A meta-analysis of suprapatellar versus infrapatellar intramedullary nailing for the treatment of tibial shaft fractures

Abstract

BackgroundWhether the optimal treatment for tibial shaft fractures is suprapatellar intramedullary nailing or infrapatellar approach is controversial.Materials and methodsPubMed, Embase, Cochrane, Web of science and CNKI, Wan fang Chinese databases were retrieved from their establishment to April 26, 2017. Seven studies (three randomized and four clinical controlled trials) were included in the final analysis. This meta-analysis included 683 patients with tibial shaft fracture (suprapatellar: 341; infrapatellar: 342).ResultsThere was significant difference between suprapatellar and infrapatellar approach surgery in the incidence of knee pain (P = 0.003). The malalignment of the sagittal and coronal plane in suprapatellar surgery was more serious than in the infrapatellar approach (sagittal plane: P < 0.00001; coronal plane:P = 0.07). The infrapatellar approach surgery was more time-consuming than suprapatellar surgery (P = 0.01), with no significant difference in knee function score (P = 0.35).ConclusionsSuprapatellar intramedullary nailing reduced the incidence of knee pain and the average malalignment of fractures compared to infrapatellar intramedullary nailing. It also reduced the operation time and fluoroscopy time. The results of the study should be interpreted with caution due to the heterogeneity of the study designs.

Suprapatellar versus infrapatellar nailing for tibial shaft fractures: A comparison of surgical and clinical outcomes between two approaches

“…20 A further metaanalysis by Xu et al supports our finding of lower incidence of anterior knee pain following SPN tibial nailing. 21 However, it is important to bear in mind that this new approach is not free from complications. A recent study evaluated 139 open tibial shaft fractures which were managed by an SPN approach 22 and demonstrated, in a single case, that septic arthritis of the knee joint may occur following SPN tibial nailing.…”

Dilemma of Supra- or Infrapatellar Tibial Nailing: Anterior Knee Pain vs. Intra-Articular Damage

“…There are multiple studies and meta-analyses in the literature comparing the extent of knee pain between supra and infrapatellar approaches [ 5 , 6 , 24 , 25 ]. The common point of most of these studies was that they all concluded that there was no difference between the two approaches regarding anterior knee pain by evaluation of scores over longer periods (12 months and above).…”

Suprapatellar versus infrapatellar approach for intramedullary nail fixation of tibial shaft fractures: a review of the literature

“…Sun et al [7] discovered a decrease in fluoroscopy time with a mean of 80.61 ± 37.23 s in the SP group compared to 118.68 ± 40.23 s in the IP group ( P = .009). Recent meta-analyses comparing the SP and IP approaches confirm significant reduction in fluoroscopy time with the SP approach [3,7,8,10,20] . MacDonald et al, [6] in a multicenter clinical trial, noted there to be no significant difference between operating or fluoroscopic time between the 2 groups.…”

“…Two recent meta-analyses show a decreased operative time with the SP approach. [3,10] Xu et al, [10] comparing 7 studies (3 randomized; 4 clinical controlled trials), found the IP approach to be more time consuming than the SP approach (P = .01). Chen et al [3] evaluated 7 randomized controlled trials (RCT) and originally found no significant difference in operative time (P = .88); however, sensitivity analysis excluding an outlier study did show a significant reduction in operative time with the SP approach (P = .002).…”