{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T14:28:24Z","timestamp":1787840904831,"version":"build-2784847793"},"reference-count":19,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2025,4,5]],"date-time":"2025-04-05T00:00:00Z","timestamp":1743811200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["J West Afr Coll Surg"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>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\u20131.5 mm to pass the nail.<\/jats:p>","DOI":"10.4103\/jwas.jwas_104_24","type":"journal-article","created":{"date-parts":[[2025,4,7]],"date-time":"2025-04-07T00:00:09Z","timestamp":1743984009000},"page":"481-484","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Clamshell Corticotomy: A Technique to Address Challenges of Narrow Medullary Canal during Intramedullary Nailing of Tibial Shaft Fracture Fixation"],"prefix":"10.4103","volume":"15","author":[{"given":"Ranjith Kumar","family":"Yalamanchili","sequence":"first","affiliation":[{"name":"Department of Orthopaedics, All India Institute of Medical Sciences, Bibinagar, Hyderabad, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deepankar","family":"Satapathy","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, All India Institute of Medical Sciences, Bibinagar, Hyderabad, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deepak Kumar","family":"Maley","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, All India Institute of Medical Sciences, Bibinagar, Hyderabad, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Syed","family":"Ifthekar","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, All India Institute of Medical Sciences, Bibinagar, Hyderabad, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maheshwar","family":"Lakkireddy","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, All India Institute of Medical Sciences, Bibinagar, Hyderabad, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,4,5]]},"reference":[{"key":"CIT0001-20250905","doi-asserted-by":"crossref","first-page":"7","DOI":"10.3944\/AOTT.2009.007","article-title":"Treatment of adult tibial diaphysis fractures with reamed and locked intramedullary nailing","volume":"43","author":"Bur\u00e7","year":"2009","journal-title":"Acta Orthop Traumatol Turc"},{"key":"CIT0002-20250905","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1177\/147323000303100612","article-title":"Anatomical characteristics of the tibial medullary canal and their implications for intramedullary fixation","volume":"31","author":"Tosun","year":"2003","journal-title":"J Int Med Res"},{"key":"CIT0003-20250905","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1097\/BOT.0000000000000555","article-title":"Intramedullary nailing of tibial shaft fractures: Size matters","volume":"30","author":"Donegan","year":"2016","journal-title":"J Orthop Trauma"},{"key":"CIT0004-20250905","doi-asserted-by":"crossref","first-page":"826","DOI":"10.1186\/s12891-022-05781-0","article-title":"Does nail size or difference between canal and nail diameter influence likelihood of union or time to union of femoral shaft fractures treated with intramedullary nailing? 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Orthop"},{"key":"CIT0014-20250905","doi-asserted-by":"crossref","first-page":"19","DOI":"10.3928\/0147-7447-19940101-05","article-title":"Complications of Seidel intramedullary nailing of narrow diameter humeral diaphyseal fractures","volume":"17","author":"Riemer","year":"1994","journal-title":"Orthopedics"},{"key":"CIT0015-20250905","doi-asserted-by":"crossref","first-page":"2306","DOI":"10.1016\/j.injury.2019.10.010","article-title":"Interlocking nailing of femoral shaft fractures with an extremely narrow medullary canal is associated with iatrogenic fractures","volume":"50","author":"Hsu","year":"2019","journal-title":"Injury"},{"key":"CIT0016-20250905","doi-asserted-by":"crossref","first-page":"e416","DOI":"10.1097\/BOT.0000000000001257","article-title":"Clamshell osteotomy for acute fractures in the malunion setting: A technical note","volume":"32","author":"Pires","year":"2018","journal-title":"J Orthop 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