SEMIEXTENDED POSITION FOR INTRAMEDULLARY NAILING OF THE PROXIMAL TIBIA

Over a 24 month period, 30 patients with proximal tibia fractures who were reviewed consecutively were treated by nonreamed, statically lock ed, intramedullary nailing, There were 16 open, 13 segmental, and 7 co mminuted fractures (Winquist III, IV), The average distance from the f racture to the proximal locking screws was 24 mm (range, 0-65 mm), All procedures were performed while the patient's affected leg was on a r adiolucent table without traction, The last 25 fractures were nailed u sing a partial (2/3) medial parapatellar incision while the leg was se miextended, This approach allowed the patella to be subluxed laterally availing the trochlear groove for use as a conduit for nail placement , Using only 15 degrees knee flexion eliminated the extension force of the quadriceps on the proximal fragment, which otherwise would have t ended to cause anterior angulation at the fracture site, In the first 5 patients, the average anterior angulation was 8 degrees (range, 5 de grees-15 degrees), Of the 25 patients who were treated while in the se miextended position, none had more than 5 degrees anterior angulation and 19 had no anterior angulation, Fractures of 3 of the 25 patients h ad greater than 5 degrees angulation in the coronal plane, 2 of which were nailed in the semiextended position, This technique greatly facil itates intramedullary nailing of proximal tibia fractures.