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Review Question - QID 8255

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QID 8255 (Type "8255" in App Search)
A 32-year-old man who is a smoker sustained an open tibial fracture and underwent a staged treatment with placement of an intramedullary nail. Four weeks after surgery, he developed a pseudomonas deep-wound infection. What is the strongest predictor of persistent infection if implants are retained until fracture union?