J Trauma Emerg Surg"},{"key":"967_CR45","doi-asserted-by":"publisher","first-page":"555","DOI":"10.2340\/17453674.2025.43477","volume":"96","author":"JL Van Agtmaal","year":"2025","unstructured":"Van Agtmaal JL, Verheul M, Vonken L, Helsen K, Vargas Guerrero MG, Van Hoogstraten SWG, Hurck BJ, Pilla G, Trinh I, De Bruijn GJ, Calum HP, De Boer MGJ, Pijls BG, Arts JJC (2025) Antimicrobial resistance in orthopedics: microbial insights, clinical impact, and the necessity of a multidisciplinary approach \u2013 a review. Acta Orthop 96:555\u2013568. https:\/\/doi.org\/10.2340\/17453674.2025.43477","journal-title":"Acta Orthop"},{"issue":"1","key":"967_CR46","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1007\/s00590-025-04282-9","volume":"35","author":"D Gonzalez-Morgado","year":"2025","unstructured":"Gonzalez-Morgado D, Fabado-Tortajada P, Nomdedeu J, Teixidor-Serra J, Tomas-Hernandez J, Joshi-Jubert N, Minguell-Monyart J, Andres-Peiro JV (2025) External fixation to intramedullary nailing for femoral and tibial fractures: an eleven-year cohort study at a level I trauma center. Eur J Orthop Surg Traumatol 35(1):219. https:\/\/doi.org\/10.1007\/s00590-025-04282-9","journal-title":"Eur J Orthop Surg Traumatol"},{"key":"967_CR47","doi-asserted-by":"publisher","first-page":"219","DOI":"10.2174\/1874325001307010219","volume":"7","author":"KG Makridis","year":"2013","unstructured":"Makridis KG, Tosounidis T, Giannoudis PV (2013) Management of infection after intramedullary nailing of long bone fractures: treatment protocols and outcomes. Open Orthop J 7:219\u2013226. https:\/\/doi.org\/10.2174\/1874325001307010219","journal-title":"Open Orthop J"},{"issue":"5","key":"967_CR48","doi-asserted-by":"publisher","first-page":"317","DOI":"10.1097\/00005131-200605000-00004","volume":"20","author":"P Tang","year":"2006","unstructured":"Tang P, Gates C, Hawes J, Vogt M, Prayson MJ (2006) Does open reduction increase the chance of infection during intramedullary nailing of closed tibial shaft fractures? J Orthop Trauma 20(5):317\u2013322. https:\/\/doi.org\/10.1097\/00005131-200605000-00004","journal-title":"J Orthop Trauma"},{"issue":"4","key":"967_CR49","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1097\/BOT.0000000000000777","volume":"31","author":"DA Auston","year":"2017","unstructured":"Auston DA, Meiss J, Serrano R, Sellers T, Carlson G, Hoggard T, Beebe M, Quade J, Watson D, Simpson RB, Kistler B, Shah A, Sanders R, Mir HR (2017) Percutaneous or open reduction of closed tibial shaft fractures during intramedullary nailing does not increase wound complications, infection or nonunion rates. J Orthop Trauma 31(4):215\u2013219. https:\/\/doi.org\/10.1097\/BOT.0000000000000777","journal-title":"J Orthop Trauma"},{"key":"967_CR50","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcot.2023.102256","volume":"44","author":"PD Korytkowski","year":"2023","unstructured":"Korytkowski PD, Panzone JM, Aldahamsheh O, Mubarak Alkhayarin M, Omar Almohamad H, Alhammoud A (2023) Open and closed reduction methods for intramedullary nailing of femoral shaft fractures: a systematic review and meta-analysis of comparative studies. J Clin Orthop Trauma 44:102256. https:\/\/doi.org\/10.1016\/j.jcot.2023.102256","journal-title":"J Clin Orthop Trauma"},{"issue":"2","key":"967_CR51","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1007\/s00113-018-0570-z","volume":"122","author":"C Michelitsch","year":"2019","unstructured":"Michelitsch C, Sommer C (2019) Reduction techniques for osteosynthesis of intra-articular fractures. Unfallchirurg 122(2):110\u2013119. https:\/\/doi.org\/10.1007\/s00113-018-0570-z","journal-title":"Unfallchirurg"}],"container-title":["Journal of Orthopaedics and Traumatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s10195-026-00967-x","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s10195-026-00967-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s10195-026-00967-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T11:38:16Z","timestamp":1789645096000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s10195-026-00967-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,16]]},"references-count":51,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["967"],"URL":"https:\/\/doi.org\/10.1186\/s10195-026-00967-x","relation":{},"ISSN":["1590-9999"],"issn-type":[{"value":"1590-9999","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,16]]},"assertion":[{"value":"29 March 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 August 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 September 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This study was approved and registered by the Ethics Committee of the University Hospital of Bari, Italy (712, 22\/05\/2023) and was conducted in accordance with the principles of the Declaration of Helsinki and its later amendments. Written informed consent for the use of clinical and imaging data for research purposes was obtained from all patients.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"50"}}