Tibia-based referencing for standard proximal tibial radiographs during intramedullary nailing

Area of Science:

• Orthopedic Surgery
• Radiology
• Anatomy

Background:

• Standardization of tibial radiographs is lacking.
• Accurate preoperative planning is crucial for intramedullary nailing procedures.
• Altered knee or proximal tibiofibular joint anatomy complicates standard radiographic assessment.

Purpose of the Study:

• To define novel radiographic landmarks on the proximal tibia.
• To establish standard anteroposterior (AP) and lateral views for tibial radiography.
• To assess the reliability and safety of new radiographic techniques for nail entry portal creation.

Main Methods:

• Evaluated two radiographic techniques in 20 cadaveric knees.
• Defined "twin peaks" AP view (sharpest tibial spine profile) and "flat plateau" lateral view (femoral condyle alignment with varus adjustment).
• Assessed intra-/inter-observer reliability using intra-class correlation coefficient (ICC) and compared portal placement and intra-articular damage.

Main Results:

• Good to excellent intra-/inter-observer reliability (ICC 0.61-0.90) for the new technique.
• "Twin peaks" AP view showed external rotation (2.7±2.1°) compared to standard.
• No significant difference in portal position or intra-articular damage between techniques (P>.05).

Conclusions:

• The "twin peaks" AP and "flat plateau" lateral views provide a safe and reliable method for creating nail entry portals.
• These tibia-based radiographic references are valuable for intramedullary nailing, especially with altered knee anatomy.
• The new techniques facilitate accurate placement within the anatomic safe zone.