Abstract:Background
This review was conducted to compare the efficacy of suprapatellar (SP) and infrapatellar (IP) approaches for treating distal tibial fractures with intramedullary nailing.
Method
This systematic review included studies comparing the outcomes of patients receiving nailing for distal tibial fractures using the SP and IP approaches. We searched the Cochrane CENTRAL, MEDLINE and Embase databases for relevant studies till 18th Sep. 2022. We u… Show more
“…Since the implementation of SP IMN into the treatment protocol of tibial fractures at our hospital, peri- or postoperative fasciotomies have not been required. To our knowledge, some benefits of using SP approach have been reported, but no previous studies are concerning ACS and the need for fasciotomies in relation to the nailing technique chosen [ 19 , 25 – 30 ].…”
Section: Discussionmentioning
confidence: 99%
“…Previously, fasciotomies might not have been considered as a complication of a surgical method but rather a treatment of compartment syndrome resulting from the fracture itself. To date, only a few studies have reported the rates of fasciotomies in association to the treatment of tibial fractures using an intramedullary nail [ 25 , 32 – 34 ]. ACS and fasciotomies after tibial fracture are associated with a higher risk for complications, slower fracture healing, and poor functional outcomes [ 3 , 7 , 10 , 18 , 25 ].…”
Section: Discussionmentioning
confidence: 99%
“…To date, only a few studies have reported the rates of fasciotomies in association to the treatment of tibial fractures using an intramedullary nail [ 25 , 32 – 34 ]. ACS and fasciotomies after tibial fracture are associated with a higher risk for complications, slower fracture healing, and poor functional outcomes [ 3 , 7 , 10 , 18 , 25 ]. Therefore, the suprapatellar approach can be recommended for reducing the rates of peri- and postoperative compartment syndrome requiring fasciotomies.…”
Section: Discussionmentioning
confidence: 99%
“…Therefore, the suprapatellar approach can be recommended for reducing the rates of peri- and postoperative compartment syndrome requiring fasciotomies. Moreover, the use of the suprapatellar approach should lead to both a decrease in the morbidity associated with fasciotomies and better functional outcomes [ 19 , 25 – 31 ].…”
Section: Discussionmentioning
confidence: 99%
“…According to recent studies and a meta-analysis, SP IMN has multiple advantages compared with IP IMN [ 25 ]. These advantages include shorter fluoroscopy time, less anterior knee pain, better or similar recovery of knee function, and more accurate fracture reduction compared with the IP technique [ 16 , 19 , 25 – 30 ]. However, surgical time, blood loss, knee infection rate, nonunion rate, and closed reduction rate do not seem to differ significantly [ 19 , 25 – 31 ].…”
Background
Intramedullary tibial nailing (IMN) is the gold standard for stabilizing tibial shaft fractures. IMN can be performed through an infra- or suprapatellar approach.
Purpose
The aim of this study is to compare the rate of fasciotomies for acute compartment syndrome between infra- and suprapatellar approaches.
Methods
A total of 614 consecutive patients who were treated with IMN for tibial fracture between October 2007 and February 2020 were included in the study. The approach used for IMN was determined by the operating surgeon. Infrapatellar IMN was performed with the knee in deep flexion position, with or without calcaneal traction. Suprapatellar IMN was performed in straight or semiflexed position. The diagnosis of compartment syndrome was based on clinical analysis, but for some patients, a continuous compartment pressure measurement was used. The primary outcome was the rate of peri- and postoperative compartment syndrome treated with fasciotomies.
Results
The study sample included 513 patients treated with infrapatellar IMN and 101 patients treated with suprapatellar IMN technique. The mean age of the patients was 44.7 years (infrapatellar technique) and 48.4 years (suprapatellar technique). High energy trauma was seen in 138 (27%) patients treated with infrapatellar technique and in 39 (39%) patients treated with suprapatellar technique. In the suprapatellar group (n = 101), there were no cases of peri- or postoperative compartment syndrome treated with fasciotomies. In the infrapatellar group (n = 513), the need for fasciotomies was stated in 67 patients, 31 patients (6.0%) perioperatively and in 36 patients (7.0%) postoperatively. The rate of fasciotomies (0/101 versus 67/513 cases) differed significantly (p < 0.001). There were no significant differences in the fracture morphology or patient demographics between the study groups.
