Whiting PS, et al. - Using an international online database, researchers conducted this prospective cohort study to determine the infection rate after fixation of open tibial shaft fractures using the Surgical Implant Generation Network (SIGN) intramedullary nail in low- and middle-income countries (LMICs) and to identify risk factors for infection. Between March 2000 and February 2013, a total of 1061 open tibia fractures treated with the SIGN nail in LMICs were included. The rate of infection of distal fractures was higher than that of midshaft fractures. Findings suggested that open tibia fractures can be effectively managed in LMICs with an overall infection rate of 11.9% using the SIGN intramedullary nail. The identified risk factors for infection include severe injury to the soft tissue, delayed nailing, delayed closure of the wound and distal fracture location. Findings suggested no association of infection rates with time from injury to initial debridement, time from injury to initial antibiotic administration, or the total duration of antibiotics.