Application of the Chinese Aircraft-shaped Sleeve system in the treatment of tibial shaft fractures using a suprapatellar approach for tibial intramedullary nailing: a randomised controlled trial

Abstract

BackgroundThe use of the suprapatellar approach for intramedullary nailing has recently become popular for the treatment of tibial fractures. This study aimed to investigate the effectiveness of using the Chinese Aircraft-shaped Sleeve (CASS) system on the clinical outcomes of tibial intermedullary nailing using a suprapatellar approach for the treatment of tibial fractures in a cohort of adult Chinese patients.MethodsMagnetic resonance images (MRI) of the knee joints of 212 healthy adults with normal lower limb function from May 2011 to May 2015 were obtained from a level I Chinese regional trauma centre. Sixty inpatients at the same trauma centre who underwent treatment for tibial shaft fractures from June 2015 to June 2018 were enrolled. Tibial intramedullary nailing fixation of tibial shaft fractures via the suprapatellar approach was performed with either a CASS system or a conventional sleeve. The measurements of patellofemoral joint anatomy, the surgical time, the assessments of the patellofemoral joint cartilage conditions, and information of residual debris based on arthroscopic analysis were subsequently collected.ResultsThe mean patellar angle (PA), sulcus angle (SA), sulcus width (SW) and sulcus depth (SD) were 135.40 ± 6.20°, 142.37 ± 5.33°, 33.37 ± 2.73 mm, and 4.29 ± 0.63 mm, respectively. The surgical time until entry reaming commencement and the irrigation time were significantly lower in the CASS group (P < 0.001). The difference in cartilage damage rate between groups was statistically significant (P = 0.031); the difference in residual debris conditions was not statistically significant (P = 0.1967).ConclusionThe use of the CASS system could improve clinical outcomes of intramedullary nailing via suprapatellar approach for patients with a small patellofemoral joint space.

The semi-extended infrapatellar intramedullary nailing of distal tibia fractures: a randomized clinical trial

“…In particular, in some Asian populations, the patellofemoral joint space is much smaller than in westerners. Therefore, the SP approach with instrumentation usage in such a narrow space may induce further damage [ 10 , 36 ]. Thus, in terms of short individuals, the SEIP approach may offer an extra-articular alternative requiring no special surgical instruments.…”

A pilot randomised prospective comparison of two approaches for tibial nailing using clinical and novel imaging outcome measures – study protocol

“…Unfortunately, none of the four included RCTs included cartilage assessment. Three previous studies have assessed cartilage using standard MRI sequences that demonstrate structural features [2][3][4] . These were able to show some cases of damage to the cartilage but due to the nature of the MRI sequences used they could not fully evaluate this.…”