Tibial intramedullary nailing in the lateral decubitus position: Technical notes and preliminary clinical outcomes

BACKGROUND: Traditional intramedullary nailing (IMN) for tibial shaft fractures through an infrapatellar approach is typically performed in the supine position and requires a specially designed operative table and an experienced assistant throughout the surgery. We attempted to perform IMN for tibial fractures in the lateral decubitus position to make the process easier both for surgeons and radiographers. METHODS: A total of 36 tibial IMN procedures were performed with the patient in the lateral position from May 1, 2014 to April 30, 2016. The technical feasibility and early results were evaluated. RESULTS: The mean time to complete the nailing procedure during surgery was 78.4 ± 1.1 min. The mean intraoperative time for fluoroscopy was 36.7 ± 1.1 min. No radiographic angular malalignment or bone non-union was reported. No surgical site infections or other surgery-related complications occurred in our series. CONCLUSION: Tibial IMN through an infrapatellar approach in the lateral decubitus position may be a valuable alternative as it simplifies the procedure for both surgeons and radiographers. This technique is highly effective for surgical operation and fluoroscopy compared to traditional supine position. This technique also seems to provide satisfactory clinical and radiographic outcomes in our preliminary clinical outcomes.