• Scott P Ryan, Brandon Steen, and Paul Tornetta.
• *Department of Orthopaedic Surgery, Tufts University School of Medicine, Boston, MA; and †Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA.
• J Orthop Trauma. 2014 May 1; 28 (5): 263-9.

ObjectivesTo review a large series of tibial metaphyseal fractures treated with nailing in semi-extension (20-30 degrees) using a superomedial portal. To report on the quality and maintenance of reduction. To compare knee pain at final follow-up with a group nailed in hyperflexion (>90 degrees) with a standard inferior incision and parapatellar approach.DesignRetrospective cohort study.SettingAcademic medical center.PatientsOne hundred eighty-five consecutive tibia fractures were treated with intramedullary nails. Eighty-four patients with fractures affecting the proximal (50) or distal (34) metaphysis were nailed with the knee in semi-extension. One hundred one with diaphyseal fractures were nailed in standard hyperflexion and were used as a comparison group.Outcome MeasuresKnee pain was recorded at the final follow-up and graded on a 0-3 scale as per Court-Brown. Alignment was measured on full-length biplanar radiographs immediately postoperative and compared with the same radiographs at union.ResultsThere was no statistical difference in the number of patients without knee pain at union (P = 0.7). Radiographic angulation at the fracture was <5 degrees in all patients immediately postoperative, and no patient lost reduction. The average follow-up was 2.3 years.ConclusionsKnee pain after semi-extended tibial nailing was similar in frequency compared with standard nailing. There were no significant angulatory deformities, and no losses of reduction for both proximal and distal metaphyseal fractures nailed with the semi-extended technique.Level Of EvidenceTherapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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