Opening the Tibia, cont'd.
Confirm nail length

Click on images for enlarged views

The distal tip of the ruler should align with the
physeal scar (or desired nail insertion depth).


AP image of proximal tibia
Position the image intensifier for an AP view of the distal tibia. With a long forceps, hold the ruler alongside the leg, parallel to and at the same level as the tibia. Adjust the ruler until the distal tip is at the level of the physeal scar or the desired nail insertion depth. Mark the skin at the bottom of the ruler.

Move the image intensifier to the proximal tibia, replace the distal end of the ruler at the skin mark, and take an AP image of the proximal tibia. Read nail length directly from the ruler image, selecting the measurement at or just below the level of the anterior edge of the tibial plateau.

When using the Large Distractor, measure the distance from the inferior border of the distal pin to the superior border of the proximal pin to determine optimal nail length.

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