Using a distractor
A large distractor is usually placed in a coronal plane. It lies posterior to the tibia, either laterally or medially. Do not obstruct planned locking screws or x-rays.
The proximal Schanz screw must be proximal and sufficiently posterior to avoid blocking the nail. Place it parallel to the tibial plateau to aid proximal fracture alignment. The distractor’s distal pin should be outside the intended nail location, posteriorly in the distal tibia, or in the talus.
An external fixator may be used instead of the distractor. Pin placements are the same.