Sanjay JosephEven in experienced hands the high shaft fractures tend not to retain reduction after nail placement. The proximal fragment tends to angulate anteriorly. Suggest minimally invasive long proximal tibial locking plate.
Abdullrab AlmarwanyaGreat thanks for presenting this case : This fracture pattern indicats high energy trauma that necessiate starting the management following the ATLS guide line air way ,breathing ,circulation, primary and secondary survey , (cervical spine, chest and pelvic x ray). After stabilization of the patient general condition ,excluding life threatening injuries: look for associated neurovascular, soft tissue and other skeletal injuries( following the principle of x-ray (2 view ,2 joint ). Finally and after good planing one could suggest ORIF using unreamed interlocked nail taking into consideration the tendency for a medial and anterior nail entrance angle in a proximal third tibia fracture in producing a procurvatum and valgus deformity. In addition, the pull of the quadriceps tendon, which is typically on the proximal fragment, tends to produce an apex anterior deformity. To prevent apex anterior deformity, a locking screw is placed from medial to lateral just posterior to the intended ideal posterior location of the intramedullary nail.To prevent valgus angulation, a blocking screw should be placed just lateral to the central axis of the tibia. As the nail is passed medial to the locking screw, the deformity is corrected. Thanks.
Gopal GoelReduce proximal # and go for unicortical plating. once done carefully for for nailing with proximal and lateral entry( Lat to lat tibial spike). Try to do nailing in extension ( As much as possible)
Jitender PalTwo options: 1. Nail- etn, but u can use a GK pattern il tibial nail, with or without polar screw. 2. Mippo with long lcp Choice is yours. Reduction is paramount. LAR. Length alignment rotation are to be restored chose the method u r comfortable with.
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