Entry points for antegrade elastic nailing

An antegrade elastic-nailing technique uses medial and lateral entry points in the proximal metaphysis of the tibia.

Each entry point is 2 cm distal to the physis, posterior to the midline in the sagittal plane, avoiding the cartilage of the apophysis.

Make a skin incision on the medial and lateral side of the proximal tibia, starting at the entry points extending 2 cm proximally.

This allows sufficient space to advance the nails at an angle to the cortex.

The incisions must be extended sufficiently proximal from the entry points to avoid soft-tissue injury by nail insertion.

On the medial side, this is a direct dissection down to the bone.

On the lateral side, retract the muscle laterally away from the cortex.

Avoid an entry point that is too dorsal as this risks injury to the peroneal nerve.

Close the skin and subcutaneous tissues only.