Skip to main content
SpringerLink
Log in

Primary rigid intramedullary nailing for fractures of the tibia: current concepts and technique

  • Review
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Intramedullary nailing of tibial shaft fractures is the preferred treatment of many tibial shaft fractures—displaced and undisplaced, open and closed, simple and multi-fragmentary. In this paper we address several important issues relating to the concepts of the procedure and review the literature available: reaming of the intramedullary cavity; the problems of achieving stability with metaphyseal fractures; achieving fracture reduction; the issue of the ideal entry point; the complications that can occur; and the timing of surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Bedi A, Le TT, Karunakar MAJ (2006) Surgical Treatment of nonarticular distal tibia fractures. Am Acad Orthop Surg 14(7):406–416

    Google Scholar 

  2. Gómez-Benito MJ, Fornells P, García-Aznar JM, Seral B, Seral-Iñnigo F, Doblaré MJ (2007) Computational comparison of reamed versus unreamed intramedullary tibial nails. Orthop Res 25(2):191–200

    Article  Google Scholar 

  3. Pell AC, Christie J, Keating JF, Sutherland GR (1993) The detection of fat embolism by transoesophageal echocardiography during reamed intramedullary nailing. A study of 24 patients with femoral and tibial fractures. J Bone Joint Surg Br 75(6):921–925

    PubMed  CAS  Google Scholar 

  4. Christie J, Robinson CM, Pell AC, McBirnie J, Burnett R (1995) Transcardiac echocardiography during invasive intramedullary procedures. J Bone Joint Surg Br 77(3):450–455

    PubMed  CAS  Google Scholar 

  5. Anwar IA, Battistella FD, Neiman R, Olson SA, Chapman MW, Moehring HD (2004) Femur fractures and lung complications: a prospective randomized study of reaming. Clin Orthop Relat Res 422:71–76

    Article  PubMed  Google Scholar 

  6. Giannoudis PV, Smith RM, Bellamy MC, Morrison JF, Dickson RA, Guillou PJ (1999) Stimulation of the inflammatory system by reamed and unreamed nailing of femoral fractures. An analysis of the second hit. J Bone Joint Surg Br 81(2):356–361

    Article  PubMed  CAS  Google Scholar 

  7. Pape HC, Zelle BA, Hildebrand F, Giannoudis PV, Krettek C, van Griensven M (2005) Reamed femoral nailing in sheep: does irrigation and aspiration of intramedullary contents alter the systemic response? J Bone Joint Surg Am 87(11):2515–2522

    Article  PubMed  Google Scholar 

  8. Karunakar MA, Frankenburg EP, Le TT, Hall J (2004) The thermal effects of intramedullary reaming. J Orthop Trauma 18(10):674–679

    Article  PubMed  Google Scholar 

  9. Giannoudis PV, Snowden S, Matthews SJ, Smye SW, Smith RM (2002) Friction burns within the tibia during reaming. Are they affected by the use of a tourniquet? J Bone Joint Surg Br 84(4):492–496

    Article  PubMed  CAS  Google Scholar 

  10. Hupel TM, Weinberg JA, Aksenov SA, Schemitsch EH (2001) Effect of unreamed, limited reamed, and standard reamed intramedullary nailing on cortical bone porosity and new bone formation. J Orthop Trauma 15(1):18–27

    Article  PubMed  CAS  Google Scholar 

  11. Hoegel F, Mueller CA, Peter R, Pfister U, Suedkamp NP (2004) Bone debris: dead matter or vital osteoblasts. J Trauma 56(2):363–367

    PubMed  Google Scholar 

  12. Forster MC, Bruce AS, Aster AS (2005) Should the tibia be reamed when nailing? Injury 36(3):439–444

    Article  PubMed  CAS  Google Scholar 

  13. Freedman EL, Johnson EE (1995) Radiographic analysis of tibial fracture malalignment following intramedullary nailing. Clin Orthop Relat Res 315:25–33

    PubMed  Google Scholar 

  14. Lang GJ, Cohen BE, Bosse MJ, Kellam JF (1995) Proximal third tibial shaft fractures. Should they be nailed? Clin Orthop Relat Res 315:64–74

