Orthopaedic Surgery

Answer 2 A proximal third metaphyseal fracture. Nailing of proximal third metaphyseal tibial fractures has been associated with a very high rate of malreduction. One series showed these fractures to have a residual deformity of greater than 5 degrees angulation in 84% of cases at postoperative follow-up.1 Technical errors leading to malalignment are generally associated with a medialized entry portal and posteriorly and laterally directed trajectory of the rod. Techniques to avoid malalignment include placement of an adjunctive antiglide plate at the fracture apex and use of the semiextended knee position at the time of nail insertion. In general, alternative methods of treating proximal third metaphyseal fractures should be considered prior to intramedullary rodding. REFERENCE 1. Lang GJ, Cohen BE, Bosse MJ, Kellam JF: Proximal third tibial shaft fractures: should they be nailed? Clin Orthop 1995;315:64-74. Click here to return to the questions

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