{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T09:55:32Z","timestamp":1790934932801,"version":"4.1.0"},"reference-count":24,"publisher":"Bioscientifica","issue":"10","license":[{"start":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T00:00:00Z","timestamp":1790899200000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["journals.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,10,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Intramedullary nailing remains the preferred definitive fixation for most open tibial shaft fractures once contamination is controlled and soft tissues permit internal implantation. External fixation should be chosen according to intent: damage control, preservation of orthoplastic access, staged bridge to internal fixation, or definitive frame-based reconstruction. Temporary frames are most useful in polytrauma, vascular injury, severe swelling, gross contamination, and wounds needing serial debridement, flap planning, or negative-pressure therapy. Conversion to intramedullary nailing is appropriate only when margins are declared, coverage is complete or reliably scheduled, contamination is controlled, and fracture-related infection (FRI) is not suspected. Definitive circular or hybrid fixation is favored when repeated excision, vascular repair, segmental bone loss, bone transport, uncertain margins, or suspected\/established FRI makes buried metal less attractive. Successful frame treatment requires safe pin placement outside flap and implant corridors, restoration of length, axis, and rotation without distraction, timely soft-tissue coverage, and standardized infection and pin-site pathways.<\/jats:p>","DOI":"10.1530\/eor-2026-0107","type":"journal-article","created":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T09:14:04Z","timestamp":1790932444000},"page":"1159-1165","update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-16","source":"Crossref","is-referenced-by-count":0,"title":["External fixation in severe open tibial shaft fractures: indications, orthoplastic strategy, and infection-aware decision-making"],"prefix":"10.1530","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2754-8423","authenticated-orcid":true,"given":"Sabri","family":"El Banna","sequence":"first","affiliation":[{"name":"Centre Hospitalier Universitaire de Charleroi (HUMANI) 1 , ,","place":["Charleroi, Belgium"]},{"name":"Faculty of Medicine, Universit\u00e9 libre de Bruxelles 2 , ,","place":["Brussels, Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","published-online":{"date-parts":[[2026,10,1]]},"reference":[{"key":"2026100205135787500_bib1","volume-title":"BOAST 4: Open Fractures","author":"British Orthopaedic Association","year":"2017"},{"key":"2026100205135787500_bib2","volume-title":"Standards for The Management of Open Fractures","year":"2020","edition":"S Eccles, B Han"},{"key":"2026100205135787500_bib3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/BOT.0000000000000262","article-title":"Type III open tibia fractures: immediate antibiotic prophylaxis minimizes infection","volume":"29","author":"Lack","year":"2015","journal-title":"J Orthop Trauma"},{"key":"2026100205135787500_bib4","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1016\/j.injury.2017.08.040","article-title":"Fracture-related infection: a consensus on definition from an international expert group","volume":"49","author":"Metsemakers","year":"2018","journal-title":"Injury"},{"key":"2026100205135787500_bib5","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1097\/BOT.0000000000001614","article-title":"Diagnosing fracture-related infection: current concepts and recommendations","volume":"34","author":"Govaert","year":"2020","journal-title":"J Orthop Trauma"},{"key":"2026100205135787500_bib6","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1007\/s00402-019-03287-4","article-title":"General treatment principles for fracture-related infection: recommendations from an international expert group","volume":"140","author":"Metsemakers","year":"2020","journal-title":"Arch Orthop Trauma Surg"},{"key":"2026100205135787500_bib7","doi-asserted-by":"crossref","first-page":"867","DOI":"10.1186\/s13018-024-05350-2","article-title":"Risk of infection and conversion time from external to definitive fixation in open tibial fracture","volume":"19","author":"Aljuhani","year":"2024","journal-title":"J Orthop Surg Res"},{"key":"2026100205135787500_bib8","doi-asserted-by":"crossref","first-page":"650","DOI":"10.1302\/0301-620X.67B4.4030869","article-title":"The influence of induced micromovement upon the healing of experimental tibial fractures","volume":"67","author":"Goodship","year":"1985","journal-title":"J Bone Joint Surg Br"},{"key":"2026100205135787500_bib9","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1097\/00003086-198901000-00038","article-title":"The tension-stress effect on the genesis and growth of tissues: part I. 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