[Intramedullary nailing of the tibia : Tips and tricks in borderline indications]

The indications for tibial nailing are increasingly extending into periarticular regions, often under critical and challenging soft tissue conditions. Furthermore, due to the demographic development fractures of compromised osteoporotic bone must increasingly be surgically treated.Suprapatellar and parapatellar approaches have emerged as effective alternatives to the traditional infrapatellar approach, which simplify the operative technique of reduction and nail insertion, reduce the duration of intraoperative fluoroscopy time and yield improved reduction outcomes particularly in complex periarticular fractures.The insertion of the intramedullary locking nail into the medullary canal does not automatically guarantee an adequate reduction outcome. This article outlines key operative tips and tricks aimed at supporting the orthopedic surgeon in obtaining reproducible optimal surgical outcomes especially in borderline indications.Technological advancements in nail design and fixation methods enable more reliable and precise reduction even in complex cases, especially with fractures involving short metaphyseal fracture fragments. This article also addresses the specific requirements for achieving stable intramedullary fixation.