Optimal use of transmedullary support screws and fibular management in distal tibial fracture nailing based on a new biomechanical classification.

Introduction: Based on a novel simple frontal view classification, a comprehensive concept for systematic management of intramedullary fixation of distal tibial fractures is introduced. Even the usage of thin (unreamed) nails allows for anatomic reduction and stable fixation if applied in combination with transmedullary support (TMS) screws. Our classification system guides the placement of the TMS screw (medial or lateral) and suggests whether to fix the fibula or not.

Locked nailing for the treatment of displaced articular fractures of the calcaneus: description of a new procedure with calcanail(®).

Although open reduction and internal fixation is considered the best method for treating displaced articular fractures of the calcaneus, lateral approach is at high risk for wound healing complications. For this reason, the authors developed a posterior approach and a new implant to perform both intrafocal reduction and internal fixation. The aim of this technical note is to describe this method of treatment for displaced articular fractures of the calcaneus, which offered the following advantages: (a) the creation of a working channel that provides also a significant bone autograft, (b) the intrafocal reduction of the displaced articular surface, (c) the insertion of a locking nail that maintains the reduced articular surface at the right height, (d) the possibility to switch from an ORIF to a reconstruction arthrodesis with the same approach and instrumentation in case of severely damaged posterior facet.