Suprapatellar versus infrapatellar approach for intramedullary nail fixation of tibial shaft fractures: a review of the literature

Ringenberg, Jonathan D.; Tobey, Jonathan; Horinek, Jeffrey L.; Teague, David

doi:10.1097/oi9.0000000000000196

Cited by 5 publications

(6 citation statements)

References 28 publications

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“…In theory, the SEIP approach may further minimize knee sepsis risk in high-risk patients such as those with open tibial fractures. Likewise, the extra-articular feature of the SEIP approach may address surgeons' concerns regarding iatrogenic damage originating from either canal preparation, nail insertion, or enhanced contact pressure on the patella and femoral condyles [ 35 ]. In particular, in some Asian populations, the patellofemoral joint space is much smaller than in westerners.…”

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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“…Due to the long fracture line of the tibia, traditional internal xation with plates exposes a large area of the operative eld and requires dissection of the periosteum, which damages the soft tissues and blood ow, making the healing time of the fracture longer and increasing the risk of postoperative wound infection and non-union of the fracture [6][7][8] . Compared with traditional plate internal xation, intramedullary nailing is less demanding on soft tissues, more securely xed, less likely to displace the fracture, and can avoid secondary injuries caused by repeated operations due to poor plate xation [9][10][11] . At the same time, intramedullary nailing has obvious biomechanical advantages, patients can recover knee and limb function faster and better after surgery, can shorten the time to get out of bed after surgery, and can improve the fracture healing rate and reduce the occurrence of postoperative complications by virtue of the autologous bone graft effect [12][13][14] .…”

Section: Discussionmentioning

confidence: 99%

Clinical efficacy of B-ultrasound-guided manual repositioning combined with intramedullary tibial nailing in the treatment of Zhang-Hou fractures

Mei

Liu

2023

Preprint

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Objective:To investigate and analyze the clinical efficacy of B-ultrasound-guided manipulative repositioning combined with tibial intramedullary nailing in the treatment of Zhang-Hou's (Z-H) fractures. Methods: Fifty-nine patients with Z-H fractures treated surgically in our hospital from January 2019 to December 2022 were selected for retrospective study, and were divided into 31 cases in the observation group (B-ultrasound-guided manipulative repositioning combined with intramedullary nailing of the tibia) and 28 cases in the control group (plate screw internal fixation) according to the surgical method. The general data, surgical indexes, VAS scores at 1, 3, 6 and 12 months after surgery, and the excellent rate of functional rehabilitation at 6 and 12 months after surgery were compared between the two groups. Results: There was no statistical difference between the general data of the two groups (P > 0.05), which was comparable. The observation group had better operating time, intraoperative blood loss, number of intraoperative fluoroscopy, hospital stay and fracture healing time than the control group, and the difference was statistically significant (P<0.05). The difference was not statistically significant when comparing the preoperative VAS scores of the two groups (P>0.05); whereas the observation group had better VAS scores than the control group at all postoperative time points, and the difference was statistically significant (P<0.05). The incidence of postoperative complications in the observation group was 6.45% (2/31, cases), which was significantly lower than that in the control group (17.86% (5/28, cases), and the difference was statistically significant (P<0.05). The excellent functional rehabilitation rate in the observation group was 93.55% (29/31, cases) at 12 months after surgery, which was significantly higher than that in the control group (78.57% (22/28, cases), and the difference was statistically significant (P<0.05). Conclusions: Compared with conventional plate and screw internal fixation for Zhang-Hou fractures, B-ultrasound-guided manual repositioning combined with intramedullary nailing of the tibia has the advantages of optimizing surgical indexes, reducing postoperative complications, and improving postoperative functional recovery, and also shortens the learning curve of clinicians for intramedullary nailing surgery.

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“…Para evitar estos posibles inconvenientes, se desarrolló la técnica suprapatelar, la cual ha recibido notorio interés debido a que, durante el proceso, la extensión total o casi total de la pierna ayuda a neutralizar las fuerzas deformantes del músculo cuádriceps y a mantener la alineación adecuada de la tibia proximal [2]. Varios estudios refieren que el enfoque suprapatelar permite la implantación más precisa del clavo, reduce el tiempo de la operación y de fluoroscopia, disminuye el riesgo de no unión, el dolor de rodilla anterior y previene los trastornos degenerativos de la articulación de la rodilla [2,3,5,8,9]. Sin embargo, existe una preocupación con esta técnica, debido a la existencia de un mayor riesgo de dañar las estructuras intraarticulares, especialmente el cartílago patelofemoral [1,3,[5][6].…”

Section: Introductionunclassified

Ventajas y desventajas del uso de clavo de tibia suprapatelar e infrapatelar en fracturas de tibia.

Rocha¹,

Campos²,

Gajardo³

et al. 2023

Preprint

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Suprapatellar versus infrapatellar approach for intramedullary nail fixation of tibial shaft fractures: a review of the literature

Cited by 5 publications

References 28 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

Clinical efficacy of B-ultrasound-guided manual repositioning combined with intramedullary tibial nailing in the treatment of Zhang-Hou fractures

Ventajas y desventajas del uso de clavo de tibia suprapatelar e infrapatelar en fracturas de tibia.

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