Extreme Nailing or Less Invasive Plating of Lower Extremity Periarticular Fractures

Intramedullary nailing of periarticular lower extremity fractures is difficult, even in the hands of skilled fracture surgeons who manage these injuries on a routine basis. The further toward the articular surface the fracture extends, the more difficult the injury becomes to stabilize with a nail. These challenging fractures often benefit from stabilization with a nail when feasible, because an intramedullary nail affords load-sharing properties not seen with a load ? Extreme nailing requires sufficient bone to allow for multiple interlocking screws- otherwise choose a plate. ? Soft tissue injury can be more critical than the fracture pattern when determining whether to plate or nail a periarticular fracture. ? Clamps and temporary K-wires are an effective strategy to convert C type fractures into A type fractures before nailing. Then place lag or position screws to avoid crowding.

Automated summary

Intramedullary nailing for periarticular lower extremity fractures is difficult, especially as the fracture extends closer to the joint surface. Factors such as bone condition, soft tissue injury, and fracture pattern need to be considered when deciding between using a nail or a plate.