Uses
-IMN tibial shaft fractures
Positioning
-Fracture table: Supine, Hip flexed 60deg, knee flexed 100-120deg+traction (boot or traction pin) No tourniquet!
-Free Leg Position: Supine, remove end table, injured leg flex over side, contralateral leg in support - flexed and abducted. No tourniquet!
Landmark - inf pole of patella, medial border of patellar tendon
Incision - 5cm incision from inf pole patella to tibial tubercle - in line with medial border patellar tendon
Internervous plane - None
Superficial Dissection
-Subq tissues
-Numerous small vessels to coagulate
-Incise fascia superior to patellar tendon
Deep Dissection
-Retract patellar tendon laterally
-Expose deep infrapatellar bursa
-Determine entry point at prox end tibia at junction of ant/sup aspects of the bone
-Entry is extrasynovial
Dangers
-infrapatellar branch saphenous nerve
-popliteal vein - if supports are in popliteal fossa
-ACL insertion/ant. horn MM if nail too post
-medial=valgus
-lateral=varus
-beware cortical bone
-patellofemoral joint if knee is not flexed enough
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