仅仅是放置胫骨髓内钉可能不会得到足够的骨折复位。因此，在整个扩髓过程和置钉过程中必须保持足够的骨折对线。
虽然轴向牵引往往可以通过韧带趋近性改善骨折对齐，但单纯的手法牵引不可能总是可以实现解剖性复位。目前有各种闭合、微创和开放复位的操作已经被报道。这些方式应该被骨科医生熟练掌握。
（1）复位技巧
闭合复位可以通过手术室常用的工具，比如F型手柄来实现。
F形工具是一种放射透明复位装置，可进行矫正内翻/外翻成角以及内侧/外侧平移的矫正。然而，由于对软组织产生过大的张力，应避免长时间使用这种复位装置。某些骨折也可以经皮放置复位夹，对于螺旋状骨折和斜向骨折更为有效。这些复位夹可以通过小切口减少软组织的创伤。
钳夹的类型和手术切口的位置应有策略地选择，以减少钳夹放置造成的长期软组织损害，
下面的不想翻译了，大家感兴趣的自己看。
The universal distractor can be used as an additional reduction tool. The universal distractr may assist in maintaining length and alignment. Careful attention must be paid to the placment of the Schanz pins. These are placed from the medial side into the proximal and distal fragment away from the planned position of the tibial nail.
Moreover, the proximal Schanz pin can beplaced in a position that mimics the position of a proximal blocking screw. This may become particularly useful when seeking fracture reduction in proximal tibia fractures with the typical apex anterior deformity. Similar to the universal distractor, two-pin external fixation can be used to obtain and maintain length and alignment during intramedullary nailing of tibial shaft fractures. When using this technique, the pin placement should follow the same principles as with the use of the universal distractor.
In some instances, closed and minimal invasivive reduction techniques remain insufficient in obtaining an anatomic fracture alignment. In these cases, open reduction techniques with respectful handling of the surrounding soft tissues should be considered.
Open reduction techniques allow for surgical reduction under direct visualization. Potential disadvantages of open reduction techniques include the additional surgical dissection which in may potentially increase the risk of surgical site infection. Moreover, the additional stripping of the blood supply to the fracture site may potentially increase the risk of subsequent fracture nonunion. However, retrospective cohort studies have not shown any increased risk of surgical site infection or fracture nonunion with the use of open reduction techniques.
(2)切开复位
切开复位不仅可以允许精确的放置手术复位夹，而且还提供了骨折部位应用小碎片钢板的机会，保证在髓内钉手术过程中实现和保持骨折的解剖复位。使用单皮质螺钉将钢板固定在近端和远端骨折碎片上，然后在整个扩髓过程和胫骨髓内钉放置过程中固定钢板。
置钉后，也可以移除钢板或保留原位，以增强固定结构的稳定性。
如果外科医生选择将钢板留在原位，应用单皮质螺钉更换双皮质螺钉。对于需要切开复位以实现可接受的胫骨干复位的病人，单皮质钢板或“复位钢板”被认为是一种安全有效的技术。
阻塞螺钉的目的是缩小干骺端区域的髓腔，并替代有缺陷的骨皮质。因此，阻塞螺钉是治疗干骺端骨折的有用工具。阻塞螺钉应该在扩髓过程和置钉之前放置。
阻塞螺钉通常放置在短的关节碎片和畸形的凹侧。例如，胫骨近端骨折的典型畸形以外翻和前向畸形为特征。
为了克服外翻畸形，可以在近端骨折碎片的外侧部分（即畸形的凹侧）前后放置阻塞螺钉。这种阻塞螺钉用于引导内侧髓内钉，从而防止外翻成角。同样，在近端碎片的后部（即畸形的凹侧）放置阻塞螺钉，可以克服前向畸形。
