Primary rigid intramedullary nailing for fractures of the tibia: current concepts and technique

Intramedullary nailing of tibial shaft fractures is the preferred treatment of many tibial shaft fractures—displaced and undisplaced, open and closed, simple and multi-fragmentary. In this paper we address several important issues relating to the concepts of the procedure and review the literature available: reaming of the intramedullary cavity; the problems of achieving stability with metaphyseal fractures; achieving fracture reduction; the issue of the ideal entry point; the complications that can occur; and the timing of surgery.