Intramedullary nailing of proximal third tibial fractures: techniques to improve reduction.

Obtaining and maintaining an acceptable reduction of proximal third tibial fractures can be problematic. Deforming forces acting on the proximal fragment and the spaciousness of the intramedullary canal at this level contribute to this challenge during intramedullary nailing. Several surgical techniques have been developed to address this problem, including the use of a more lateral and proximal starting point, adjunctive plate fixation, blocking screws, semiextended nailing, and most recently the use of a retropatellar portal approach. Familiarity with these techniques is critical to achieve satisfactory results when nailing proximal third tibial fractures.