Semiextended Tibial Nail Insertion Using an Extraarticular Lateral Parapatellar Approach: A 24-Month Follow-up Prospective Cohort Study

Stella, Marco; Santolini, Emmanuele; Felli, Lamberto; Santolini, Federico; Horwitz, Daniel S.

doi:10.1097/bot.0000000000001554

Cited by 13 publications

(9 citation statements)

References 24 publications

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“…Kubiak et al previously developed a semi-extended extra-articular PP approach [ 29 ]. The corresponding modified techniques have since been published [ 28 , 37 ]. Small capsular rupture is, however, possible, and would require extra repair [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

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

Lü

Wang

et al. 2022

J Orthop Traumatol

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Background Malalignment is a common event during the intramedullary nailing (IMN) of distal tibia fractures (DTFs). Although it is reported that the semi-extended IMN techniques such as suprapatellar (SP) and parapatellar (PP) approaches may be superior in preventing malalignment, the application of these techniques is concerning owing to the intra-articular involvement. We thus developed an extra-articular semi-extended infrapatellar (SEIP) approach which utilizes the infrapatellar (IP) space while maintaining the knee in a semi-extended position. However, there are no studies on the safety and efficacy of SEIP in treating DTFs. Therefore, in this study, the SEIP technique was examined, particularly in terms of the potential alignment improvement of DTFs, and this technique was compared with the traditional hyperflexed infrapatellar (HFIP) procedure. Materials and methods This randomized clinical trial (RCT) compared IMN malalignment while correcting extraarticular and nondisplaced intra-articular DTFs between April 2018 and June 2021 using the HFIP and SEIP techniques at a level I trauma center in China. The study participants were clinically and radiographically examined for at least 12 months of follow-ups. Intraoperative fluoroscopy time, operation time, blood loss, hospitalization duration, functional ankle score, and complications were assessed as well. Results Among the 88 recruited participants, 45 (51%) underwent traditional HFIP IMN and 43 (49%) underwent SEIP IMN. Malalignment occurred in 9 patients (20.0%) from the HFIP cohort and in 2 patients (4.7%) from the SEIP cohort (P value = 0.030). In addition, the SEIP IMN technique significantly reduced the intraoperative fluoroscopy time, operation time, and improved the postoperative ankle function compared to the HFIP IMN technique. However, the intraoperative blood loss, hospitalization duration, infection, delay union, and nonunion remained the same between the two cohorts. Conclusions In summary, we demonstrated that the SEIP IMN provides markedly enhanced alignment of extraarticular and nondisplaced intra-articular DTFs compared to the traditional HFIP IMN procedure. The described technique represents an effective option for IMN of DTFs. Level of evidence Level 2. Trial registration The Chinese Clinical Trial Registry, ChiCTR2100043673. Registered 26 February 2021, retrospectively registered, http://www.chictr.org.cn/showprojen.aspx?proj=122263

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Section: Discussionmentioning

confidence: 99%

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

Lü

Wang

et al. 2022

J Orthop Traumatol

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“…In contrast, a 3.8% incidence of malalignment when IMN insertion was performed using the SP approach was observed. Marco Stella reported 2.9% malalignment in tibia fractures treated with IMN using the SP approach [25]. In the IP approach, the pull of the quadriceps and the backward deviation of the intramedullary nail caused the flexion of the proximal segment, resulting in the anterior flexion deformity [26].…”

Section: Discussionmentioning

confidence: 99%

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

Wang²,

Ren

et al. 2020

J Orthop Surg Res

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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.

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“…Marco Stella reported 2.9% malalignment in tibia fractures treated with IMN using the SP approach [25]. In the IP approach, the pull of the quadriceps and the backward deviation of the intramedullary nail caused the flexion of the proximal segment, resulting the anterior flexion deformity [26].…”

Section: Discussionmentioning

confidence: 99%

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

Wang²,

et al. 2020

Preprint

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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.

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Semiextended Tibial Nail Insertion Using an Extraarticular Lateral Parapatellar Approach: A 24-Month Follow-up Prospective Cohort Study

Cited by 13 publications

References 24 publications

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

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

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

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

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