Safe surgical technique: Intramedullary nail fixation of tibial shaft fractures

Boris A. Zelle, Guilherme Boni

Research output: Contribution to journalReview articlepeer-review

44 Scopus citations


Statically locked, reamed intramedullary nailing remains the standard treatment for displaced tibial shaft fractures. Establishing an appropriate starting point is a crucial part of the surgical procedure. Recently, suprapatellar nailing in the semi-extended position has been suggested as a safe and effective surgical technique. Numerous reduction techiques are available to achieve an anatomic fracture alignment and the treating surgeon should be familiar with these maneuvers. Open reduction techniques should be considered if anatomic fracture alignment cannot be achieved by closed means. Favorable union rates above 90% can be achieved by both reamed and unreamed intramedullary nailing. Despite favorable union rates, patients continue to have functional long-term impairments. In particular, anterior knee pain remains a common complaint following intramedullary tibial nailing. Malrotation remains a commonly reported complication after tibial nailing. The effect of postoperative tibial malalignment on the clinical and radiographic outcome requires further investigation.

Original languageEnglish (US)
Article number40
JournalPatient Safety in Surgery
Issue number1
StatePublished - Dec 12 2015


  • Fracture
  • Intramedullary
  • Knee pain
  • Nail
  • Tibia

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Anesthesiology and Pain Medicine


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