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Related Concept Videos

Fractures: Bone Repair01:27

Fractures: Bone Repair

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Treatment for a fracture is based on the type of break, the bone affected, and the patient's age.
Minor fractures with no bone displacement are treated by immobilizing the fractured bone using a cast or splint. However, in the case of fractures with displaced bones, the broken bones are repositioned before immobilization to ensure successful healing without deformation and loss of function. The realignment of fractured bone ends is performed through a process called reduction. If the...
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Related Experiment Video

Updated: Oct 14, 2025

Treatment with Locking Intramedullary Nailing for Intertrochanteric Fracture of the Femur Utilizing a New Awl with a Distal Positioner
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Treatment with Locking Intramedullary Nailing for Intertrochanteric Fracture of the Femur Utilizing a New Awl with a Distal Positioner

Published on: June 6, 2025

307

Nailing distal tibial fractures: does entry technique affect distal alignment?

Matthew Hague1, Dominic Texeira2, Thomas Anderson3

  • 1Epsom and St Helier University Hospitals NHS Trust, London, UK. matthewrhague@doctors.org.uk.

European Journal of Orthopaedic Surgery & Traumatology : Orthopedie Traumatologie
|November 2, 2021
PubMed
Summary

The suprapatellar technique for tibial nailing of distal third tibial fractures may improve coronal alignment compared to the infrapatellar approach. This study found better axial alignment in the coronal plane with the suprapatellar method.

Keywords:
Distal tibial fractureInfrapatellarIntramedullary nailingSuprapatellar

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Area of Science:

  • Orthopedic surgery
  • Traumatology
  • Biomechanical analysis

Background:

  • Distal third tibial fractures require accurate reduction to prevent tibiotalar joint malalignment.
  • Intramedullary nailing is a common treatment for these fractures.
  • The choice of nail entry technique (suprapatellar vs. infrapatellar) may influence reduction accuracy.

Purpose of the Study:

  • To compare the accuracy of reduction and axial alignment in distal third tibial fractures treated with suprapatellar versus infrapatellar intramedullary nailing.
  • To determine if the entry technique impacts coronal and sagittal plane alignment.

Main Methods:

  • Retrospective cohort study of 125 patients (74 suprapatellar, 51 infrapatellar) undergoing tibial nailing for distal third fractures.
  • Radiographic assessment of anteroposterior and sagittal plane alignment.
  • Inter- and intra-observer reliability analysis of radiographic measurements.

Main Results:

  • Suprapatellar nailing showed significantly less malalignment in the coronal plane (2.8° ± 0.7°) compared to infrapatellar nailing (4.7° ± 0.9°, P < 0.01).
  • No significant difference in sagittal plane malalignment was observed between the two techniques (P = 0.42).
  • High intra- and inter-observer correlations confirmed measurement reliability.

Conclusions:

  • The suprapatellar technique may offer superior coronal plane alignment for distal third tibial fractures.
  • No significant difference in sagittal plane alignment was found.
  • Suprapatellar nailing could potentially reduce malalignment and improve clinical outcomes in these fractures.