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J. Albert Key, M.D.
JAMA. 1955;158(12):1001-1003. doi:10.1001/jama.1955.02960120001001.
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American surgeons have now had sufficient experience with medullary fixation to permit them to accept this method as a valuable addition to our armamentarium in the treatment of fractures of long bones. However, the introduction of a suitable nail may require an operative exposure of the fracture site, and this converts a simple fracture into a compound one with its attendant danger of infection and of nonunion. Furthermore, the danger of infection seems to be greater after medullary nailing than after most other clean surgical operations. Consequently, the method should not be used routinely and fractures that can be treated satisfactorily by closed reduction and external fixation, or by traction, should be so treated. The frequency with which medullary fixation is used will and should vary directly with the surgeon's interest and skill in the use of the method and indirectly with his ability to treat fractures by more conservative


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