Intramedullary Nailing of the Tibia

Indications

  • Displaced diaphyseal tibial fractures
  • Open fractures after debridement
  • Nailing of tibial shaft fractures gives faster mobilisation than casting
  • Contraindicated in a narrow canal or open physes

Position

  • Supine, knee flexed over a radiolucent triangle, or semi extended position
  • Image intensifier on the opposite side
  • Check rotation against the other leg

Operative Steps

  1. Entry point just medial to the lateral tibial spine on AP and at the anterior edge of the plateau on lateral
  2. Infrapatellar, transpatellar or suprapatellar approach
  3. Pass a ball tip guide wire across the reduced fracture
  4. Ream to 1 to 1.5 mm above nail size
  5. Insert the nail and lock proximally and distally
  6. Use blocking screws or plating for proximal and distal third fractures
  7. Suprapatellar nailing in semi extension eases reduction of proximal fractures
  8. Measure length and avoid distraction at the fracture
  9. Lock statically, with dynamisation later for delayed union

Postoperative Care

  • Weight bear as tolerated for stable patterns
  • Monitor for compartment syndrome
  • Early knee and ankle motion
  • Radiographs at 6 and 12 weeks
  • Union at about 4 to 6 months

Complications

  • Anterior knee pain
  • Valgus and procurvatum malalignment in proximal fractures
  • Compartment syndrome
  • Nonunion and infection
  • Malrotation
  • Fat embolism with reaming
  • Neurovascular injury from distal locking screws

Related Pages

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.