{"product_id":"intramedullary-nail-lateral-parapatellar-approach-case-03","title":"INTRAMEDULLARY NAIL | Lateral Parapatellar Approach - Case 03","description":"\u003cp\u003eThis educational case presents a segmental tibial diaphyseal fracture with an associated mid-third fibular fracture treated with tibial intramedullary nailing through a lateral parapatellar portal. The discussion follows the procedural reasoning from patient positioning and fluoroscopic planning to portal selection, guidewire placement, reaming, nail insertion, proximal locking, distal locking, and end-cap placement.\u003c\/p\u003e\n\u003cp\u003eThe case emphasizes how the lateral parapatellar portal was selected based on patellar mobility, soft-tissue tension, and the ability to obtain a favorable attack angle while preserving the patellar tendon and working extra-articularly. Key technical considerations include marking the tibial canal axis, maintaining AP and lateral fluoroscopic control, using guidewire curvature to improve trajectory, protecting soft tissues during reaming, and monitoring the segmental tibial fragment to avoid unintended rotation during canal preparation.\u003c\/p\u003e\n\u003cp\u003eThe distal fragment is close to the ankle region, making central guidewire positioning and distal nail alignment important educational points. The case also demonstrates the importance of aligning small distal-locking incisions with the nail holes under fluoroscopy to reduce soft-tissue conflict during screw placement.\u003c\/p\u003e\n\u003ch1\u003eLearning objectives\u003c\/h1\u003e\n\u003cul\u003e\n\u003cli\u003eHow to plan a lateral parapatellar portal for tibial intramedullary nailing based on patellar mobility and soft-tissue tension\u003c\/li\u003e\n\u003cli\u003eHow supine positioning with modest knee flexion can support fluoroscopic access and guidewire control\u003c\/li\u003e\n\u003cli\u003eHow to identify and protect the patellar tendon while maintaining an extra-articular working pathway\u003c\/li\u003e\n\u003cli\u003eHow AP and lateral fluoroscopic views guide the starting point and guidewire trajectory\u003c\/li\u003e\n\u003cli\u003eHow guidewire curvature can assist passage toward the center of the distal tibia and ankle region\u003c\/li\u003e\n\u003cli\u003eWhy controlled, intermittent reaming may be important in a segmental tibial shaft fracture\u003c\/li\u003e\n\u003cli\u003eHow tactile monitoring of the intermediate segment can help recognize and avoid rotational stress during reaming\u003c\/li\u003e\n\u003cli\u003eHow to introduce the nail carefully across the fracture region while minimizing unnecessary force\u003c\/li\u003e\n\u003cli\u003eHow proximal and distal locking steps are performed with fluoroscopic confirmation\u003c\/li\u003e\n\u003cli\u003eWhy distal-locking skin incisions should be aligned with the nail holes to reduce soft-tissue conflict\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003ch1\u003eTopics covered\u003c\/h1\u003e\n\u003cul\u003e\n\u003cli\u003eCase-based procedural overview\u003c\/li\u003e\n\u003cli\u003ePortal selection rationale\u003c\/li\u003e\n\u003cli\u003eSupine positioning and knee-flexion setup\u003c\/li\u003e\n\u003cli\u003eFluoroscopic marking of the tibial canal axis\u003c\/li\u003e\n\u003cli\u003eExtra-articular lateral parapatellar access\u003c\/li\u003e\n\u003cli\u003ePatellar tendon identification and protection\u003c\/li\u003e\n\u003cli\u003eGuidewire insertion and trajectory correction\u003c\/li\u003e\n\u003cli\u003eUse of an olive-tip guidewire with distal curvature\u003c\/li\u003e\n\u003cli\u003eControlled reaming strategy in a segmental fracture\u003c\/li\u003e\n\u003cli\u003eIntramedullary nail insertion technique\u003c\/li\u003e\n\u003cli\u003eProximal locking screw placement\u003c\/li\u003e\n\u003cli\u003eEnd-cap placement considerations\u003c\/li\u003e\n\u003cli\u003eDistal freehand locking technique\u003c\/li\u003e\n\u003cli\u003eSoft-tissue-conscious incision planning\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003ch1\u003eTarget audience\u003c\/h1\u003e\n\u003cul\u003e\n\u003cli\u003eOrthopedic trauma surgeons\u003c\/li\u003e\n\u003cli\u003eOrthopedic residents and fellows\u003c\/li\u003e\n\u003cli\u003eTrauma surgery educators\u003c\/li\u003e\n\u003cli\u003eMedical learners studying tibial shaft fracture fixation\u003c\/li\u003e\n\u003cli\u003eOperating room professionals involved in orthopedic trauma education\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003ch1\u003eEducational notice\u003c\/h1\u003e\n\u003cp\u003eThis content is intended for medical and procedural education only. It does not provide medical advice, does not replace formal surgical training, and does not establish a standard of care. All procedural decisions require appropriate clinical evaluation, institutional protocols, imaging review, supervision when applicable, and mandatory human expert review.\u003c\/p\u003e\n\u003cp\u003e\u003c!-- notionvc: dba8361b-84ce-404e-a35a-4b3cf6f055f1 --\u003e\u003c\/p\u003e","brand":"Dr Savio Chami","offers":[{"title":"Default Title","offer_id":44501663973437,"sku":null,"price":0.0,"currency_code":"BRL","in_stock":true}],"thumbnail_url":"\/\/cdn.shopify.com\/s\/files\/1\/0641\/3664\/2621\/files\/Capturadetela2026-10-29164315_result.webp?v=1794257477","url":"https:\/\/surgie.com\/pt-br\/products\/intramedullary-nail-lateral-parapatellar-approach-case-03","provider":"Surgie","version":"1.0","type":"link"}