Dr. Ebraheim’s educational animated video describes intramedullary nailing of proximal tibial fractures.
Tibial shaft fractures are common. IM nailing is the procedure of choice for fractures of the tibial shaft. Proximal tibial fractures are noted to produce deformities when an IM nail is used. There are deformin forces in the proximal tibia (patellar tendon), also the wide intrameduallary canal of the proximal tibia contributes to the deformity. Proximal tibial fractures are noted to produce deformities when an IM nail is used.
What are the types of deformities that may occur with IM nailing? Valgus and procurvatum.
Surgical approaches:
1-lateral parapatellar
2-semiextended knee position: incision may be used with knee in about 15 degrees of flexion (some surgeons use it).
3-Retrosuprapatellar (transquadriceps approach): avoid trochlear injury.
Enhance for the IM nail should be in line with the medial border of the lateral tibial eminence.
•Surgical techniques to help the IM nail:
•Unicortical temporary anterior plate
•External fixator
•Blocking screws.: blocking screws are very helpful for reduction of the fracture during nail insertion. The blocking screw is posterior to the proposed nail site from medial to lateral in order to prevent procurvatum. Another blocking screw is inserted lateral to the central axis of the tibia (to prevent valgus deformity). The point of entry is usually lateral. Using blocking screws will prevent valgus and procurvatum deformity of the proximal tibia. Another set of locking screws are used through the rod proximally and distally.
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Background music provided as a free download from YouTube Audio Library.
Song Title: Every Step
