Primary external fixation and secondary intramedullary nailing in the treatment of tibial fractures.

The results of primary external fixation and secondary intramedullary nailing of 21 tibial fractures are presented. It is shown that if secondary nailing is delayed until after granulation of the pin sites the technique is associated with a low infection rate. The union time for tibial fractures compares well with that of external fixation, although in closed and Gustilo type I open fractures primary intramedullary nailing gives superior results.