Intramedullary nailing of tibial fractures is commonplace and freehand techniques are increasingly popular. The standard freehand method has the knee of the injured leg flexed over a radio-lucent bolster. This requires the imaging C-arm to swing from antero-posterior to lateral position several times. Furthermore, guide wire placement; reaming and nail insertion are all performed well above most surgeons' shoulder height. If instead the leg is hung over the edge of the table, the assistant must crouch and hold the leg until the nail is passed beyond the fracture.

We describe a method of nailing which is easier both for the surgeons and the (often inexperienced) radiographer and present a series of 87 consecutive cases managed with this technique.