Determination of the Best Method of Tibial Nail Length Estimation in Patients with Tibia Fracture


1 Assistant Professor of Orthopedics, Afzalipour School of Medicine, Kerman University of Medical Sciences, Kerman, Iran

2 Resident of Orthopedics, Afzalipour School of Medicine, Kerman University of Medical Sciences, Kerman, Iran


Background & Aims: Tibia fractures are the most common long bone fracture. Due to minimal soft tissue and its blood supply, inadequate treatment of injuries could be a major cause of morbidity and disability. The intramedullary nail is the preferred method of treatment; however, despite all previous studies, no accurate method to measure nail length prior to surgery exists as yet. Due to the importance of this issue in stability and alignment and reduction of operation time, in this study, we compared several methods of measuring tibia nail length. Methods: This was a cross-sectional study in which the nail length was estimated using different methods such as X-ray of the opposite leg, tubercle-medial malleolar distance (TMD), and olecranon to fifth metacarpal distance. In addition, the length of the tibia canal was measured using a metal rod during the surgery. Subsequently, the obtained results were compared. Results: None of the studied methods showed a significant difference between the estimation and the length of used nail. However, the results from the combination of the two methods of olecranon to fifth metacarpal and X-ray of the opposite leg had the closest correlation with the length of used nail. Conclusion:The aim of this study was to determine the best method of preoperative estimation of the length tibia canal for the reduction of operative time and better fracture fixation. Among these methods, the combination of olecranon to fifth metacarpal and opposite leg X-ray showed the strongest correlation.


  1. Rudloff MI. Fractures of the lower extremity. In: Canale ST, Beaty JH, Editors. Campbell's operative orthopaedics. Philadelphia, PA: Elsevier/Mosby; 2012. p. 2644, 2650-1.
  2. Benkalfate T, Chagneau F, Mauvoisin G, Poudens A, Levasseur M, Thomazeau H. ['Endolock' femoral and tibial nail. Concept and laboratory studies]. Acta Orthop Belg 1995; 61(Suppl 1): 177-83.
  3. Petrisor BA, Bhandari M, Schemitsch E. Tibia and fibula fractures. In: Rockwood CA, Bucholz RW, Court-Brown CM, Heckman JD, Tornetta P, Editors. Rockwood and green's fractures in adults. Philadelphia, PA: Lippincott Williams & Wilkins, 2010. p. 1883, 1890-1.
  4. Sledge SL, Johnson KD, Henley MB, Watson JT. Intramedullary nailing with reaming to treat non-union of the tibia. J Bone Joint Surg Am 1989; 71(7): 1004-19.
  5. Bong MR, Kummer FJ, Koval KJ, Egol KA. Intramedullary nailing of the lower extremity: biomechanics and biology. J Am Acad Orthop Surg 2007; 15(2): 97-106.
  6. Della Rocca GJ, Crist BD. External fixation versus conversion to intramedullary nailing for definitive management of closed fractures of the femoral and tibial shaft. J Am Acad Orthop Surg 2006; 14(10 Spec No.): S131-S135.
  7. Kuhn S, Hansen M, Rommens PM. Extending the indications of intramedullary nailing with the Expert Tibial Nail. Acta Chir Orthop Traumatol Cech 2008; 75(2): 77-87.
  8. Venkateswaran B, Warner RM, Hunt N, Shaw DL, Tulwa N, Deacon P. An easy and accurate preoperative method for determining tibial nail lengths. Injury 2003; 34(10): 752-5.
  9. Lakhey S, Pradhan RL, Bishwakarma M, Pradhan S, Pradhanaga S, Pandey BK, et al. Pre-operative assessment of K-nail length in fracture shaft of femur. Kathmandu Univ Med J (KUMJ) 2006; 4(3): 316-8.
  10. Colen RP, Prieskorn DW. Tibial tubercle-medial malleolar distance in determining tibial nail length. J Orthop Trauma 2000; 14(5): 345-8.
  11. Waldron VD. Predicting intramedullary nail length. Am J Orthop (Belle Mead NJ) 1998; 27(5): 383.
  12. Blair S. Estimating tibial nail length using forearm referencing. Injury 2005; 36(1): 160-2.
  13. Schmidt AH, Finkemeier CG, Tornetta P, III. Treatment of closed tibial fractures. Instr Course Lect 2003; 52: 607-22.
  14. Noumi T, Yokoyama K, Ohtsuka H, et al. Intramedullary nailing for open fractures evaluation of contributing factores on deep infection and nonunions using multivarient analysis injury 2005: 36(9): 1085-91.
  15. Garcia Juarez JD, Aguilera Zepeda JM, Bienvenu AT, Encalada Diaz MI, Sheldon OD. [Use of the orthofix intramedullary nail in tibial shaft fractures. A review of 22 cases]. Acta Ortop Mex 2007; 21(4): 212-6.
  16. Krettek C, Blauth M, Miclau T, Rudolf J, Konemann B, Schandelmaier P. Accuracy of intramedullary templates in femoral and tibial radiographs. J Bone Joint Surg Br 1996; 78(6): 963-4.
  17. Fischmeister MF, Lang T, Reichl C, Wechselberger C. How to predict requisite nail length in tibial fractures. Arch Orthop Trauma Surg 1994; 113(4): 194-5.