title: Intramedullary nailing of tibial shaft fractures in the semi-extended position using a suprapatellar portal technique.
abstract: Intramedullary nail fixation remains the standard treatment for displaced tibial shaft fractures. Establishing an appropriate starting point remains a crucial step in the surgical procedure. Tibial nailing using an infrapatellar starting point with the knee flexed over a radiolucent triangle has been established as a widely-used standard technique. Tibial nail insertion with the knee in the semi-extended position was introduced with the goal to counteract post-operative procurvatum deformities that frequently have been reported as a common problem in proximal third tibial shaft fractures. Early reports on tibial nailing in the semi-extended position used a knee arthrotomy in order to establish the proximal tibial starting point. Recent technological advances have provided the surgical community with instrumentation systems that allow for tibial nailing in the semi-extended position using a suprapatellar portal with nail insertion through the patellofemoral joint. Preliminary clinical studies have suggested favorable outcomes that can be achieved with this technique. This article provides a description of the surgical technique and a review of the currently available evidence.
authors.affiliation: Department of Orthopaedic Surgery, Division of Orthopaedic Traumatology, UT Health Science Center at San Antonio, 7703 Floyd Curl Dr, MC-7774, San Antonio, TX, 78229, USA. zelle@uthscsa.edu.
authors.forename: Boris A
authors.initials: BA
authors.lastname: Zelle
mesh_terms: D000328:Adult; D001858:Bone Nails / Q000009:adverse effects*; D018483:Diaphyses / Q000293:injuries / Q000601:surgery; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007719:Knee Joint; D008297:Male; D057071:Patellofemoral Joint / Q000601:surgery*; D056888:Patient Positioning / Q000009:adverse effects / Q000379:methods*; D016059:Range of Motion, Articular; D013977:Tibia / Q000601:surgery; D013978:Tibial Fractures / Q000601:surgery*; D016896:Treatment Outcome
keywords: Diaphysis; Fracture; Nail; Tibia