Comparison between suprapatellar and parapatellar approaches for intramedullary nailing of the tibia. Cadaveric study

Zamora, Rodolfo; Wright, Craig; Short, Adam; Seligson, David

doi:10.1016/j.injury.2016.07.024

Cited by 40 publications

(28 citation statements)

References 13 publications

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“…The etiology of anterior knee pain is undoubtedly multifactorial, which may be related to cartilage injury, patellar ligament injury, iatrogenic damage to the IP nerve, and the protruding nail end at the tibial plateau [22][23][24]. Zamora et al [25] and Gaines et al [23] conducted cadaveric studies and found that the SP approach for tibial nailing has a similar rate of soft tissue damage compared to the IP approach. These results might interpret the equal pain score in SP and IP groups in the present study.…”

Section: Resultsmentioning

confidence: 99%

Suprapatellar versus infrapatellar approaches in the treatment of tibia intramedullary nailing ： A retrospective cohort study

Cui

Hua

Schmidutz

et al. 2019

Preprint

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Background: Tibial shaft fractures are routinely managed with intramedullary nailing (IMN). An increasingly accepted technique is the suprapatellar (SP) approach. The purpose of this study was to compare the clinical and functional outcomes of knee joint after tibia IMN through an suprapatellar (SP) or traditional infrapatellar (IP) approach. Methods: Retrospective analysis was performed in patients with tibial shaft fractures that were treated with IMN through a SP or IP approach between 01/01/2014 and 31/12/2016. The clinical and functional outcomes of the knee were assessed with the Hospital for Special Surgery (HSS) Knee Score. Secondary outcomes included the operation time and intraoperative blood loss. Results: A total of 50 patients/fractures (26 IP and 24 SP) with a minimum follow-up of 15 months were evaluated. All fractures were OTA 42. No significant differences were found between the two groups in age, gender, side of fractures, operation time, intra-operative blood loss, and follow-up time. No significant difference was seen in HSS score ( P = 0.62) between them. Sub analysis of all the HSS components scores revealed no significant differences between pain ( P = 0.57), the stand and walk ( P = 0.54), the need for walking stick ( P = 0.60) and extension lag ( P = 0.60). The other HSS components showed full scores (IP 10 vs. SP 10) in both approaches, including muscle force, flexion deformity and stability components. The range of motion (ROM) component score was superior in the IP group ( P = 0.04) suggesting a higher ROM. Conclusions: Both SP and IP approach results in equivalent overall HSS knee scores. However, for the HSS component, the IP approach was superior to SP approach regarding the ROM.

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Section: Resultsmentioning

confidence: 99%

Suprapatellar versus infrapatellar approaches in the treatment of tibia intramedullary nailing ： A retrospective cohort study

Cui

Hua

Schmidutz

et al. 2019

Preprint

View full text Add to dashboard Cite

show abstract

“…The etiology of anterior knee pain is undoubtedly multifactorial, which may be related to cartilage injury, patellar ligament injury, iatrogenic damage to the IP nerve, and the protruding nail end at the tibial plateau [22–24]. Zamora et al [25] and Gaines et al [23] conducted cadaveric studies and found that the SP approach for tibial nailing has a similar rate of soft tissue damage compared to the IP approach. These results might interpret the equal pain score in SP and IP groups in the present study.…”

Section: Discussionmentioning

confidence: 99%

Suprapatellar versus infrapatellar approaches in the treatment of tibia intramedullary nailing: a retrospective cohort study

