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Tibial Shaft Intramedullary Nail

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Evolution of Tibial Shaft Intramedullary Nail

The most commonly employed device for surgical fixation of tibia shaft fracture are intramedullary nails. However, tibial intramedullary nails may also be used for the following: corrective osteotomy for pseudoarthrosis (fibrous tissue that grows between bone ends), impending pathologic fractures/tumor resection, and non-unions or malunions of the tibial shaft.

These nails are essentially metal rods that are inserted from the top of the tibia and span nearly the full length of the bone. An incision to access the starting point of the nail may be made at the top of the tibia and below the patella (knee cap), or an incision will be made just above the knee and the nail inserted under the patella – this access point is now often used as it can help the surgeon properly insert the nail without causing malalignment of the tibia.

Once the appropriate starting point has been obtained, a small guide wire is passed down the full length of the tibia. In order to do so, the surgeon must first reduce the fractured portions of the tibia into appropriate alignment. Once the guide wire is in place, the canal may be hollowed out with drill bits, which ensures a snug fit of the nail. Once the nail is inserted, screws are then placed through the nail at both the proximal and distal portions of the tibia through small (~1-2cm) incisions in order to lock it in place.

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