Intramedullary nail fixation is useful for some distal tibia fractures. Reduction requires careful planning, positioning, and mechanical aids. The fracture must be reduced before the nail is placed across it. A tourniquet is rarely necessary.
The patient is supine. Position the injured leg with the knee flexed at
least 90°. The thigh is supported on a padded rest so that the fracture may be
manipulated. Alternatively, an external fixator or distractor may hold the
fracture reduced while the foot rests on the table surface. The uninjured leg
Place the image intensifier on the opposite side of the table.
Radiolucent table with knee support
If a radiolucent table with a knee support is used, the padding should be
under the distal femur (not compressed under the popliteal fossa).
A traction table may be helpful, particularly if a skilled assistant is not
available. Countertraction is provided by well-padded support under the distal
The leg position should allow AP and lateral fluoroscopy with the image
intensifier on the opposite side of the table.