Young-Soo Byun; Dong-Ju Shin

doi:10.12671/jkfs.2009.22.3.197

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Intramedullary Nailing of Proximal Tibial Fractures: Young-Soo Byun, Dong-Ju Shin, M.D.; Journal of the Korean Fracture Society 2009;22(3):197-205.
DOI: https://doi.org/10.12671/jkfs.2009.22.3.197
Published online: July 31, 2009

Department of Orthopedic Surgery, Daegu Fatima Hospital, Daegu, Korea.

Address reprint requests to: Dong-Ju Shin, M.D. Department of Orthopedic Surgery, Daegu Fatima Hospital, 576-31, Sinam-dong, Dong-gu, Daegu 701-600, Korea. Tel: 82-53-940-7320, Fax: 82-53-954-7417, fatimaos@unitel.co.kr

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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REFERENCES

REFERENCES

1. Benirschke SK, Henley MB, Ott JW. Proximal onethird tibial fracture solution. Orthop Trans, 1994;18:1055-1056.
2. Bolhofner BR. Indirect reduction and composite fixation of extraarticular proximal tibial fractures. Clin Orthop Relat Res, 1995;315:75-83.Article
3. Bono CM, Levine RG, Rao JP, Bebrens FF. Nonarticular proximal tibia fractures: treatment options and decision making. J Am Acad Orthop Surg, 2001;9:176-186.Article
4. Buehler KC, Green J, Woll TS, Duwelius PJ. A technique for intramedullary nailing of proximal third tibia fractures. J Orthop Trauma, 1997;11:218-223.Article
5. Cannada LK, Anglen JO, Archdeacon MT, Herscovici D Jr, Ostrum RF. Avoiding complications in the care of fractures of the tibia. Instr Course Lect, 2009;58:27-36.
6. Freedman EL, Johnson EE. Radiographic analysis of tibial fracture malalignment following intramedullary nailing. Clin Orthop, 1995;315:25-33.Article
7. Gerber A, Ganz R. Combined internal and external osteosynthesis. A biological approach to the treatment of complex fractures of the proximal tibia. Injury, 1998;29:Suppl 3. C22-C28.
8. Gosling T, Schandelmaier P, Muller M, Hankemeier S, Wagner M, Krettek C. Single lateral locked screw plating of bicondylar tibial plateau fractures. Clin Orthop Relat Res, 2005;439:207-214.Article
9. Henley MB, Meier M, Tencer AF. Influences of some design parameters on the biomechanics of the undreamed nail. J Orthop Trauma, 1993;7:311-319.
10. Hicks CA, Noble P, Tullos H. The anatomy of the tibial intramedullary canal. Clin Orthop Relat Res, 1995;321:111-116.Article
11. Hutson JJ Jr, Zych GA. Infections in periarticular fractures of the lower extremity treated with tensioned wire hybrid fixators. J Orthop Trauma, 1998;12:214-218.Article
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17. Laflamme GY, Heimlich D, Stephen D, Kreder HJ, Whyne CM. Proximal tibial fracture stability with intramedullary nail fixation using oblique interlocking screws. J Orthop Trauma, 2003;17:496-502.Article
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Fig. 1

Radiographs show a healed fracture of the proximal tibia with valgus deformity and apex anterior deformity after locked nail.

Fig. 2

The CT scan of the proximal tibia shows triangular shape of the medullary canal with most narrow medial portion. The proximal-medial portion of the tibia is a chute (white arrow) that deflects the nail laterally because of lessened sagittal space and pronounced lateral slope of the medial cortex of the proximal tibia.

Fig. 3

Medial entry point and laterally directed insertion angle of the nail into the proximal fragment results in valgus malalignment as the nail engages into the distal fragment.

Fig. 4

Posteriorly directed insertion of the nail into the proximal fragment results in apex anterior angulation at the fracture site when the nail engages into the distal fragment.

Fig. 5

Lateral radiograph of the proximal tibial fracture treated with an AO unreamed interlocking nail shows anterior displacement of the proximal fragment (posterior displacement of the distal fragment) by the wedge effect of the nail. Note. The AO unreamed interlocking nail has a more distally located Herzog bend.

Fig. 6

Postoperative radiographs of this proximal tibial shaft fracture show good alignment after locked tibial nailing using the lateral starting point in line with the lateral intercondylar eminence and more proximal and posterior starting point.

Fig. 7

(A, B) Initial radiographs show simple oblique fracture of the proximal tibia.

(C, D, E) The fracture was reduced and alignment was maintained by temporary percutaneous use of pointed reduction forceps during nailing procedures.

