Complex Tibial Fractures: Tips and Tricks for Intramedullary Nail Fixation

Abstract

Intramedullary nailing of metaphyseal and segmental tibia fractures can be technically challenging for a variety of reasons. Restoring length, alignment and rotation of the injured limb requires careful preoperative planning and meticulous attention to surgical technique, while avoiding common pitfalls. Understanding the deforming forces on the fracture segments and normal tibial osteology provides a background for recognizing the most common pitfalls when nailing these fractures. Many adjuncts for obtaining and maintaining fracture reduction while nailing have been described, including extended positioning, use of the femoral distractor, blocking screws, and provisional plating. We discuss these techniques as well as the role of intramedullary fixation for treating metaphyseal fractures with articular extension. The purpose of this paper is to describe the background and technique for a variety of operative tips and tricks to facilitate intramedullary nailing of metaphyseal and segmental tibia fractures.

Intramedullary Interlocking Nail in Distal One Third Tibia Fracture: A Retrospective Study in Tertiary Care Center

“…We have used plating in where syndesmotic injury is suspected, otherwise we fixed with Kirschner wire which acts as an intramedullary nail and reduction tool for tibia fracture. Ghithens and bishop suggested that stability which comes with distal multidirectional locking of tibia nail and suggest that fibular fixation in distal tibia fractures may not be necessary unless the ankle mortise is unstable or fibular fixation is being used as a reduction tool [13] .…”

Suprapatellar Nailing of Tibial Fractures - Evaluation of Clinical and Radiological Results

“…Existují i alternativní techniky hřebování z IP přístupu, bez nutnosti použití extenčního stolu. K polohování končetiny a zajištění repozice jsou využívány firemně vyráběné nebo individuálně zhotovené podložky či rámy (11,13,24). Jsou obvykle zhotoveny z rtg transparentního materiálu a zajišťují tak dostatečnou přehlednost oblasti proximální tibie zejména v boční projekci.…”

Suprapatellar intramedullary nailing of the tibia

“…The treatment of choice for extra-articular tibial fractures, regardless of their location (epiphysis, metaphysis, or diaphysis), is fixation and osteosynthesis with intramedullary nails (2) , which are inserted through an infrapatellar portal with the knee in the maximum flexion position (3) . There are two problems with this approach.…”