Do you even speak English or are you just using google translate? What are you even talking about. You have failed to answer any question posed to you.
You said internal tibia is better and safer HOW? You are ignorant.
Here is the evidence IM nailing causes problems.
http://www.ors.org/Transactions/55/0764.pdfQuote
The potential causes of anterior knee pain after intramedullary (IM) nailing of the tibia are not completely understoo d. Knee pain usually begins several months after IM nailing of the tibia and nail removal does not always provide pain relief 1 . From more than 20 factors potentially associated with knee pain, only two factors are strongly correlated with knee pain: activity level 2, 3, 4 and size of the tibia 5 . Clinical studies suggest that the knee pain is activity - related in most patients and is exacerbated by kneeling. The current study tests the hypothesis that the entry hole resulted from tibial nailing could cause anterior knee pain by significantly altering the local strain distribution in the proximal tibia. Using the finite element method, this study explores the etiology of anterior knee pain after intramedullary nailing and examines the effects of standing, walking, and kneeling on a normal tibia model, a nailed tibia model and a tibia model with the IM nail removed.
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The hypothesis of the current study was that the entry hole resulted from tibial nailing could cause anterior knee pain by significantly altering the local stress and strain distribution. The strain values recorded for the tibia with the nail removed in single - limb kneeling were significantly greater than the values recorded for the intact tibia. Strain values recorded around the hole for the tibia with the nail removed were higher than the strain values for the intact tibia for all the loading configurations considered. For each load case, the highest principal strain values were found in the nailed tibia model. Removing the nail does not reduce the strain to normal values encountered in an intact tibia
http://www.bjj.boneandjoint.org.uk/content/88-B/5/576Quote
However, one of the most common problems associated with tibial primarily, and retrograde femoral nailing secondarily, is chronic anterior knee pain.15,43,45–51 This can be an important handicap for the patient, affecting his employment and daily or leisure activities. Its incidence has been reported to be as high as 86%.52 It may be present even in patients who have an intact knee as with antegrade femoral nailing.7,15,30,43,44,51,53,54 Its aetiology is unclear, but a multifactorial origin has been suggested.
http://upoj.org/wp-content/uploads/v24/09_Courtney.pdfQuote
While much has been written about the incidence of anterior knee pain through a patellar splitting or parapatellar approach, the clinical effects of knee pain after suprapatellar nails have yet to be addressed in the literature. Our data show no difference in the Oxford Knee Score between the two groups.
So the suprapatellar nailing, praised by Dr. Monegal and proclaimed to be 'completely safe' regarding knee pain, appears to be barely studied. Also:
http://www.amjorthopedics.com/fileadmin/qhi_archive/ArticlePDF/AJO/041120546.pdfQuote
Based on this cadaveric study, tibial nailing in the semi- extended position with a superomedial arthrotomy and lateral patellar mobilization (ie, suprapatellar nailing) is associated with risks to anterior knee anatomy at the starting point comparable to other previously described tibial nailing techniques. A superomedial arthrotomy places the portal closer to the medial meniscus, compared with a quadriceps splitting approach. We feel that the technique may offer significant advantages in the management of proximal tibia fractures undergoing nailing; however, because risks to the patellofemoral joint have not been clearly elucidated by this or other studies, it may not be the approach of choice for more simple fractures not predisposed to malalignment. Additional clinical studies are warranted to further define the role of this technique in the management of tibia fractures, including those of the proximal third.
http://theglobaljournals.com/ijsr/file.php?val=November_2014_1416664332__124.pdfnov 2014
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Background -Intramedullary tibial nail needs to give a careful thought. Its correlation with chronic anterior knee
pain seems to be crucial factor.
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There has been a growing concern about the tibial nailing being accompanied by an increase in the incidence of anterior knee pain. Suggested contributing factors include younger, more active patients, nail prominence above the proximal tibial cortex, meniscal tear, unrecognized articular injury, increased contact pressure in the patellofemoral articulation, damage to the infrapatellar nerve, and surgically induced scar formation. Some authors have suggested that a transtendinous approach is associated with more frequent anterior knee pain than is a medial paratendinous approach. The cause of this knee pain is still unclear.
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20 patients (67%) in our study complained of anterior knee pain related to the nail entry site during the follow up. 80 % (16 of 20 in pain group) of the patients who developed knee pain had done so within 6 months of surgery. Out of the 20 pain group patients, 11(55%) reported Mild pain (VAS 2.1 – 4), 5(25%) Moderate pain (VAS 4.1 – 6), 4(20%) re - ported severe pain (VAS > 6.1). On analysis of functional knee score it was observed that the most common problem encountered was with kneeling, and 90% (18 of 20) of the patients experienced pain during this activ - ity. Half of these patients could not kneel at all because of knee pain
Squatting was the next, with 70% (14 of 20) of patients experiencing discomfort and one third of these patients finding the activity impossible.
From this thread
http://www.limblengtheningforum.com/index.php?topic=2168.0Check MATE
Waiting for your so called sources in reply ...tick tick
