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Intramedullary nailing of tibial shaft fractures


Locked intramedullary nailing is currently considered the treatment of choice for most tibial shaft fractures and is especially useful for segmental and bilateral tibial fractures.

Fracture table

  • If a fracture table is used, place a calcaneal traction pin before positioning. Place the patient supine with the hip flexed 45 degrees and the knee flexed 90 degrees ( Fig. 25.1 ).

    Figure 25.1, Patient positioning for intramedullary nailing of tibial shaft fractures .

  • Place a well-padded crossbar proximal to the popliteal fossa to support the thigh in the flexed position. Adequate padding should reduce the risk of compression neuropathy.

  • Attach the calcaneal pin to the traction apparatus on the fracture table, apply traction, and reduce the fracture under fluoroscopic guidance.

  • To decrease the risk of traction injury to neurologic structures, release the traction after the ability to reduce the fracture has been confirmed.

  • Prepare and drape the limb allowing full exposure of the knee to above the patella and enough access to the distal tibia for locking screw placement. Reapply traction after the entry portal is made.

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