Summary: Proximal tibia shaft fractures are often challenging to manage because of their intrinsic tendency toward valgus and apex anterior deformity. In recent years, intramedullary nailing (IMN) has become more frequently used to treat these injuries, allowing for biologic advantages such as load-sharing, immediate weight-bearing, and avoidance of disruption of periosteal blood supply. Several adjunctive techniques, such as semiextended positioning, blocking screws, and external fixation, have been developed to assist with fracture reduction during IMN. We describe a new adjunctive reduction technique—tensioned wire–assisted IMN—for the treatment of proximal tibia shaft fractures. We have found that tensioned wire assistance facilitates fracture reduction during IMN, does not interfere with intraoperative image intensification, and is compatible with both standard nailing instrumentation and additional adjunctive techniques. We present tensioned wire nailing as a technical trick for anatomic and stable reduction of proximal tibia fractures and compare a cohort of proximal tibia shaft fractures managed with and without tensioned wire assistance.

A 51-year-old right-hand dominant man was evaluated for an enlarging, painless left wrist mass of 2 months duration. The patient reported no recent injury or antecedent trauma and denied any local neurologic symptoms, fevers, chills, or changes in weight.Physical examination revealed a nontender, 3 9 2-cm firm, mobile mass overlying the volar aspect of the left distal ulna. There was no rash or other identifiable overlying skin changes, and the lesion did not transilluminate. The patient had normal strength and ROM, and sensation to light touch was intact in all three nerve distributions. There was a negative Tinel's sign and the mass was nonpulsatile with a normal vascular examination.AP and lateral views of the left wrist ( Fig. 1) and MRI of the wrist (Fig. 2) were obtained.