Tornetta and Collins describe a modified surgical approach for intramedullary nailing of proximal tibia fractures: positioning the knee in only 15°–20° of flexion (semiextended) with a partial medial parapatellar arthrotomy, rather than the traditional 80°–90° flexion. The study asks whether this position can prevent the anterior angulation that reliably plagued standard flexed nailing of proximal tibial fractures.
When nailing a fracture in the proximal third of the tibia, flex the knee only 15°–20° and use a partial medial parapatellar arthrotomy to sublux the patella laterally — this neutralizes the patellar tendon's extension pull on the proximal fragment and is the key maneuver preventing anterior angulation.
Watch the coronal plane independently with fluoroscopy: the semiextended position does not protect against varus/valgus drift, and portal size should not exceed the nail diameter or proximal stability will be lost.
Tornetta and Collins describe a modified surgical approach for intramedullary nailing of proximal tibia fractures: positioning the knee in only 15°–20° of flexion (semiextended) with a partial medial parapatellar arthrotomy, rather than the traditional 80°–90° flexion. The study asks whether this position can prevent the anterior angulation that reliably plagued standard flexed nailing of proximal tibial fractures.
When nailing a fracture in the proximal third of the tibia, flex the knee only 15°–20° and use a partial medial parapatellar arthrotomy to sublux the patella laterally — this neutralizes the patellar tendon's extension pull on the proximal fragment and is the key maneuver preventing anterior angulation.
Watch the coronal plane independently with fluoroscopy: the semiextended position does not protect against varus/valgus drift, and portal size should not exceed the nail diameter or proximal stability will be lost.