Tibial shaft fractures are the most common long bone fractures and account for 4% of all fractures seen in...
Tibial Shaft Intramedullary Nail
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.
The Stryker T2 Alpha Tibia Nailing System ™ was first introduced in 2018, and in the time since it has become one of the most common intramedullary nail systems used today. This nail comes in a variety of sizes to accommodate a patient’s unique dimensions. Once the nail is inserted, it is kept in place by the use of locking screws. Older generation nails traditionally only had one or two screw holes in the same plane both above and below the fracture site.
The T2 Alpha offers the surgeon the added benefit of multiple proximal locking screw options (how the nail is “locked” in place above the fracture) as well as a distal locking pattern (below the fracture) for increased angular stability. Furthermore, after an intramedullary nail is placed past the fracture, the fracture ends can become separated. This nail allows for 7mm of active internal compression at the fracture site to ensure contact between bone ends, helping to prevent non-union (refer to pictures below for how this is accomplished).