Suprapatellar technique may provide successful alignment in proximal tibia fractures
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WAIKOLOA, Hawaii — The suprapatellar nailing technique for proximal tibia fractures can be successful with a good starting and end point, fracture reduction and use of a sizable nail, according to a presenter here.
In his presentation at Orthopedics Today Hawaii, Cory A. Collinge, MD, said that to obtain “good nailing” in proximal tibia fractures, surgeons need to have a good starting point by moving the patella anteriorly, placing the pin in the right direction and reaming over the pin without deviating from that direction. He added the leg should be placed in a semi-extended position, which allows for an easier X-ray and reduction.
“With the leg in the semi-extended position, you should get a nice, relaxed starting point,” Collinge said. “That has evolved into suprapatellar nailing.”
Use of a sizable nail is important to obtain good alignment, especially among isthmal fractures, according to Collinge. For proximal tibia fractures, Collinge noted use of the semi-extended approach and the suprapatellar nailing technique may neutralize muscle forces and provide better alignment.
When there is trouble with alignment, Collinge said surgeons can use percutaneous clamps to hold the proximal tibia fracture in place while inserting the nail. Another option would be to use blocking screws, according to Collinge.
“Put in a screw where your nail is going to go, the blocking screw will then pivot out of the way and correct, hopefully, the malalignment problem and it provides some extra stability to prevent things from moving back to a malaligned position,” Collinge said.
He added surgeons can also use a unicortical plate for alignment issues.
“If you’re struggling, make a little incision, put a third tubular plate or a little reconstruction plate on with unicortical screws out of the way of your nail and it’ll hold the position of your fracture proximally while you insert the nail,” Collinge said.
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Collinge CA. Proximal tibia nailing: Suprapatellar nailing tips and tricks. Presented at: Orthopedics Today Hawaii 2022. Jan. 9-13, 2022; Waikoloa, Hawaii.
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