(F, G) Postoperative radiographs show anatomical reduction of the fracture after fixing with a locked tibial nail and adjunctive percutaneous lag screws.

Fig. 8

(A, B) Initial radiographs show the proximal tibial fracture at the proximal meta-diaphyseal junction.

(C, D) Postoperative radiographs show good alignment of the fracture fixed with a locked tibial nail and blocking screws to prevent malalignment. A blocking screw was placed lateral to the central axis to prevent valgus angulation and the other blocking screw was placed posterior to the central axis to prevent apex anterior angulation.

Fig. 9

(A, B) Initial radiographs show the segmental fracture of the proximal and distal tibial shafts.

(C, D) The proximal fracture was reduced and stabilized with a 1/3 tubular plate through a small incision before locked tibial nailing to prevent malalignment. Postoperative radiographs show anatomical alignment of the fracture fixed with a locked nail and a small plate.

(E, F) Radiographs 7 months after surgery show the healed fracture with external callus in good alignment.

Figure & Data

REFERENCES

Citations

Citations to this article as recorded by

Clinical Outcome after Treatment of Tibia Segmental Fracture with Intramedullary Nailing and Minimal Invasive Plate Osteosynthesis
Jun Young Lee, Hyung Seok Park, Dong Hyuk Cha
Journal of the Korean Fracture Society.2020; 33(3): 142. CrossRef
Clinical Outcomes of the Tibia Segmental Fractures Treated by Intramedullary Nail Using Various Reduction Techniques
Oog-Jin Shon, Ji-Hoon Shin, Chul-Wung Ha
Journal of the Korean Fracture Society.2013; 26(1): 50. CrossRef
Management of Open Fracture
Gu-Hee Jung
Journal of the Korean Fracture Society.2010; 23(2): 236. CrossRef

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Intramedullary Nailing of Proximal Tibial Fractures

J Korean Fract Soc. 2009;22(3):197-205. Published online July 31, 2009

DOI: https://doi.org/10.12671/jkfs.2009.22.3.197

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Figure

We recommend

Intramedullary Nailing of Proximal Tibial Fractures

Fig. 1 Radiographs show a healed fracture of the proximal tibia with valgus deformity and apex anterior deformity after locked nail.

Fig. 2 The CT scan of the proximal tibia shows triangular shape of the medullary canal with most narrow medial portion. The proximal-medial portion of the tibia is a chute (white arrow) that deflects the nail laterally because of lessened sagittal space and pronounced lateral slope of the medial cortex of the proximal tibia.

Fig. 3 Medial entry point and laterally directed insertion angle of the nail into the proximal fragment results in valgus malalignment as the nail engages into the distal fragment.

Fig. 4 Posteriorly directed insertion of the nail into the proximal fragment results in apex anterior angulation at the fracture site when the nail engages into the distal fragment.

Fig. 5 Lateral radiograph of the proximal tibial fracture treated with an AO unreamed interlocking nail shows anterior displacement of the proximal fragment (posterior displacement of the distal fragment) by the wedge effect of the nail. Note. The AO unreamed interlocking nail has a more distally located Herzog bend.

Fig. 6 Postoperative radiographs of this proximal tibial shaft fracture show good alignment after locked tibial nailing using the lateral starting point in line with the lateral intercondylar eminence and more proximal and posterior starting point.

Fig. 7 (A, B) Initial radiographs show simple oblique fracture of the proximal tibia. (C, D, E) The fracture was reduced and alignment was maintained by temporary percutaneous use of pointed reduction forceps during nailing procedures. (F, G) Postoperative radiographs show anatomical reduction of the fracture after fixing with a locked tibial nail and adjunctive percutaneous lag screws.

Fig. 8 (A, B) Initial radiographs show the proximal tibial fracture at the proximal meta-diaphyseal junction. (C, D) Postoperative radiographs show good alignment of the fracture fixed with a locked tibial nail and blocking screws to prevent malalignment. A blocking screw was placed lateral to the central axis to prevent valgus angulation and the other blocking screw was placed posterior to the central axis to prevent apex anterior angulation.

Fig. 9 (A, B) Initial radiographs show the segmental fracture of the proximal and distal tibial shafts. (C, D) The proximal fracture was reduced and stabilized with a 1/3 tubular plate through a small incision before locked tibial nailing to prevent malalignment. Postoperative radiographs show anatomical alignment of the fracture fixed with a locked nail and a small plate. (E, F) Radiographs 7 months after surgery show the healed fracture with external callus in good alignment.