title: [Suprapatellar approach to tibial medullary nailing with electromagnetic field-guided distal locking].
abstract: Closed tibial shaft fractures are the domain of intramedullary nailing. With the introduction of new nail designs and technologies, even small, dislocated distal fragments can be anatomically aligned and safely fixed. Unsolved or to a lesser degree controlled are the problems of distal locking in the freehand technique, which can still be difficult and can lead to a significant radiation exposure, and how to control very short proximal tibial fragments in metaphyseal tibial fractures or tibial segmental fractures, where the proximal fracture line also runs through the metaphysis.By using a suprapatellar approach, i.e. a skin incision proximal to the patella with an entry point into the tibial bone from within the knee at the same site as for a standard infrapatellar approach, and then nailing the tibia in a semi-extended position, i.e. the knee is only flexed 10-20°, the intraoperative dislocation of a short proximal fragment can be avoided. The main indications for semi-extended tibial nailing are a short diaphyseal fragment in an isolated tibial shaft fracture, a segmental fracture where the proximal fracture line is metaphyseal and in patients where infrapatellar soft tissues are compromised.The use of the electromagnetic guidance system SureShot® generates reliable and reproducible results, reduces the operating time and is independent from radiation for distal locking.
authors.affiliation: Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland, jmrueger@uke.de.
authors.forename: J M
authors.initials: JM
authors.lastname: Rueger
authors.forename: A H
authors.initials: AH
authors.lastname: Rücker
authors.forename: M
authors.initials: M
authors.lastname: Hoffmann
mesh_terms: D001858:Bone Nails; D001860:Bone Plates; D001863:Bone Screws; D004574:Electromagnetic Fields; D004867:Equipment Design; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation*; D006801:Humans; D011474:Prosthesis Design; D025321:Surgery, Computer-Assisted / Q000295:instrumentation*; D013978:Tibial Fractures / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome
references.citation: J Orthop Trauma. 1997 Jan;11(1):10-3
references.pmid: 8990026
references.citation: J Orthop Trauma. 2010 Nov;24(11):672-6
references.pmid: 20926965
references.citation: Injury. 2008 Oct;39(10 ):1210-5
references.pmid: 18703184
references.citation: Injury. 2008 Feb;39(2):170-5
references.pmid: 17884055
references.citation: Orthop Clin North Am. 2014 Jan;45(1):33-45
references.pmid: 24267205
references.citation: J Orthop Trauma. 2010 Nov;24(11):665-71
references.pmid: 20926959
references.citation: J Orthop Trauma. 1999 Nov;13(8):550-3
references.pmid: 10714781
references.citation: J Orthop Trauma. 2014 May;28(5):256-62
references.pmid: 24464093
references.citation: J Trauma Acute Care Surg. 2012 Jul;73(1):243-8
references.pmid: 22710783
references.citation: J Orthop Trauma. 2011 Dec;25(12 ):726-30
references.pmid: 21886003
references.citation: Int Orthop. 2009 Aug;33(4):1107-12
references.pmid: 18500514
references.citation: Clin Orthop Relat Res. 1992 Aug;(281):199-203
references.pmid: 1499210
references.citation: J Orthop Trauma. 2010 Nov;24(11):659-64
references.pmid: 20926963
references.citation: Arch Biochem Biophys. 2000 Sep 15;381(2):205-12
references.pmid: 11032407
references.citation: Arch Orthop Trauma Surg. 2012 Jan;132(1):57-63
references.pmid: 21877127
references.citation: J Bone Joint Surg Am. 2013 Aug 21;95(16):e116(1-8)
references.pmid: 23965710
references.citation: J Orthop Trauma. 2014 May;28(5):263-9
references.pmid: 24751605
references.citation: Injury. 2001 Nov;32(9):732-5
references.pmid: 11600124
references.citation: J Am Acad Orthop Surg. 2014 Oct;22(10):665-73
references.pmid: 25281261
references.citation: J Orthop Trauma. 2006 Jan;20(1):73-4
references.pmid: 16424816
references.citation: J Orthop Trauma. 2001 Mar-Apr;15(3):207-9
references.pmid: 11265012
references.citation: Clin Orthop Relat Res. 1996 Jul;(328):185-9
references.pmid: 8653954
references.citation: J Orthop Trauma. 1999 May;13(4):247-51
references.pmid: 10342349
references.citation: Med Eng Phys. 2011 May;33(4):479-89
references.pmid: 21183392
references.citation: Injury. 2006 Feb;37(2):109-19
references.pmid: 16310192
references.citation: J Orthop Trauma. 2003 Oct;17(9):635-41
references.pmid: 14574191
references.citation: Clin Orthop Relat Res. 2006 Aug;449:303-7
references.pmid: 16702914
references.citation: Acta Orthop Belg. 2011 Dec;77(6):834-7
references.pmid: 22308632
references.citation: J Orthop Trauma. 2014 Aug;28 Suppl 8:S29-39
references.pmid: 25046413
references.citation: J Orthop Trauma. 2010 Nov;24(11):704-8
references.pmid: 20881632
references.citation: J Am Acad Orthop Surg. 2011 Nov;19(11):690-700
references.pmid: 22052645