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Updated: Jan 14, 2026

An Intramedullary Locking Nail for Standardized Fixation of Femur Osteotomies to Analyze Normal and Defective Bone Healing in Mice
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Extreme nailing: standardized definition and outcomes.

Abhishek Ganta1,2, Fiona Cherry3, Nirmal Tejwani3

  • 1New York University Langone Medical Center, New York, USA. abhishek.ganta@nyulangone.org.

European Journal of Orthopaedic Surgery & Traumatology : Orthopedie Traumatologie
|October 24, 2025
PubMed
Summary

Extreme tibial nailing is feasible for fractures extending to the bone ends. This intramedullary nailing technique shows acceptable alignment and healing outcomes, despite some complications.

Keywords:
Distal fractureIntramedullary nailMetaphysealProximal fractureTibia

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Area of Science:

  • Orthopedic Surgery
  • Trauma Surgery
  • Bone Fracture Management

Background:

  • Tibial fractures extending to the proximal or distal ends pose treatment challenges.
  • Intramedullary nailing is a common treatment, but its feasibility in extreme cases requires definition.

Purpose of the Study:

  • To define "extreme tibial nailing" and assess its feasibility.
  • To evaluate outcomes of tibial intramedullary nailing for fractures involving the nail's locking zone.

Main Methods:

  • Retrospective review of 555 tibia fractures from a single academic center.
  • Defined "extreme nailing" as fractures within the proximal/distal 25% of the tibia, involving the nail's locking bolt zone.
  • Excluded patients with supplemental periarticular plating.

Main Results:

  • Twenty-five "extreme IMN" cases were analyzed (mean age 45.8 years, 72% female).
  • High-energy (50%+) and open fractures (40%) were common.
  • Complications included fracture-related infection (12%), nonunion (20%), and reoperation (32%). Malalignment occurred in 8%.

Conclusions:

  • Tibial intramedullary nailing is effective for extreme tibial fractures extending to articular surfaces.
  • The majority of patients achieved acceptable alignment and radiographic union within 6 months.
  • This technique demonstrates feasibility with manageable complication rates.