Definition and Determination of the Correct Tibial Entry Portal With Accuracy in Intramedullary Nailing of Tibial Fractures.

Background Tibial shaft fractures, frequently caused by high-energy trauma, significantly challenge orthopedic trauma management. Intramedullary interlocking nailing, favored for its biomechanical advantages and reduced complications, critically depends on accurately identifying the tibial entry portal to ensure optimal alignment and functional outcomes. Methodology A prospective observational study was designed to evaluate the optimal tibial entry portal for improving alignment outcomes in patients undergoing intramedullary nailing (IMN) for tibial shaft fractures. Conducted at Mahatma Gandhi Medical College and Hospital, Jaipur, the study included 32 adult patients with tibial fractures suitable for IMN. Radiological outcomes and alignment accuracy were assessed at nine-month follow-ups. Results Participants had a mean age of 44.63±18.17 years; men predominated (18, 56.3%). The primary injury cause was road traffic accidents (18, 56.3%) and surpassed falls (14, 43.8%) and fracture types were predominantly closed (20, 62.5%), with notable representation of Arbeitsgemeinschaft für Osteosynthesefragen (AO) types 42 A (11, 34.4%) and 42 C (10, 31.3%). Surgical approaches were evenly distributed (16, 50% suprapatellar; 16, 50% infrapatellar). Coronal and sagittal plane malalignments were prevalent, with significant variations linked to entry portal positioning. Complication rates remained low, with delayed union and infection each observed in only one (3.1%) case. Conclusion Critical factors influence tibial alignment post-surgery, emphasizing precise entry point selection to reduce malalignment complications and improve patient outcomes.