Background: Tibial nailing is a standard treatment of tibial fracture. Placing the nail in the wrong position will\r\nresult in poor fracture alignment and potentially damage to cortical bone. But the exactly entry point of this technique\r\nin Thai people has never been studied. In Chiang Mai University hospital, a tibial SIGN nail is commonly used in\r\ntibial shaft fracture.\r\nObjective: To identify the accurate entry point for tibial nailing with tibial SIGN nail, defined as the point which\r\nwill provide adequate fracture alignment.\r\nDesign: Cadaveric study\r\nMethods: Twelve cadavers with attached knee joints underwent tibial nailing with tibial SIGN nails. After\r\nplacement of the nail, the specimens underwent osteotomies at the level of 10 centimeters distal to the articular\r\nsurface. Multiple entry points were tested to determine fracture alignment. Medialââ?¬â??lateral and anteriorââ?¬â??posterior\r\ndisplacements from plain radiography were recorded for these various points of entry.\r\nResults: In coronal plane, the entry point at the sixty percent from medial edge of tibial plateau was identified as\r\nminimizing the medial-lateral displacement of the tibial shaft following fracture. In sagittal plane, the entry point of 20\r\nmm posterior to the tibial tubercle resulted in the least anterior-posterior displacement.\r\nConclusion: When tibial nailing with tibial SIGN nail was used, the entry point of 20 mm posterior to the tibial\r\ntubercle and sixty percent of the total distance from medial tibial plateau provided the accurate balance of fracture\r\nreduction.
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