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Semiextended position during nailing
76%
3065/4036
Lateral blocking screws in proximal tibia fragment
4%
149/4036
Use of a radiolucent triangle to flex the knee
5%
193/4036
Anterior blocking screw in the proximal tibia fragment
14%
579/4036
Medial parapatellar arthrotomy avoiding the patellar tendon
1%
28/4036
Select Answer to see Preferred Response
The semiextended position for intramedullay nailing of proximal tibia shaft fractures has shown to cause less complications of flexion deformity and malunion. Proximal third tibia fractures are often times difficult to reduce anatomically due to the tendency for both valgus and flexion deformity at the fracture site. The semiextended position helps to eliminate the tendency for the fracture to flex, due to the avoidance of excessive knee flexion during the reduction. Illustration A is an example of semiextended positioning for tibial nailing. Illustration B shows radiograph utilizing posterior blocking screws to prevent procurvatum deformity. Tornetta et al looked at the semiextended intramedullary nailing of proximal tibia fractures. Of the 24 patients nailed using this technique, 19 had no anterior angulation, while only 5 had less than 5 degrees of flexion deformity. In their study, Kubiak et al also advocate the semiextended position for tibial nailing. They note better control of fracture alignment and stabilization especially in the sagittal plane, and better ability to obtain imaging and maintenance of reduction during nail insertion and locking. Incorrect answers: Answer 2 would help to avoid valgus deformity. Answer 3 would worsen the flexion deformity. Answer 4 would worsen the flexion deformity and drive the nail posterior in distal segment. Answer 5 would not affect flexion deformity.
4.7
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