Intramedullary tibial nailing using infrapatellar and suprapatellar approaches: A systematic review and meta-analysis

Packer, Timothy; Naqvi, Ali; Edwards, Tim

doi:10.1016/j.injury.2020.09.047

Cited by 18 publications

(28 citation statements)

References 41 publications

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“…In fact, there was a small trend toward superior outcomes in the IP group, when evaluated by outcome measures other than the Lysholm Knee Score; however, this comparison was not statistically significant. These findings are consistent with the analysis performed by Packer et al, 31 who reported that the significant difference in Lysholm outcome scores was similarly not reproduced when using other knee outcome measures.…”

Section: Discussionsupporting

confidence: 91%

“…In addition, the review by Wang et al 30 included 2 manuscripts, which were only published in the Chinese language and 1 study which only reported on intraoperative outcomes, without any postoperative follow-up data on patient outcomes. Although Packer et al 31 more recently performed a meta-analysis assessing all published outcome measures, 3 recent studies presenting PROMs comparing SP and IP tibial IMN, all published in 2020, were not included in that review.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of Patient-Reported Outcomes After Suprapatellar Versus Infrapatellar Nailing Techniques for Tibial Shaft Fractures: A Systematic Review and Meta-analysis

Sepehri

You

Lobo

et al. 2022

Journal of Orthopaedic Trauma

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Comparison of Patient-Reported Outcomes After Suprapatellar Versus Infrapatellar Nailing Techniques for Tibial Shaft Fractures: A Systematic Review and Meta-analysis

Sepehri

You

Lobo

et al. 2022

Journal of Orthopaedic Trauma

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“…From our study, we have been able to establish a shorter patient positioning time, with potentially shorter operative time and reduced TRD for SP tibial nail fixations. Several large studies including systematic reviews and meta-analyses demonstrate the superiority of the SP approach for tibial intramedullary nailing in comparison to the IP approach, an opinion we indeed share and corroborate with, in this study [18][19][20].…”

Section: Discussionsupporting

confidence: 88%

Tibial Intramedullary Nailing by Suprapatellar Approach: Is It Quicker and Safer?

Jayaraju¹,

Rammohan²,

Awad³

et al. 2022

Cureus

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BackgroundWith the increasingly accepted method of suprapatellar tibial nailing for tibial shaft fractures, we aimed to compare intraoperative and postoperative outcomes of infrapatellar (IP) vs suprapatellar (SP) tibial nails. MethodsThis is a retrospective cohort analysis of 34 SP tibial nails over three years vs 24 IP tibial nails over a similar time frame. We compared total radiation dose (TRD), patient positioning time (PPT), fracture healing and follow up time. Knee pain in the SP group was evaluated utilising the Hospital for Special Surgery (HSS) Knee Injury and Osteoarthritis Outcome Score (KOOS). ResultsFifty-eight patients with a mean age of 43 years were included. Mean intraoperative radiation dose for SP nails was 61.78 cGy (range: 11.60-156.01 cGy) vs 121.09 cGy (range: 58.01-18.03 cGy) for IP nails (p < 0.05). Mean PPT for SP nails was 10 minutes vs 18 minutes for IP nails (p < 0.05). All fractures united in the SP group vs one non-union in the IP group. Mean follow up was 5.5 months vs 11 months in the IP and SP groups, respectively. Mean KOOS was 7 (range: 0-22) at six months for the SP group. ConclusionThe semi-extended position (SP group) leads to reduced TRD because of ease of imaging. Patients showed improved outcomes with shorter follow up and fracture union in all patients (SP group). The KOOS revealed that SP nail patients had minimal pain and good knee function. This study establishes a management and patient-reported outcome measures (PROMs) baseline for ongoing evaluation of SP nails.

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“…Although risks have been hypothesized, a few cadaveric and clinical studies have been conducted and established the limitations and consequences of the suprapatellar approach to IMN [ 4 , 7 ]. Systematic reviews and meta-analyses demonstrated significant reduction in total blood loss, post-operative knee pain, reduction in fluoroscopy exposure, and improvement in knee scores [ 8 ]. Although there seemed to be no significant differences in pain, disability, or knee range of motion, a few cases documented articular changes and evidence of chondromalacia on MRI [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…The clinical outcomes of the suprapatellar approach have been evaluated in the recently published systematic review and meta-analysis [ 8 ]. To the best of our knowledge, only one clinical study of suprapatellar IMN has attempted to evaluate the clinical outcomes of suprapatellar IMN.…”

Section: Discussionmentioning

confidence: 99%

Trochlear Lesion Caused by Suprapatellar Intramedullary Nailing and Treated with Autologous Chondrocytes Implant

Lane¹,

Smith²

2022

JOCR

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Introduction:Intramedullary nailing remains the most common method of treatment for tibial shaft fractures. The suprapatellar technique has proven to be useful in gaining and maintaining alignment, especially in proximal one-third tibia shaft fractures. It has been adopted by many surgeons taking trauma call, because it requires less set-up time and allows the surgery to be done with less assistance. We present a case of a femoral trochlea lesion following the placement of a reamed suprapatellar intramedullary nail for fixation of a tibial shaft fracture. Case Presentation:An active 33-year-old male with no prior history of knee pain sustained a distal tibial shaft fracture and was treated with suprapatellar intramedullary nail fixation. Five months later, he underwent revision surgery with exchange nail placement and reaming via an infrapatellar technique for delayed healing of the fracture with subsequent successful healing. The patient, otherwise healthy, continued to experience persistent anterior knee pain with clunking and inability to arise from a flexed knee position approximately 18 months post-surgery. Magnetic resonance imaging and arthroscopic evaluation of the joint were performed, and a full-thickness cartilage lesion was identified in the central portion of the femoral trochlear groove. Conclusion: The purpose of the present case is to bring awareness to the fact that the suprapatellar approach to intramedullary nailing tibial shaft fracture fixation can be accompanied by trochlear articular cartilage damage, which can be successfully treated with cartilage restoration.

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Intramedullary tibial nailing using infrapatellar and suprapatellar approaches: A systematic review and meta-analysis

Cited by 18 publications

References 41 publications

Comparison of Patient-Reported Outcomes After Suprapatellar Versus Infrapatellar Nailing Techniques for Tibial Shaft Fractures: A Systematic Review and Meta-analysis

Comparison of Patient-Reported Outcomes After Suprapatellar Versus Infrapatellar Nailing Techniques for Tibial Shaft Fractures: A Systematic Review and Meta-analysis

Tibial Intramedullary Nailing by Suprapatellar Approach: Is It Quicker and Safer?

Trochlear Lesion Caused by Suprapatellar Intramedullary Nailing and Treated with Autologous Chondrocytes Implant

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