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Intraarticular anatomic risks of tibial nailing
P Tornetta1, J Riina, J Geller
1Boston Medical Center, Massachusetts 02467, USA.
Journal of Orthopaedic Trauma
|May 26, 1999
Summary
Tibial nailing risks knee joint damage. A small safe zone for nail placement exists, emphasizing a slightly lateral starting point to avoid intraarticular structures.
Area of Science:
- Orthopedic surgery
- Anatomy
- Biomechanics
Background:
- Tibial nailing is a common procedure for fractures.
- Portal creation for tibial nail insertion poses risks to intraarticular knee structures.
- Identifying a safe zone is crucial to minimize iatrogenic injury.
Purpose of the Study:
- To determine the risks associated with tibial portal creation.
- To define the safe zone for tibial nail placement.
- To identify optimal entry points for tibial nailing.
Main Methods:
- Cadaveric anatomical study of 40 fresh frozen knees.
- Nail placement via medial and lateral parapatellar approaches.
- Measurement of distances from nail portal to intraarticular structures.
Main Results:
- Tibial portal averaged 4.4 mm lateral to plateau midline.
- 20% of specimens had intraarticular damage; 30% had nail subjacent to menisci.
- Safe zone identified: 9.1 mm lateral to plateau midline, 3 mm lateral to tibial tubercle center; average width 22.9 mm.
Conclusions:
- Intraarticular knee structure damage is possible during tibial nailing.
- The safe zone for nail placement is limited and can be compromised by reamed nails.
- A starting point slightly lateral to the tibial tubercle center is recommended for safer tibial nailing.