Terminal position of a tibial intramedullary nail: a computed tomography (CT) based study
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ORIGINAL ARTICLE
Terminal position of a tibial intramedullary nail: a computed tomography (CT) based study Adam Phillip Schumaier1 · Frank Roman Avilucea2 · Brendan Ryan Southam1 · Preetha Sinha1 · Theodore Toan Le1 · John Dwight Wyrick1 · Michael Thomas Archdeacon1 Received: 30 June 2018 / Accepted: 20 August 2018 © Springer-Verlag GmbH Germany, part of Springer Nature 2018
Abstract Purpose The purpose of this study is to characterize the distal anatomic end-point of a tibial intramedullary nail placed using modern surgical techniques. The goal is to improve reduction of distal tibia fractures. Methods An intramedullary nail was placed in 14 skeletally mature legs. This included 8 patients with mid-shaft tibial fractures and 6 intact cadaveric legs. Each nail was a titanium cannulated tibial nail, size 10- or 11-mm. The nails were placed using a suprapatellar or transpatellar approach with an ideal starting point. All legs received post-nail insertion CT scans and fluoroscopy. The main outcome measure was the terminal location of the nail just proximal to the distal tibial physeal scar, as seen on axial CT and fluoroscopic views of the ankle (mortise and lateral). The end-point was measured as the (1) ratio of medial–lateral tibial width (ML ratio) and (2) ratio of anterior–posterior tibial width (AP ratio). Two-tailed Welch’s t tests were used to compare the actual, observed position of the nail to the hypothesized center–center position (H0 = ML and AP ratio of 0.5). Results All enrolled patients (n = 8) and cadaveric legs were included (n = 6). On axial CT, the average distance from the medial tibial cortex to the nail center as a ratio of medial–lateral tibial width was 0.63, 95% CI 0.60–0.67, p
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