Intramedullary Nailing of Lower-Extremity Periarticular Fractures

Area of Science:

• Orthopedic Surgery
• Trauma Surgery
• Biomedical Engineering

Background:

• Intramedullary nailing is a surgical technique used for stabilizing fractures.
• It is particularly indicated for periarticular fractures of the distal femur, proximal tibia, and distal tibia with short segments.
• This method is also applicable to certain intra-articular fractures and complex patterns with diaphyseal extension or segmental injuries.

Purpose of the Study:

• To outline the indications and detailed procedural steps for intramedullary nailing of specific fracture types.
• To highlight considerations for preoperative planning, surgical technique, and postoperative management.
• To discuss potential benefits such as reduced incision burden and challenges like posttraumatic arthritis.

Main Methods:

• Preoperative planning involving imaging review and selection of appropriate interlocking nails.
• Surgical approach selection (suprapatellar, infrapatellar, or arthrotomy) and fracture reduction techniques.
• Nailing procedure including starting point, reaming, nail insertion, interlocking screw placement, and adjunctive fixation.

Main Results:

• Successful stabilization of distal femoral, proximal tibial, and distal tibial periarticular fractures.
• Effective management of complex fracture patterns, including those with diaphyseal extension and segmental injuries.
• Maintained alignment is generally expected for extra-articular fractures postoperatively.

Conclusions:

• Intramedullary nailing is a versatile technique for stabilizing various periarticular fractures, offering advantages in complex cases and for patients requiring minimal incisions.
• Careful preoperative planning and meticulous surgical technique are crucial for optimal outcomes.
• Posttraumatic arthritis remains a concern for intra-articular fracture stabilization.