Semiextended tibial nailing approaches have gained popularity over the past decade, not only for proximal quarter tibia fractures but also for distal third tibia fractures because of the inherent advantages of supine positioning for reduction and fixation. This surgical technique guide presents a modification of the suprapatellar technique that allows for a steeper and deeper insertion angle and position that will resist anterior migration of the nail insertion point, which is a common problem with the suprapatellar tibial nailing technique. This modification can be used to salvage the suprapatellar insertion point when the patella is not mobile enough to facilitate the suprapatellar cannulas.Quick Tips