Good ideas Tom. Basically, it needs a shorter nail with a more lateral starting point. I once had a resident's case I was called into the middle of with the same problem occurring. I took the nail out, enlarged the incision to visualize the starting point, and lateralized the starting point considerably. I was amazed at how the valgus disappeared as I moved it laterally (it took a few tries- each one improving the valgus as I moved the starting point more lateral). Poller screws, and a nail without such a proximal bend are also good adjuncts. Also, the valgus won't correct unless you use a shorter nail that can be buried some- otherwise it impinges on the proximal entry cortex, and pushes it into valgus. In fact, during nail insertion, the tibia will continue to deform until the nail is fully buried.
Jim Carr
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