1. DISCUSSION OF IM NAILING OF TIBIAL FX.

2. PREPARATIONS & PLANNING:
1-closed or open
2-degree of comminution
3-alignment of fracture
4-comp. syndrome
5-x-ray st. need CTscan

3. POSITIONING:
Supine-----prep. & drepe with full accessto foot & ankle.( lengh, rotation& alignment)

4. APPROCHES :
-medial parapatellar APP.
-lateral parapatellar APP.
-patellar tendon splitting APP.
-suprapatellar APP.
Guidepin starting point medial to lateral tibial spine in AP view.& use starting point reamer to open canal.

5. Starting pin & reamer------guide wirt in T – handle
Reduction
AP & Lat. Views
Reaming
Insert nail manually as much as possible
Then remove guide wire before insertion of IL screws.

6. Irrigation & heamostasis
Tissue closure—skin closure & dressing
Postop. Care:
1-check for c.s
2- wt. bearing
3-exercise of knee joint.
4- DVT prophylaxis.

7. Complications:
1-knee joint pain
2-symp. Prominent of screws.
3- malunion, non-union & mal rotatoin
4- c. s
5- infection