Comparison of suprapatellar versus infrapatellar approaches of intramedullary nailing for distal tibia fractures

Abstract

Background This study aimed to analyze and compare the clinical and functional outcomes of distal tibia fractures treated with intramedullary nailing (IMN) using the suprapatellar (SP) and infrapatellar (IP) surgical approaches. Methods A retrospective analysis was performed in 63 patients with distal fractures that were treated with IMN between August 2014 and August 2018. A total of 27 and 36 patients underwent IMN using the SP and IP techniques, respectively. The surgical time, blood loss, closed reduction rate, rate of adjuvant reduction technique, fracture healing time, and complications were reviewed in this study. Anterior knee pain was assessed using the visual analog scale. The Lysholm Knee Scoring Scale and American Orthopaedic Foot and Ankle Society (AOFAS) scale were used as clinical measurements. Results A total of 63 patients, with a minimum follow-up of 12 months, were evaluated. The average surgical time, blood loss, rate of adjuvant reduction technique, closed reduction rate, fracture healing time, and Lysholm Knee Scoring Scale score were insignificantly different (P > 0.05) between the two groups. However, the SP approach was superior to the IP approach in terms of pain score, AOFAS score, and fracture deformity rate (P < 0.05). Conclusions In the treatment of distal tibia fractures, the SP IMN technique is associated with a significantly higher functional outcome, lower knee pain, and lower rate of fracture deformity than the IP IMN technique.

Infrapatellar versus suprapatellar approach for intramedullary nailing of the tibia: a systematic review and meta-analysis

“…Malalignment is one of the noted complications to intramedullary nailing of the tibia. Courtney [14,27]. This has also been observed in extra-articular proximal tibia fractures as per Kulkarni et al [28].…”

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

“…In another retrospective cohort study comparing 74 SP and 51 HFIP nails, Hague et al suggested that the SP technique may enhance coronal plane alignment with the intramedullary nailing of DTFs [ 32 ]. Lu et al analyzed and compared the clinical and functional endpoints of DTFs managed with IMN, and the authors reported that the malalignment rate in SP patients (4.8%, 2/42) was considerably diminished compared to HFIP patients (14.3%,8/56) [ 14 ]. In the current study, the malalignment rate of SEIP patients was 4.7%, which was markedly reduced relative to HFIP patients, which corroborated the radiographical outcomes of a prior investigation.…”

“…The following patients were selected for analysis: those with extraarticular fractures (OTA 43-A) and (OTA 43-C1 and C2) with a nondisplaced intraarticular fracture line [ 8 ]. Moreover, we only included fractures with major fracture lines located within 12 cm of the distal tibial plafond [ 14 ]. The following patients were eliminated from the analysis: those with a fracture occurring too distal to achieve proper fixation of four cortices using distal interlocking screws [ 5 ] and those with an ipsilateral proximal tibia fracture or knee injury, prior knee or ankle surgery preexisting ankle arthrodesis, and pathological fracture.…”

Combined Medial Plate and Intramedullary Nailing for the Fixation of Extra-Articular Proximal Tibial Fractures: a Biomechanics Study

“…The tibial IMN was inserted under a standard technique in all sawbones ( Lu et al, 2020 ). An unstable extra-articular proximal tibial fractures (OTA/AO 41A2) were created in all sawbones.…”