Suprapatellar versus infrapatellar intramedullary nailing for treatment of tibial shaft fractures in adults

Abstract

Background:Numerous studies have compared suprapatellar (SP) nailing to infrapatellar (IP) nailing for treatment of tibial shaft fractures; however, the best strategy remains controversial. The aim of this meta-analysis is to assess whether SP or IP nailing is more effective for tibial shaft fractures in adults.Methods:Literature searches of PubMed, Embase, OVID, Cochrane Library, Web of Science, Chinese Biomedical Literature, Wanfang, Weipu Journal, and CNKI databases were performed up to July 2017. Only randomized controlled trials (RCTs) comparing SP versus IP intramedullary nailing for tibial shaft fractures were included. Data collection and extraction, quality assessment, and data analyses were performed according to the Cochrane standards.Results:Twelve RCTs were selected for analysis. SP intramedullary nailing reduced knee joint pain, visual analog score, fluoroscopy time, and sagittal angle, resulting in better Harris hip score, Lysholm knee score, short-form 36 questionnaire, range of motion, and rates of “excellent” and “good” outcome. There were no significant differences in operative time, blood loss, length of hospital stay, union time, and coronal angle between groups.Conclusion:The present meta-analysis indicates that SP intramedullary nailing has obvious advantages over IP intramedullary nailing for treatment of tibial shaft fractures in adults. However, owing to the low-quality evidence currently available, additional high-quality RCTs are needed to confirm these findings.

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

“…These findings are confirmed by Sun Q et al who reported a mean operation time of 71.01 min and an intraoperative blood loss of 22.11 ml for SP IMN, showing no difference compared to IP IMN with operation time of 73.26 min and intraoperative blood loss of 21.67 ml. Chen X et al conducted a meta-analysis of RCTs and reported that there were no significantdifferences in the operative time and blood loss between SP and IP groups[19]. However, review analysis of RCTs indicated that SP IMN could significantly reduce total blood loss compared to IP IMN[20].…”

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

“…In accordance with other studies, the present study revealed comparable operation time and blood loss between SP IMN and IP IMN. RCTs and reported that there were no significant differences in the operative time and blood loss between SP and IP groups [19]. However, review analysis of RCTs indicated that SP IMN could significantly reduce total blood loss compared to IP IMN [20].…”

Intramedullary nailing of tibial non-unions using the suprapatellar approach: a case series

“…No additional complications with the use of the suprapatellar approach had been proven in the literature. [10][11][12][13] Crossing the non-union site is difficult in some cases. It is necessary to have specialised equipment available in the form of solid flexible reamers.…”

“…The suprapatellar approach allows insertion of the nail in an extended knee, which aids correction of malalignment in the sagittal and coronal planes. [10][11][12][13] It also creates a straight working channel, allowing the passage of rigid, straight reamers to cross the nonunion site, facilitating IMN for shaft non-unions not previously treated with IMN. Currently there is no literature available on the use of this technique to treat non-unions of the tibia.…”