Tibial nail length

Several methods exist to decide on tibial nail length

• Tibial tuberosity to medial malleolus - TMD

• Body height

• Medial knee joint line to medial malleolus - MM

• Knee joint line to ankle joint line (medial) - JJm

Venkateswaran et al showed

Medial knee joint line to medial ankle joint line JJm -2cm was the most reliable formula.

The JJm is measured with the knee flexed and ankle dorsiflexed with the leg in external rotation.

The proximal bony landmark is two fingerbreadths medial to the edge of patellar tendon. This tibial crest can be best palpated with
leg in external rotation. The distal measurement is to the distal rim of the tibial plafond with ankle dorsiflexed.

Alternatively or to check you can use

Medial knee joint line to medial malleolus - MM - 4 cm

Forearm referencing

Blair showed how it is possible to calculate the range of nails needed:

OMD was the longest nail needed and generally

OMD = Olecranon to head of 5th Metacarpal with elbow flexed and clenched fist

Nail length range (OMD - 50mm) to OMD
For example, if the OMD was measured at 340 mm
then the nail range required is from 290 (340 50 mm) to 340 mm. The author has measured the
forearm reference in 10 cases of tibial nailing. In all
cases, the length of nail used was within the range
estimated from the forearm.

References

An easy and accurate preoperative method for determining tibial nail lengths, Injury, Volume 34, Issue 10, October 2003, Pages 752-755, B. Venkateswaran, R. M. Warner, N. Hunt, D. L. Shaw, N. Tulwa and P. Deacon
 

Estimating tibial nail length using forearm referencing, Injury, Volume 36, Issue 1, January 2005, Pages 160-162, Stephen Blair

Page created by: Lee Van Rensburg

Last updated: 11/09/2015