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This paper reports early experiences with the immediate use of the AO unreamed tibial nail, the immediate complications and the 14 months follow-up of 13 patients with Gustilo grades I, II and IIIa open tibial fractures. The nail insertion technique was found to be clear and quickly acquired by the surgeons unfamiliar with it. There were two equipment complications associated with insertion and one early compartment syndrome. Two patients needed a split skin graft and one other patient required hyperbaric oxygen therapy with a split skin graft to bring about impact wound closure. At 14 months two nails had been electively removed. There had been four cases of locking bolt failure leading to metalwork exchange in two cases, metalwork exchange and bone graft in one case and nail removal in one cases. Two patients had undergone bone graft with nail removal or exchange. Five patients had undergone no further bony procedures. Four patients had not achieved bony union. There were no cases of early or late bone or soft-tissue infection. The authors suggest that the unreamed nail principle has a valuable place in the early management of open tibial fractures.
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Accepted: March 24, 1994
© 1994 Published by Elsevier Inc.