Review Question - QID 3002

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Proximal Third Tibia Fracture Techniques Intramedullary nailing QID: 3002 (OBQ09.189)

QID 3002 (Type "3002" in App Search)

A 37-year-old male sustains the closed injury seen in figure A. What technique can be utilized to avoid the characteristic deformity seen in this fracture pattern if an intramedullary nail is used for treatment?

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Medial starting point

240/2578

Lateral starting point

64%

1661/2578

Aiming the nail posteriorly in the proximal segment

56/2578

Anterior blocking screw in the proximal segment

197/2578

Medial blocking screw in the proximal segment

16%

414/2578

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Figure A shows a proximal metaphyseal tibia fracture, which characteristically is malreduced into valgus and apex anterior (procurvatum) deformity. Some techniques to avoid these deformities are: provisional reduction with unicortical plates/clamps, semi-extended nailing, suprapatellar nailing, usage of a more lateral starting point, usage of an external fixator or femoral distractor, and usage of blocking screws - posterior screw and/or a lateral screw in the proximal segment.

The two referenced studies draw attention to the high rate of malalignment with nailing of this fracture pattern; the first study reported a 58% malalignment rate, and the second reported an 84% rate (>5 degrees in either coronal or sagittal planes).