The indications for tibial nailing are evolving and expanding from diaphyseal fractures to include proximal, distal, and open fractures. The biologic and mechanical advantages of intramedullary (IM) nail fixation, as well as the increasing number of surgeons who have become proficient in the technique, are the impetus for extending the indications of this technique. Nailing of proximal tibial fractures represents perhaps the most demanding indication. The correct use of nailing in these fractures requires a great deal of surgical experience. To achieve good results in proximal fractures, the surgeon must be proficient at conventional IM nailing and be able to expand on routine nailing techniques appropriate for diaphyseal fractures. Because of the inherent difficulties of nailing proximal fractures, less experienced surgeons may prefer to continue stabilizing these fractures by other methods. Anyone who wants to use nailing for the treatment of proximal tibial fractures must appreciate the unique characteristics of this procedure. Failure to master these techniques will lead to less than optimal results, which has been evidenced by a reported high incidence of malunion.1 In this article, the advantages and pitfalls of nailing proximal tibia fractures are summarized and strategies developed to address the surgical problems associated with the application of this technique.
Address correspondence and reprint requests to J. Dean Cole, MD, 1118 S. Orange Ave., Suite 205, Orlando, FL 32806, U.S.A.
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