Shinbone Fractures: Repair With a Bone Nail and Screws Animation

Shinbone Fractures: Repair With a Bone Nail and Screws Animation

This animation demonstrates the repair of a shinbone fracture, also known as a tibial shaft fracture, using a bone nail and screws. When the shinbone, or tibia, fractures in the middle part of the bone, called the tibial shaft, it can be treated with a bone nail and screws. A bone nail, also called an intramedullary nail, is a long metal rod that sits within the center portion of the bone, called the medullary canal. Bone nails are often locked in place with screws to provide support and stability.

The patient will be lying face up on the operating table with the knee bent. Here we can see a left leg with a fracture in the tibial shaft. There is also a fracture in the fibular shaft. The placement of this nail will provide the stability that both bones need to heal, so this break will likely not need any treatment. Before treatment with the nail, these fractures are aligned so that they will heal properly. This may need additional incisions for tools to hold the bones.

To begin the placement of the nail in the shinbone, an incision is made along the front of the knee through the skin and patellar tendon, which is below the kneecap. A guide is placed on the top of the shinbone at the starting location for the nail, and a guide pin is inserted through the guide. Then, the inner sleeve of the guide is removed, and a reamer is placed over the guide pin to drill a starting hole in the bone. The guide pin is removed.

Next, a longer guidewire is placed down the center of the shinbone. The length of the guidewire is measured to determine the length of the nail that will fit within the shinbone. Then, a series of reamers is drilled into the center of the shinbone over the guidewire to progressively make the path bigger, until it is the right size for the nail. The guide is removed.

The appropriately sized nail is inserted into the shinbone over the guidewire. It fits tightly, so it is gently malleted down the rest of the way. The guidewire is removed. A guide called a targeting guide is connected to the top of the nail and contains holes that align perfectly with the screw holes in the nail.

A nut and a drill guide are inserted into the targeting guide, with the tip of the drill guide resting on the shinbone. A drill is inserted through the drill guide and is used to make a hole for a screw that will lock the nail in place. The length of the hole is measured. The drill guide is removed, and the measured screw is screwed into place through the nail with a screwdriver. The screwdriver, drill guide, and nut are removed from the targeting guide.

Next, the bottom part of the nail near the foot will need to be locked in place. A small incision will be made along the side of the ankle. As before, a hole is drilled and measured, and a screw is placed into the bottom of the shin bone through the nail. These steps are repeated for the other screws.

To compress the fracture for healing, a bolt is placed into the targeting guide and turned until the fracture is compressed. The remaining screws at the top of the nail are inserted following the same steps: drilling and measuring the length of a hole and placing a screw through the nail. Now that the nail is locked in place, the compression bolt is removed. The targeting guide is disconnected from the nail. The skin incisions will be closed, and the procedure is complete.