Related Experiment Video
Updated: Aug 2, 2025
04:42
Treatment with Locking Intramedullary Nailing for Intertrochanteric Fracture of the Femur Utilizing a New Awl with a Distal Positioner
Published on: June 6, 2025
154
Is Patellar Instability a Contraindication to Semiextended Tibial Nailing?: A Case Report
Gabrielle S Ray1, Taryn E Leroy2, Scott P Ryan2
1Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
JBJS Case Connector
|April 18, 2023
Summary
Intramedullary nailing for tibia fractures can worsen patellofemoral instability, especially with the medial parapatellar approach. Surgical correction restored stability and knee function in a case study.
Area of Science:
- Orthopedic Surgery
- Biomechanics
- Traumatology
Background:
- Chronic patellofemoral instability presents a surgical challenge.
- Intramedullary nailing is a common treatment for distal tibia fractures.
Observation:
- A 40-year-old woman experienced worsened patellofemoral instability post-tibia fracture intramedullary nailing.
- The surgical approach utilized was a semiextended position via a partial medial parapatellar route.
Findings:
- Surgical intervention including intramedullary nail removal, medial patellofemoral ligament repair, and tibial tubercle transposition resolved instability.
- The patient achieved restored patellar stability and asymptomatic knee function.
Implications:
- The medial parapatellar approach in semiextended position may exacerbate patellofemoral instability in susceptible patients.
- Further research is needed to define optimal surgical techniques for tibial intramedullary nailing in patients with pre-existing patellar instability.
