Intramedullary fixation is valuable and appropriate for the majority of tibial fractures. It is well-suited for the mid diaphysis. With newer nail designs and attention to technique, nailing can be extended to both proximal and distal extraarticular fractures.
If the medullary canal is deformed (e.g. prior fracture, or developmental abnormality) nailing may not be possible.
If severe bacterial contamination or infection are present, nailing may spread infection through the medullary canal, and should be avoided. External fixator pins are a common source of contamination. If such pins appear to be infected, or have been present for more than 2-3 weeks, preliminary pin removal, debridement, and antibiotics may be advisable before nailing.
Intramedullary nailing in severe trauma may cause respiratory distress.