Original ArticleDefining the Ideal “Nail Exit Path” of a Tibial Intramedullary Nail—A Computed Tomography Analysis of 860 TibiaeTrompeter, Alex FRCS (Tr + Orth)a; Williamson, Mike FRCS (Tr + Orth)a; Bates, Peter FRCS (Tr + Orth)b; Petersik, Andreas PhDc; Kelly, Michael FRCS (Tr + Orth)d Author Information aDepartment of Trauma and Orthopaedics, St George's University Hospitals NHS Foundation Trust, London, United Kingdom; bDepartment of Trauma and Orthopaedics, The Royal London Hospital Barts Health NHS Trust, London, United Kingdom; cStryker Trauma GmbH, Schönkirchen, Germany; and dDepartment of Trauma and Orthopaedics, North Bristol NHS Trust, Bristol, England. Reprints: Mike Williamson, FRCS (Tr + Orth), St George's University Hospitals NHS Foundation Trust, London, United Kingdom SW17 0QT (e-mail: [email protected]). A. Trompeter, M. Kelly, and P. Bates have an Education consultancy and/or R and D contract with Stryker. A. Petersik is an employee of Stryker. However, no payment or work is related to this project in anyway. The remaining authors report no conflict of interest. Journal of Orthopaedic Trauma: November 2021 - Volume 35 - Issue 11 - p e392-e396 doi: 10.1097/BOT.0000000000002098 Buy Metrics Abstract Objectives: To identify the ideal distal nail position in the distal tibia, using a computed tomography analysis. Methods: Three-dimensional models of 860 left tibiae were analyzed using the Stryker Orthopaedic Modeling and Analytics software (SOMA, Stryker, Kiel, Germany). The nail axis was defined by 7 center points at the middle of the inner cortical boundary. The point where this line fell relative to the center of the tibial plafond in both the anteroposterior and mediolateral planes was calculated. Results: The mean mediolateral offset of the tibial nail exit path was 4.4 ± 0.2 mm (95% confidence interval) lateral to the center of the tibial plafond. The mean anteroposterior offset of the tibial nail exit path was 0.6 ± 0.1 mm anterior to the center of the tibial plafond. Conclusions: We have presented an anatomic study analyzing the ideal nail exit path using computed tomography scans of 860 tibiae. We defined that the ideal nail exit path of a tibial nail is lateral with respect to the center of the tibial plafond. This is supported by previous clinical studies and has significant implications for preventing malalignment when treating distal tibial fractures with intramedullary nailing. Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.