Periarticular and Intra-articular Fractures

Intramedullary (IM) fixation is a reliable and predictable fixation strategy for long bone diaphyseal fractures with advantages that include preservation of periosteal blood supply and load sharing. It can be used to address peri- and intra-articular fractures but does have certain anatomical limitations. Disadvantages result from a wide metaphyseal diameter and thin cortical bone that may require supplemental fixation or alternative techniques to avoid malreduction. However, the indications to treat a peri- and intra-articular fracture with IM nails have increased with modern implant designs. Biomechanical studies support the use of IM nailing in these fractures. However, the basic principles of internal fixation, such as fracture reduction, minimizing fracture gap, and fracture morphology, need to be appreciated to obtain successful results when IM fixation is used in peri- and intra-articular fractures.