title: Safe surgical technique: intramedullary nail fixation of tibial shaft fractures.
abstract: Statically locked, reamed intramedullary nailing remains the standard treatment for displaced tibial shaft fractures. Establishing an appropriate starting point is a crucial part of the surgical procedure. Recently, suprapatellar nailing in the semi-extended position has been suggested as a safe and effective surgical technique. Numerous reduction techiques are available to achieve an anatomic fracture alignment and the treating surgeon should be familiar with these maneuvers. Open reduction techniques should be considered if anatomic fracture alignment cannot be achieved by closed means. Favorable union rates above 90 % can be achieved by both reamed and unreamed intramedullary nailing. Despite favorable union rates, patients continue to have functional long-term impairments. In particular, anterior knee pain remains a common complaint following intramedullary tibial nailing. Malrotation remains a commonly reported complication after tibial nailing. The effect of postoperative tibial malalignment on the clinical and radiographic outcome requires further investigation.
authors.affiliation: Department of Orthopaedic Surgery, Division of Orthopaedic Traumatology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, MC-7774, San Antonio, TX 78229 USA.
authors.forename: Boris A
authors.initials: BA
authors.lastname: Zelle
authors.affiliation: Department of Orthopaedics and Traumatology, Federal University of São Paulo, Rua Borges Lagoa, 783-50 Andar, São Paulo, 04038032 Brazil.
authors.forename: Guilherme
authors.initials: G
authors.lastname: Boni
keywords: Fracture; Intramedullary; Knee pain; Nail; Tibia