Safe surgical technique: intramedullary nail fixation of tibial shaft fractures

Abstract

Statically locked, reamed intramedullary nailing remains the standard treatment for displaced tibial shaft fractures. Establishing an appropriate starting point is a crucial part of the surgical procedure. Recently, suprapatellar nailing in the semi-extended position has been suggested as a safe and effective surgical technique. Numerous reduction techiques are available to achieve an anatomic fracture alignment and the treating surgeon should be familiar with these maneuvers. Open reduction techniques should be considered if anatomic fracture alignment cannot be achieved by closed means. Favorable union rates above 90 % can be achieved by both reamed and unreamed intramedullary nailing. Despite favorable union rates, patients continue to have functional long-term impairments. In particular, anterior knee pain remains a common complaint following intramedullary tibial nailing. Malrotation remains a commonly reported complication after tibial nailing. The effect of postoperative tibial malalignment on the clinical and radiographic outcome requires further investigation.

Suprapatellar versus infrapatellar approaches in the treatment of tibia intramedullary nailing: A retrospective cohort study

“…[8], and later modified to a suprapatellar (SP) approach using a midline quadriceps tendon insertion site by Cole et al [9]. This new approach suggests that valgus and procurvatum malalignment has been more easily avoided when the knee is maintained in extension and allows for easier anteroposterior and lateral imaging of the tibia [10,11]. However, the main concern of this approach is the potential for damage to the patellofemoral articulation with a concurrent effect on anterior knee pain after intramedullary nail fixation and patellofemoral arthritis [12].…”

Minimally Invasive Treatment for Tibial Malrotation after Locked Intramedullary Nailing

“…The surgical implant offers biomechanical fracture stabilization and acts as a load-sharing device, allowing early postoperative mobilization [2]. Some reports, however, have described complications associated with the procedure [3, 4].…”

Suprapatellar approach for fractures of the tibia: Does the fracture level matter?

“…Surgical treatment of tibial fractures via intramedullary nailing (IMN) is a common practice. [1,[3][4][5] Intramedullary nailing is a biomechanical load-sharing device that has the potential advantages of early rehabilitation and weight bearing. [1,3,5] Intramedullary nailing also possesses other major benefits such as minimal soft tissue damage and preservation of extraosseous blood supply.…”

“…[1,[3][4][5] Intramedullary nailing is a biomechanical load-sharing device that has the potential advantages of early rehabilitation and weight bearing. [1,3,5] Intramedullary nailing also possesses other major benefits such as minimal soft tissue damage and preservation of extraosseous blood supply. [6,7] Recently, several techniques have been described for IMN of the tibia, including the medial parapatellar, lateral parapatellar, and transpatellar routes.…”

“…[4,7,9,10,13] In the hyperflexed position, sagittal dislocating forces caused by the quadriceps tendon on the proximal part of the tibia can lead to malreduction in apex anterior angulation. [3,7,8,10,14,15] Additional tools, such as plates, external fixators, and blocking screws might be required to avoid malalignment after IMN. To overcome these drawbacks, the semiextended nailing technique, using a medial parapatellar entry route after lateral subluxation of patella, was described by Tornetta and Collins.…”