Non-Articular Tibia Fractures

**69**

**Chapter 4**

**Abstract**

**1. Introduction**

tion and functional outcomes.

achievement of these goals.

**2. General preparation and positioning**

Far Proximal and Far Distal Tibial

*Luis Bahamonde, Alvaro Zamorano and Pierluca Zecchetto*

Operative treatment of tibial fractures located at the proximal metaphysealepiphyseal and distal metaphyseal-epiphyseal areas, including those with articular extensions, is a technical challenge. Common methods for surgical management include plates (locking and nonlocking), external fixation devices, and intramedullary nails. All these methods have shown satisfactory results in terms of quality of reduction and clinical and radiological outcomes. The authors present some technical methods and strategies that have been useful for the surgical approach, reduc-

Tibial fractures located in the proximal and distal meta-epiphyseal areas pose a technical challenge for surgical management [1, 2]. A very proximal or distal fracture fragment, which may include intraarticular involvement, is difficult for proper reduction and alignment with the diaphysis [3], and at times, there is little bone stock available for solid fixation, either with plates or with nails. Aside from this, the soft tissue envelope is tenuous – especially at the distal tibia – and may result in damage due to trauma [4]. The evaluation of the quality of soft tissues is key when selecting any method for surgical treatment. Common surgical techniques include plates (either locking or nonlocking), locked intramedullary nails, and external fixators [5, 6]. These methods have shown good results in terms of quality of reduc-

Intramedullary nailing (extreme nailing) is a competent method for the management of these difficult injuries [1]. Careful planning and surgical technique are essential for good reduction and stable fixation [7]. The authors present some strategies, technical considerations, and methods that have been useful for the

Positioning of the patient is the first and at the same time critical aspect to be considered that influences the final surgical result. For conventional, transpatellar or parapatellar intramedullary nailing, the senior author (LB) uses a thigh holder

tion, and fixation of these lesions with the use of locked nails.

**Keywords:** proximal, distal tibial fractures

Fractures: Management with

Intramedullary Nails

### **Chapter 4**
