Preoperative Considerations

Nail Selection

Although definitive nail length and diameter are determined intraoperatively, nail selection should be part of the preoperative plan.

An approximate nail length is determined by measuring the patient from the knee joint to the ankle joint and subtracting 2 cm.

An approximate nail diameter is determined by measuring the isthmus of the affected medullary canal from an X-ray. If the isthmus is obliterated by the fracture pattern, a measurement is made from the contralateral side.

The Universal Tibial Nail Ruler, found in the Preoperative Planning Kit, may also be used to determine approximate nail size. The ruler depicts the nails 15% larger than actual size, to compensate for the magnification which occurs when taking an X-ray at the standard tube-to-film distance of one meter. Placing the ruler directly over the preoperative X-ray of the uninjured leg provides an estimation of nail length and diameter.

Based on these measurements, a minimum of three diameters of nails in three lengths should be made available for surgery.



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