Incision placement for intramedullary tibial nailing: an anatomic study

Area of Science:

• Orthopaedic Surgery
• Traumatology
• Anatomy

Background:

• Intramedullary nailing of tibial shaft fractures requires precise entry site access.
• Current approaches, including transpatellar, may lead to anterior knee pain.
• Optimal access to the tibial nail entry site is debated.

Purpose of the Study:

• To determine the ideal incision site for intramedullary tibial nail insertion using anatomical measurements.
• To evaluate the relationship between the lateral tibial spine and patellar tendon anatomy.
• To inform surgical approach selection for tibial nailing.

Main Methods:

• Part I: Survey of Orthopaedic Trauma Association (OTA) members regarding surgical approaches.
• Part II: Anatomical study involving clinical examination and radiographic analysis of 56 healthy volunteers (112 knees).
• Measurements were taken to assess the patellar tendon's relationship to the tibial nail entry site.

Main Results:

• OTA members utilize various approaches for tibial nailing, with 57% using only one method.
• Anatomical analysis revealed the preferred entry site's location relative to the patellar tendon zones.
• The ideal entry point for tibial nailing was found in different zones depending on individual anatomy.

Conclusions:

• Individual patellar tendon anatomy necessitates consideration when selecting the tibial nail entry site.
• Preoperative fluoroscopic measurement can guide the choice between medial parapatellar, transpatellar, or lateral parapatellar approaches.
• A standardized, single approach for all tibial nailings may not be optimal.