Pro Tip for Preventing Rotation During IM Nailing of the Tibia

Here's how to use fibular displacement as a proxy for tibial malrotation

What’s the Claim?

A neat image analysis based on CT scans of 50 patients with normal tibial anatomy simulated the effect of tibial rotation on the amount of fibular overlap in a simulated tib-fib fracture. The authors did this at three levels: mid-diaphyseal, as well as the junction of the proximal and middle 1/3, and the junction of the middle and distal 1/3. They found that when fibular contact was lost on either the AP or lateral view, ≥20° of tibial malrotation was likely present; conversely, ≥50% loss of fibular contact should raise one’s suspicion for tibial malrotation of ≥10°.

  • Most practically, a well-fixed fibula and an IM rod down the canal precludes any substantial tibial malrotation.

How’s It Stack Up?