Anatomical Characteristics of the Tibial Medullary Canal and Their Implications for Intramedullary Fixation

The use of intramedullary fixation methods in the tibia is limited by the anatomical characteristics of this bone. In this study, the shape and degree of axial lateral rotation of the medullary canal were determined in 45 human dry cadaver bones using X-ray and computed tomography examinations and direct measurement of rotation in inserted nails. Forty bones (88.8%) had slight and five bones (11.1%) had excessive anterior bowing along the tibial shaft. Six of the 45 bones (13.3%) had an extremely narrow medullary canal. Axial lateral rotation was demonstrated in the middle third of the medullary canal, being on average (± SD) 32.35 ± 16.25° (range 10-75°). This study revealed that extreme narrowing of the medullary canal, axial lateral rotation of the medullary canal, and extreme anterior bowing of the tibial shaft are the anatomical characteristics most likely to cause difficulties when using intermedullary fixation in the tibia.

[1]  C. Krettek,et al.  Experimental study of distal interlocking of a solid tibial nail: radiation-independent distal aiming device (DAD) versus freehand technique (FHT). , 1998, Journal of orthopaedic trauma.

[2]  M. Alms.  Medullary nailing for fracture of the shaft of the tibia. , 1962, The Journal of bone and joint surgery. British volume.

[3]  M. Chapman,et al.  Nonreamed Locking Intramedullary Nailing for Open Fractures of the Tibia , 1997, Clinical orthopaedics and related research.

[4]  C. Krettek,et al.  The mechanical effect of blocking screws ("Poller screws") in stabilizing tibia fractures with short proximal or distal fragments after insertion of small-diameter intramedullary nails. , 1999, Journal of orthopaedic trauma.

[5]  M. Itoman,et al.  Closed intramedullary osteotomy for rotational deformity after long bone fractures , 1997, International Orthopaedics.

[6]  R. Brumback.  The rationales of interlocking nailing of the femur, tibia, and humerus. , 1996, Clinical orthopaedics and related research.

[7]  C. Krettek,et al.  Biomechanical study of nine different tibia locking nails. , 1996, Journal of orthopaedic trauma.

[8]  B. Cunningham,et al.  Stability of reamed and unreamed intramedullary tibial nails: a biomechanical study. , 1995, Injury.

[9]  D. Seligson,et al.  Difficulty in Removal of Certain Intramedullary Nails , 1997, Clinical orthopaedics and related research.

[10]  B. Riemer,et al.  Comparison of Reamed and Nonreamed Solid Core Nailing of the Tibial Diaphysis After External Fixation: A Preliminary Report , 1993, Journal of orthopaedic trauma.