Nail length is estimated preoperatively, but intraoperative measurement is more precise. Use a radiographic ruler, provided with the nail’s instruments. With the fracture reduced, measure the distance from the planned nail entry site to just above the ankle joint.
Select a nail that extends from the distal tibia to the entry site without protruding above the bone surface. Nail length may be critical for distal fractures. Some nails have proximal extensions of different lengths, that can be added after insertion to correct for an excessively short nail.