Proximal Tibial Nailing Using the Semiextended Technique


Intramedullary nailing of proximal tibia fractures has been associated with a high incidence of malalignment following osteosynthesis. Valgus malalignment has been attributed to poor endosteal fit of the implant in the widened tibial diaphysis as well as a laterally directed nail insertion angle from a medially placed starting portal. Anterior angulation has been attributed to the pull of the patellar tendon on the proximal fracture fragment when the knee is flexed during conventional tibial nailing. In this paper, we describe the use of the semiextended position, which eliminates the malalignment problems associated with conventional nailing and minimizes the risk of infection by using a relatively small incision while leaving the musculature around the fracture untouched.

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