Abstract

OBJECTIVES: To identify the ideal distal nail position in the distal tibia, using computed tomography (CT) analysis. METHODS: 3D models of 860 left tibiae were analysed using the Stryker Orthopaedic Modelling and Analytics software (SOMA, Stryker, Kiel, Germany). The nail axis was defined by seven centre points at the middle of the inner cortical boundary. Where this line fell relative to the centre of the tibial plafond in both the anteroposterior and mediolateral planes was calculated. RESULTS: The mean mediolateral offset of the tibial nail exit path was 4.4 ± 0.2mm (95% confidence interval) lateral to the centre of the tibial plafond. The mean anteroposterior offset of the tibial nail exit path was 0.6 ± 0.1mm anterior to the centre of the tibial plafond. CONCLUSIONS: We have presented an anatomic study analysing the ideal nail exit path using CT scans of 860 tibiae. We have defined the ideal nail exit path of a tibial nail is lateral with respect to the centre of the tibial plafond. This is supported by previous clinical studies and has significant implications for preventing malalignment when treating distal tibial fractures with intramedullary nailing. LEVEL OF EVIDENCE: Level IV. See Instructions for Authors for a complete description of levels of evidence.