Cui

Hua

Schmidutz

et al. 2019

BMC Musculoskelet Disord

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BackgroundTibial shaft fractures are routinely managed with intramedullary nailing (IMN). An increasingly accepted technique is the suprapatellar (SP) approach. The purpose of this study was to compare the clinical and functional outcomes of knee joint after tibia IMN through an suprapatellar (SP) or traditional infrapatellar (IP) approach.MethodsRetrospective analysis was performed in patients with tibial shaft fractures that were treated with IMN through a SP or IP approach between 01/01/2014 and 31/12/2016. The clinical and functional outcomes of the knee were assessed with the Hospital for Special Surgery (HSS) Knee Score. Secondary outcomes included the operation time and intraoperative blood loss.ResultsA total of 50 patients/fractures (26 IP and 24 SP) with a minimum follow-up of 15 months were evaluated. All fractures were OTA 42. No significant differences were found between the two groups in age, gender, side of fractures, operation time, intra-operative blood loss, and follow-up time. No significant difference was seen in HSS score (P = 0.62) between them. Sub analysis of all the HSS components scores revealed no significant differences between pain (P = 0.57), the stand and walk (P = 0.54), the need for walking stick (P = 0.60) and extension lag (P = 0.60). The other HSS components showed full scores (IP 10 vs. SP 10) in both approaches, including muscle force, flexion deformity and stability components. The range of motion (ROM) component score was superior in the IP group (P = 0.04) suggesting a higher ROM.ConclusionsBoth SP and IP approach results in equivalent overall HSS knee scores. However, for the HSS component, the IP approach was superior to SP approach regarding the ROM.

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“…In the case of parapatellar approach, three legs had intra-articular disruption, one leg had cartilage damage. In legs with a suprapatellar approach, two legs showed damaged patellar cartilage and trochlea cartilage, respectively, and one incidence of ACL injury was reported (29). There were no meniscal injuries and partial laceration of the intermeniscal ligament was observed in three legs in each group.…”

Section: Discussionmentioning

confidence: 88%

Semi-extended Intramedullary Nailing of the Tibia Using an Infrapatellar Approach

Lü

Gao

Wang

et al. 2020

Preprint

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Background The semi-extended tibial intramedullary nailing method would enable easier and improved reductions for tibial fractures as well as facilitate fluoroscopic imaging; however, its in-articular nature remains controversial. The aim of this study was to compare the clinical and functional outcomes of the semi-extended infrapatellar (SEIP) approach and hyper-flexed infrapatellar (HFIP) approach for intramedullary nailing to treat tibial shaft fractures.MethodsThis study involved the retrospective analysis of the medical records of patients with tibial shaft fractures that were fixed through either the SEIP approach or the HFIP approach of intramedullary nailing and who were admitted to a level 1 trauma center. The minimum patient follow-up period was 12 months and the clinical and functional outcomes were estimated at the 12-month visit. ResultsOf the 80 patients whose medical records were analyzed, 40 (50%) underwent SEIP nailing and the remaining 40 (50%) underwent the traditional HFIP nailing. Compared with the HFIP group, patients in the SEIP group had a higher Lysholm knee score (median, 92 [interquartile range, 88-95] vs median, 88 [interquartile range, 81-92]; p = .01), a shorter intraoperative fluoroscopy time (median, 93 [interquartile range, 78-105] s, vs median, 136 [interquartile range, 110-157] s; p < .001), and operation time (mean, 88.1 [SD, 17.8] min vs mean, 98.7 [SD, 19.3] min; p = .01). The VAS score was significantly lower in the SEIP group (median, 0; interquartile range, 0-0) than in the HFIP group (median, 0; interquartile range, 0-2) (p = .03). There were two cases (5%) in the SEIP group and 10 cases (25%) in the HFIP group of moderate AKP (p = .03). Meanwhile, there was no significant difference in malalignment, nonunion, delayed union, infection, and other complications, as well as SF-36 physical and mental scores.ConclusionWe found that the SEIP approach to tibia intramedullary nailing was superior to the HFIP approach based on the intraoperative and postoperative outcomes. Thus, this novel technique provides an infrapatellar option for semi-extended tibial nailing.

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Comparison between suprapatellar and parapatellar approaches for intramedullary nailing of the tibia. Cadaveric study

Cited by 40 publications

References 13 publications

Suprapatellar versus infrapatellar approaches in the treatment of tibia intramedullary nailing ： A retrospective cohort study

Suprapatellar versus infrapatellar approaches in the treatment of tibia intramedullary nailing ： A retrospective cohort study

Suprapatellar versus infrapatellar approaches in the treatment of tibia intramedullary nailing: a retrospective cohort study

Semi-extended Intramedullary Nailing of the Tibia Using an Infrapatellar Approach

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