Intramedullary Nailing for Tibial Shaft Fractures

Preoperative Considerations

• Assess fracture pattern, location, and presence of comminution through appropriate imaging to determine optimal nail length and diameter, and evaluate for associated injuries, especially in cases of high-energy trauma, considering temporary external fixation followed by delayed definitive intramedullary nailing once the patient is stabilized, and for isolated tibial shaft fractures without severe associated injuries, early definitive osteosynthesis within the first 24 hours is recommended to reduce local and systemic complications 1
• For patients with severe associated injuries, circulatory shock, or respiratory failure, consider temporary external fixation followed by delayed definitive intramedullary nailing once the patient is stabilized, and in cases of severely comminuted fractures or those with bone loss, consider staged procedures with temporary external fixation followed by definitive nailing once soft tissues have recovered 1