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We observed significantly increased tibial aperture size and shape after transtibial femoral drilling with a medial tibial starting point. Medial tibial tunnels, compared with more central tunnels, resulted in a more acute tibial tunnel in the coronal plane and less acute tibial tunnels relative to the sagittal plane. Medial tibial tunnels started farther from the tibial tubercle but ended farther from the medial joint line and closer to the anterior edge of the tibia in comparison to central tunnels Clinical Relevance Femoral tunnel placements may be best accomplished using a technique other than transtibial drilling through a medial tibial tunnel. Tibial tunnel angle, intra-articular position, and femoral tunnel placement are affected by the choice of extra-articular starting position.

In the following case, a 20-year-old male was involved in a motorcycle accident where he sustained an open midshaft femur fracture treated with open reduction and internal fixation. Several weeks later, the wound became infected and the plate was removed. Over the following 20 years numerous incision and debridements were performed, with multiple courses of antibiotics for persisting infection. One year following reaming with the reamer-irrigator-aspirator (RIA), the patient is symptom free. It is our belief that organisms were sequestered in the fibrous and bony tissue at the healed fracture site, and, by opening the canal and allowing it to revascularize, the infection was cleared.

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