    PubMed  Google Scholar 

  15. Nork SE, Barei DP, Schildhauer TA, Agel J, Holt SK, Schrick JL, Sangeorzan BJ (2006) Intramedullary nailing of proximal quarter tibial fractures. J Orthop Trauma 20(8):523–528

    Article  PubMed  Google Scholar 

  16. Roth SE, Kreder H, Stephen D, Whyne CM (2005) Biomechanical stability of intramedullary nailed high proximal third tibial fractures with cement augmented proximal screws. J Orthop Trauma 19(7):457–461

    Article  PubMed  Google Scholar 

  17. Zelle BA, Bhandari M, Espiritu M, Koval KJ, Zlowodzki M (2006) Treatment of distal tibia fractures without articular involvement: a systematic review of 1125 fractures. Evidence-Based Orthopaedic Trauma Working Group. J Orthop Trauma 20(1):76–79

    Article  PubMed  Google Scholar 

  18. Im GI, Tae SK (2005) Distal metaphyseal fractures of tibia: a prospective randomized trial of closed reduction and intramedullary nail versus open reduction and plate and screws fixation. J Trauma 59(5):1219–1223

    PubMed  Google Scholar 

  19. Nork SE, Schwartz AK, Agel J, Holt SK, Schrick JL, Winquist RA (2005) Intramedullary nailing of distal metaphyseal tibial fractures. J Bone Joint Surg Am 87(6):1213–1221

    Article  PubMed  Google Scholar 

  20. Janssen KW, Biert J, van Kampen A (2006) Treatment of distal tibial fractures: plate versus nail: a retrospective outcome analysis of matched pairs of patients Int Orthop, Dec 12

  21. Obremskey WT, Medina M (2004) Comparison of intramedullary nailing of distal third tibial shaft fractures: before and after traumatologists. Orthopedics 27(11):1180–1184

    PubMed  Google Scholar 

  22. Krettek C, Miclau T, Schandelmaier P, Stephan C, Möhlmann U, Tscherne H (1999) The mechanical effect of blocking screws (“Poller screws”) in stabilizing tibia fractures with short proximal or distal fragments after insertion of small-diameter intramedullary nails. J Orthop Trauma 13(8):550–553

    Article  PubMed  CAS  Google Scholar 

  23. Laflamme GY, Heimlich D, Stephen D, Kreder HJ, Whyne CM (2003) Proximal tibial fracture stability with intramedullary nail fixation using oblique interlocking screws. J Orthop Trauma 17(7):496–502

    Article  PubMed  CAS  Google Scholar 

  24. Krettek C, Stephan C, Schandelmaier P, Richter M, Pape HC, Miclau T (1999) The use of Poller screws as blocking screws in stabilising tibial fractures treated with small diameter intramedullary nails. J Bone Joint Surg Br 81(6):963–968

    Article  PubMed  CAS  Google Scholar 

  25. Tang P, Gates C, Hawes J, Vogt M, Prayson MJ (2006) Does open reduction increase the chance of infection during intramedullary nailing of closed tibial shaft fractures? J Orthop Trauma 20(5):317–322

    Article  PubMed  Google Scholar 

  26. Dunbar RP, Nork SE, Barei DP, Mills WJ (2005) Provisional plating of Type III open tibia fractures prior to intramedullary nailing. J Orthop Trauma 19(6):412–414

    Article  PubMed  Google Scholar 

  27. Kutty S, Laing AJ, Prasad CV, McCabe JP (2005) The effect of traction on compartment pressures during intramedullary nailing of tibial-shaft fractures. A prospective randomised trial. Int Orthop 29(3):186–190. Epub 7

    Article  PubMed  Google Scholar 

  28. Hernigou P, Cohen D (2000) Proximal entry for intramedullary nailing of the tibia. The risk of unrecognised articular damage. J Bone Joint Surg Br 82(1):33–41

    Article  PubMed  CAS  Google Scholar 

  29. Johnson DL, Swenson TM, Livesay GA et al (1995) Insertion- site anatomy of the human menisici: gross, arthroscopic and topographical anatomy as a basis for meniscal transplantation. Arthroscopy 11:386–394

