title: Anatomic assessment of the proper insertion site for a tibial intramedullary nail.
abstract: OBJECTIVE
  To locate the proper insertion point for a tibial intramedullary nail in the coronal plane.
  
  
  METHODS
  Fifty-seven cadaveric lower legs were disarticulated at the knee and ankle and stripped of their soft tissue. Each tibia was nailed in a retrograde fashion through the center of the tibial plafond with a seven-millimeter sharp-tipped rod through the proximal tibia. The exit point of the nail was measured in the coronal plane in relation to the tibial tubercle.
  
  
  RESULTS
  Except for one tibia, the intramedullary nail exit point was always located medial to the center of the tibial tubercle with the average being eight millimeters +/- six millimeters medial to the center of the tibial tubercle. Forty-six percent of the nails exited medial to the whole tibial tubercle.
  
  
  CONCLUSIONS
  The insertion point of a tibial nail should be over the medial aspect of the tibial tubercle in the coronal plane. Our data supports using a medial or patellar splitting approach for nail insertion. Insertion sites lateral to the tibial tubercle should be avoided.
authors.affiliation: Department of Orthopaedic Surgery, University of Southern California, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Samuelson
authors.forename: Edward J
authors.initials: EJ
authors.lastname: McPherson
authors.forename: Linda
authors.initials: L
authors.lastname: Norris
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017760:Bone Malalignment / Q000517:prevention & control; D001858:Bone Nails; D002102:Cadaver; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D012680:Sensitivity and Specificity; D013977:Tibia / Q000033:anatomy & histology*; D013978:Tibial Fractures / Q000601:surgery*