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Proximal Tibia

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Book cover Intramedullary Nailing

Abstract

Fractures of the proximal metaphysis and of the proximal third of the tibia shaft represent a minority of tibia fractures. Intramedullary nailing is discussed controversially because of the risk of malalignment. Nevertheless, the biomechanical and biological advantages of intramedullary nailing are also valid for fractures of the proximal tibia. The fracture needs reduction before the nailing procedure is started. Reduction is done with the help of pointed reduction forceps, Schanz’ screws, cerclage wires, and secured with lag screws, K-wires or a small plate. The choice of the correct entry portal is of utmost importance for good alignment. The safe zone for tibia nail insertion is located in front of the lateral tibial spine. The recently described suprapatellar entry portal is a promising alternative to the conventional infrapatellar approach. Slight reaming, the use of a guide wire and a cannulated nail are recommended. Poller screws may help to guide the nail into its correct position. The proximal fragment should be fixed with three interlocking screws in different directions. Outcome is excellent if the procedure has been performed successfully and stable fixation obtained.

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Authors and Affiliations

  1. Center of Orthopedics and Traumatology, University Medical Center, Johannes Gutenberg-University, Langenbeckstrasse 1, Mainz, 55131, Germany

    Pol M. Rommens MD, PhD

  2. Department of Orthopaedic and Trauma Surgery, Academic Teaching Hospital Fulda, Pacellialllee 4, Fulda, D-36043, Germany

    Martin H. Hessmann MD, PhD

Authors
  1. Pol M. Rommens MD, PhD
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  2. Martin H. Hessmann MD, PhD
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Correspondence to Pol M. Rommens MD, PhD .

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Editors and Affiliations

  1. Center for Orthopedics &Traumatology, University Medical Center Johannes Gutenberg University, Mainz, Germany

    Pol M. Rommens

  2. Academic Teaching Hospital Fulda, Fulda, Germany

    Martin H. Hessmann

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Rommens, P.M., Hessmann, M.H. (2015). Proximal Tibia. In: Rommens, P., Hessmann, M. (eds) Intramedullary Nailing. Springer, London. https://doi.org/10.1007/978-1-4471-6612-2_21

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  • DOI: https://doi.org/10.1007/978-1-4471-6612-2_21

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