Tibial Shaft Fracture: Intramedullary Nail

Fixation of a tibial shaft fracture with a nail inserted from the top of the tibia, over a guide wire, after reaming. The surgeon chooses the approach (infrapatellar, parapatellar or suprapatellar) and keeps the fracture reduced throughout.

Position and prep

Supine on a radiolucent table; knee flexed over a triangle or bump, or nearly straight for a suprapatellar approach; C-arm from the opposite side.

Prep: Leg from the upper thigh to the toes.

Room setup

C-arm and lead for everyone in the room
Power reamer and drill (tested, batteries fresh)
Radiolucent triangle or bump
Tibial nail system: nails, insertion jig, reamers, guide wires
Suprapatellar sleeve set if that approach is used

Implants

Tibial nail: length and diameter measured during the case
Proximal and distal interlocking screws
End cap per surgeon

Instruments

Entry awl or entry reamer
Ball-tipped guide wire and guide wire pusher or holder
Flexible reamers in order
Nail insertion handle and jig, aiming guides
Reduction tools: pointed reduction clamps, bone holders, reduction finger per system
Mallet
Basic orthopedic tray

In the free instrument guide: Verbrugge Bone Holding/Reduction Forcep, Orthopedic mallet, Drill, Army-Navy Retractor.

How the case runs

Time-out, including laterality; estimate nail length from the other leg or a ruler under images
Incision for the chosen approach; protect the patellar tendon and joint
Entry point with a guide pin or awl; images AP and lateral; open the canal
Reduce the fracture; pass the ball-tipped guide wire across it; images

The rest of the case is in the app

5 more steps, the Mayo setup, draping order, closing, pearls, and a three-stage “what would you do next?” case. Free to start.

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Clinically reviewed by William Guglielmo on October 15, 2026. Generic teaching content. Your surgeon's preference card, the implant system's technique guide and facility policy always come first.