Extra-articular technique for semiextended tibial nailing

Intramedullary nailing is a widely accepted technique for the stabilization of unstable diaphyseal tibia fractures. When this method of stabilization is applied to proximal and distal metadiaphyseal fractures, achieving and maintaining fracture reduction is more difficult. The intramedullary nailing of proximal metadiaphyseal fractures in semiextension has been advocated to make stabilization less difficult. The intra-articular nature of this technique makes it less appealing. We present a nailing technique that facilitates extra-articular semiextended tibial nailing. The technique simplifies intraoperative imaging, fracture reduction, and maintenance of reduction during nail insertion and locking.