Intramedullary nailing of femoral and tibial shaft fractures

secondary infection.5 Neurologic problems such as paralysis slow ambulation, an aid to healing.Psychiatric diseases may result in decreased patient compliance.6 Social factors also affect outcome.Use of tobacco slows fracture healing.7,8 Addictions to alcohol and street drugs impair patient compliance and increase the risk of complications.Poor family support also may limit patient compliance and the ability to participate in physical therapy or comply with weight-bearing restrictions.Nonsteroidal antiinflammatory medications have been shown to delay bone healing.Ibuprofen blocks the bone healing process, which does not recover after stopping the medication.9 We currently are evaluating a classification of patients' "host status" as a predictor of the outcome of complicated fractures.Host status categories include three levels, designated "A," "B," and "C." Host status "A" indicates no negative findings."B" status indicates at least one medical or social factor negatively affecting outcome, such as smoking, bipolar disease, or incarceration."C" host status indicates more than one negative factor.An example of a "C" host is a patient with bipolar disease who smokes or has hepatitis C.This determination may help when choosing the proper therapy for complicated fractures (Table 1).We believe that "A" host patients who are medically stable should have the most definitive fixation regardless of the situation."B" hosts are more prone to problems and may require more attention to avoid complications."C" hosts are the most complication prone and tend to have wound and fixation problems.This is especially true with regard to leg and ankle injuries.We tend to avoid extensive lower extremity surgery in these patients.Percutaneously locked intramedullary nail fixation is a good option in this difficult patient group.The initial evaluation of the patient is essential for appropriate planning of fixation with intramedullary nails.In accordance with the Advanced Trauma Life