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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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