Technical tip: distal locking of a tibial nail in the presence of a preexisting distal tibial plate

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Tibial refracture is a common problem among active individuals, with a second surgery presenting several challenges and difficulties. Previously implanted metalwork can cause obstruction of distal locking of the intramedullary tibial nails due to radiographic overlap. Full removal of a distal tibial plate is associated with significant surgical morbidity and wound complications as well as increased operative time and X-ray exposure. We report a simple method to overcome the above problem by removing only some tibial plate screws percutaneously, leaving the plate itself in situ and using some of the plate holes for distal locking of the tibial nail.

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