- Technique:
- while obtaining a perfect circle under flouroscopy it is important not to rotate the foot because this will cause a malalignment
of the foot progression angle;
- instead, rotate either the entire leg as a unit or the flouro machine to achieve a perfect circle;
- drill / screw insertion may be performed in a medial to lateral or a lateral medial direction;
- advantage of the lateral to medial direction is ease of insertion (because the opposite leg does not get in the way), and
decreased prominence of the screw head;
- disadvantages include possible injury to the anterior tibial artery on entry (especially if nail is short) and superficial peroneal nerve;
- note however, the ATA and SPN can be just as easily injured upon perforation of the opposite cortex from the M-L direction;
- ref: Should distal interlocking of tibial nails be performed from a medial or lateral direction?
Anatomical and biomechanical considerations.
CS Roberts et al.
Journal of Orthopaedic Trauma. Vol 13. No 1. p 27-32.
- place the tip of the drill bit oblique to the X-ray beam into the stab incision and onto the tibia until the tip of the drill bit
is centered in the locking hole;
- since the holes thru the nail weaken it significantly, no hole must be at the fracture level or left empty if near the hole;
- Complications:
Fatigue failure in small diameter tibial nails.
Mechanical failures of intramedullary tibial nails applied without reaming.
Interlocking Intramedullary Nailing with and without Reaming for the Treatment of Closed Fractures of the Tibial Shaft.
P.A. Blachut MD, P.J. O'brien MD, R.N. Meek MD, and H.M. Broekhuyse MD.
JBJS Vol 79-A, No 5, May 1997.
Locking Intramedullary Nailing with and without Reaming for Open Fractures of the Tibial Shaft.
A prospective study.
J.F. Keating, P.J. Obrien MD, P.A. Blachut MD, R.N. Meed MD, and H.M. Broekhuyse MD. JBJS Vol. 79-A. No 3, March 1997.
Pseudoaneurysm After Tibial Nailing.
