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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