• Boris A Zelle.
• Department of Orthopaedic Surgery, Division of Orthopaedic Traumatology, UT Health Science Center at San Antonio, 7703 Floyd Curl Dr, MC-7774, San Antonio, TX, 78229, USA. zelle@uthscsa.edu.
• Int Orthop. 2017 Sep 1; 41 (9): 1909-1914.

AbstractIntramedullary nail fixation remains the standard treatment for displaced tibial shaft fractures. Establishing an appropriate starting point remains a crucial step in the surgical procedure. Tibial nailing using an infrapatellar starting point with the knee flexed over a radiolucent triangle has been established as a widely-used standard technique. Tibial nail insertion with the knee in the semi-extended position was introduced with the goal to counteract post-operative procurvatum deformities that frequently have been reported as a common problem in proximal third tibial shaft fractures. Early reports on tibial nailing in the semi-extended position used a knee arthrotomy in order to establish the proximal tibial starting point. Recent technological advances have provided the surgical community with instrumentation systems that allow for tibial nailing in the semi-extended position using a suprapatellar portal with nail insertion through the patellofemoral joint. Preliminary clinical studies have suggested favorable outcomes that can be achieved with this technique. This article provides a description of the surgical technique and a review of the currently available evidence.

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