    Article  PubMed  CAS  Google Scholar 

  30. Kohn D, Moreno B (1995) Meniscus insertion anatomy as a basis for meniscus replacement: a morphological cadaveric study. Arthroscopy 11:96–103

    PubMed  CAS  Google Scholar 

  31. Althausen PL, Neiman R, Finkemeier CG, Olson SA (2002) Incision placement for intramedullary tibial nailing: an anatomic study. J Orthop Trauma 16(10):687–690

    Article  PubMed  Google Scholar 

  32. Toivanen JA, Väistö O, Kannus P, Latvala K, Honkonen SE, Järvinen MJ (2002) Anterior knee pain after intramedullary nailing of fractures of the tibial shaft. A prospective, randomized study comparing two different nail-insertion techniques. J Bone Joint Surg Am 84-A(4):580–585

    PubMed  Google Scholar 

  33. Petrisor B, Anderson S, Court-Brown CM (2005) Infection after reamed intramedullary nailing of the tibia: a case series review. J Orthop Trauma 19(7):437–441

    Article  PubMed  Google Scholar 

  34. Katsoulis E, Court-Brown C, Giannoudis PV (2006) Incidence and aetiology of anterior knee pain after intramedullary nailing of the femur and tibia. J Bone Joint Surg Br 88(5):576–580

    Article  PubMed  CAS  Google Scholar 

  35. Drosos GI, Bishay M, Karnezis IA, Alegakis AK (2006) Factors affecting fracture healing after intramedullary nailing of the tibial diaphysis for closed and grade 1 open fractures. J Bone Joint Surg Br 88(2):227–231

    Article  PubMed  CAS  Google Scholar 

  36. Puloski S, Romano C, Buckley R, Powell J (2004) Rotational malalignment of the tibia following reamed intramedullary nail fixation. J Orthop Trauma 18(7):397–402

    Article  PubMed  CAS  Google Scholar 

  37. Brinker MR, O’Connor DP (2007) Exchange nailing of ununited fractures. J Bone Joint Surg Am 89(1):177–188

    Article  PubMed  Google Scholar 

  38. Pape HC, Schmidt RE, Rice J, van Griensven M, das Gupta R, Krettek C, Tscherne H (2000) Biochemical changes after trauma and skeletal surgery of the lower extremity: quantification of the operative burden. Crit Care Med 28:3441–3448

    Article  PubMed  CAS  Google Scholar 

  39. Bone LB, Johnson KD, Weigelt J, Scheinberg R (1989) Early versus delayed stabilization of femoral fractures. A prospective randomized study. J Bone Joint Surg Am 71:336–340

    PubMed  CAS  Google Scholar 

  40. Pape HC, Grimme KM, Giannoudis PV, Sott AL, Hildebrand F, Krettek C (2003) The impact of fracture fixation on the systemic cytokine response in stable polytrauma patients—a prospective randomized analysis of intramedullary instrumentation versus damage control for femoral fractures. Program and abstracts of the 2003 OTA Annual Meeting; 9–11; Salt Lake City, Utah. Abstract 27

  41. Pape HC, van Griensven M, Rice J, Gänsslen A, Hildebrand F, Zech S, Winny M, Lichtinghagen R, Krettek CJ (2001) Major secondary surgery in blunt trauma patients and perioperative cytokine liberation: determination of the clinical relevance of biochemical markers. Trauma 50(6):989–1000

    Article  CAS  Google Scholar 

Download references

Conflict of interest statement

No funds were received in support of this study.

Author information

Authors and Affiliations

  1. Department of Orthopaedics and Trauma, University Hospital Coventry and Warwick, 21 Dove House Lane, Solihull, West Midlands, B91 2HA, UK

    James E. Arbuthnot, Anthony Perera & David Powers

Authors
  1. James E. Arbuthnot
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anthony Perera
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David Powers
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to James E. Arbuthnot.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Arbuthnot, J.E., Perera, A. & Powers, D. Primary rigid intramedullary nailing for fractures of the tibia: current concepts and technique. Eur J Orthop Surg Traumatol 18, 435–440 (2008). https://doi.org/10.1007/s00590-008-0327-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-008-0327-4

Keywords

Search

Navigation