Clamshell Corticotomy: A Technique to Address Challenges of Narrow Medullary Canal during Intramedullary Nailing of Tibial Shaft Fracture Fixation

Intramedullary nailing for diaphyseal fractures is a gold standard procedure, that is, often associated with some intraoperative challenges. Fixing an intramedullary nail in a narrow canal in an unplanned surgery is a nightmare. Forceful implantation leads to iatrogenic fracture or comminution at the fracture site. Forceful reaming in such scenarios is also associated with thermal osteonecrosis and at times incarceration of flexible reamer head. It is not uncommon to face a challenge intraoperatively with regards to a narrow medullary canal, however, well we plan preoperatively. Clamshell osteotomy is described in addressing an acute fracture in the malunited bones and in the setting of diaphyseal deformity correction. We describe the technical note of a modified clamshell osteotomy, wherein a corticotomy was performed at the site of the narrow medullary canal to pass an intramedullary nail for a tibia shaft fracture, to decompress and yield the medullary canal by another 1-1.5 mm to pass the nail.