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Natoli RM, Sardesai NR, Richard RD, et al. Intramedullary Nailing of Lower-Extremity Periarticular Fractures. JBJS Essent Surg Tech. 2019;9(4)doi: 10.2106/JBJS.ST.18.00112.
Natoli, R. M., Sardesai, N. R., Richard, R. D., Sorkin, A. T., Gaski, G. E., & Virkus, W. W. (2019). Intramedullary Nailing of Lower-Extremity Periarticular Fractures. JBJS essential surgical techniques, 9(4), . https://doi.org/10.2106/JBJS.ST.18.00112
Natoli, R M, et al. "Intramedullary Nailing of Lower-Extremity Periarticular Fractures." JBJS essential surgical techniques vol. 9,4 (2019). doi: https://doi.org/10.2106/JBJS.ST.18.00112
Natoli RM, Sardesai NR, Richard RD, Sorkin AT, Gaski GE, Virkus WW. Intramedullary Nailing of Lower-Extremity Periarticular Fractures. JBJS Essent Surg Tech. 2019 Nov 01;9(4). doi: 10.2106/JBJS.ST.18.00112. eCollection 2019. PMID: 32051781; PMCID: PMC6974312.
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JBJS Essent Surg Tech. 2019 Nov 01;9(4). doi: 10.2106/JBJS.ST.18.00112. eCollection 2019.

Intramedullary Nailing of Lower-Extremity Periarticular Fractures.

JBJS essential surgical techniques

R M Natoli, N R Sardesai, R D Richard, A T Sorkin, G E Gaski, W W Virkus

Affiliations

  1. Indiana University Health Methodist Hospital, Indianapolis, Indiana.

PMID: 32051781 PMCID: PMC6974312 DOI: 10.2106/JBJS.ST.18.00112

Abstract

Intramedullary nailing is used to stabilize distal femoral, proximal tibial, and distal tibial periarticular fractures with short proximal or distal segments, as well as some intra-articular fractures in which a stable articular block can be created. Intramedullary nailing may be beneficial in complex fracture patterns with diaphyseal extension, segmental injuries, or patients who might benefit from a decreased incision burden. Step 1: Preoperative planning. Review imaging and make sure there is a nail with adequate interlocks. Consider the use of adjunctive techniques to obtain and maintain alignment, and how intra-articular fracture lines will be stabilized. Step 2: Position and prepare the patient. Step 3: Exposure for nailing via suprapatellar, infrapatellar, or knee arthrotomy approaches. Limited exposure of fracture planes may also be necessary for adjunctive techniques. Step 4: Convert an OTA/AO C-type fracture to an A-type fracture if needed. Step 5: Obtain appropriate starting point and trajectory with the nail starting wire and use the opening reamer. Step 6: Obtain reduction, if not yet done, and pass the ball-tipped reaming wire across the fracture. Step 7: Ream while holding reduction. Step 8: Pass nail. Step 9: Verify reduction is maintained and correct if needed. Step 10: Place interlocks, preferably multiplanar, in the short segment. Create a fixed angle construct if desired and convert adjunctive techniques/provisional fixation to definitive fixation as needed. Step 11: Perform final checks. Step 12: Closure. Step 13: Postoperative plan. For extra-articular fractures, one may expect healing with maintained alignment from what was present at the case end intraoperatively in the vast majority of cases. For intra-articular fractures, development of posttraumatic arthritis is an additional concern.

Copyright © 2019 by The Journal of Bone and Joint Surgery, Incorporated.

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