Conclusions
The suprapatellar technique is recommended over the infrapatellar approach in the treatment of tibial shaft fractures. The rate of peri- and postoperative compartment syndrome and the need for fasciotomies was significantly lower with the suprapatellar technique. The major cause of increased rate of peri- or postoperative acute compartment syndrome with infrapatellar IMN technique is presumably associated with the positioning of the patient during the operation.
Level of evidence
3.
“…Since the implementation of SP IMN into the treatment protocol of tibial fractures at our hospital, peri- or postoperative fasciotomies have not been required. To our knowledge, some benefits of using SP approach have been reported, but no previous studies are concerning ACS and the need for fasciotomies in relation to the nailing technique chosen [ 19 , 25 – 30 ].…”
Section: Discussionmentioning
confidence: 99%
“…Previously, fasciotomies might not have been considered as a complication of a surgical method but rather a treatment of compartment syndrome resulting from the fracture itself. To date, only a few studies have reported the rates of fasciotomies in association to the treatment of tibial fractures using an intramedullary nail [ 25 , 32 – 34 ]. ACS and fasciotomies after tibial fracture are associated with a higher risk for complications, slower fracture healing, and poor functional outcomes [ 3 , 7 , 10 , 18 , 25 ].…”
Section: Discussionmentioning
confidence: 99%
“…To date, only a few studies have reported the rates of fasciotomies in association to the treatment of tibial fractures using an intramedullary nail [ 25 , 32 – 34 ]. ACS and fasciotomies after tibial fracture are associated with a higher risk for complications, slower fracture healing, and poor functional outcomes [ 3 , 7 , 10 , 18 , 25 ]. Therefore, the suprapatellar approach can be recommended for reducing the rates of peri- and postoperative compartment syndrome requiring fasciotomies.…”
Section: Discussionmentioning
confidence: 99%
“…Therefore, the suprapatellar approach can be recommended for reducing the rates of peri- and postoperative compartment syndrome requiring fasciotomies. Moreover, the use of the suprapatellar approach should lead to both a decrease in the morbidity associated with fasciotomies and better functional outcomes [ 19 , 25 – 31 ].…”
Section: Discussionmentioning
confidence: 99%
“…According to recent studies and a meta-analysis, SP IMN has multiple advantages compared with IP IMN [ 25 ]. These advantages include shorter fluoroscopy time, less anterior knee pain, better or similar recovery of knee function, and more accurate fracture reduction compared with the IP technique [ 16 , 19 , 25 – 30 ]. However, surgical time, blood loss, knee infection rate, nonunion rate, and closed reduction rate do not seem to differ significantly [ 19 , 25 – 31 ].…”
Background
Intramedullary tibial nailing (IMN) is the gold standard for stabilizing tibial shaft fractures. IMN can be performed through an infra- or suprapatellar approach.
Purpose
The aim of this study is to compare the rate of fasciotomies for acute compartment syndrome between infra- and suprapatellar approaches.
Methods
A total of 614 consecutive patients who were treated with IMN for tibial fracture between October 2007 and February 2020 were included in the study. The approach used for IMN was determined by the operating surgeon. Infrapatellar IMN was performed with the knee in deep flexion position, with or without calcaneal traction. Suprapatellar IMN was performed in straight or semiflexed position. The diagnosis of compartment syndrome was based on clinical analysis, but for some patients, a continuous compartment pressure measurement was used. The primary outcome was the rate of peri- and postoperative compartment syndrome treated with fasciotomies.
Results
The study sample included 513 patients treated with infrapatellar IMN and 101 patients treated with suprapatellar IMN technique. The mean age of the patients was 44.7 years (infrapatellar technique) and 48.4 years (suprapatellar technique). High energy trauma was seen in 138 (27%) patients treated with infrapatellar technique and in 39 (39%) patients treated with suprapatellar technique. In the suprapatellar group (n = 101), there were no cases of peri- or postoperative compartment syndrome treated with fasciotomies. In the infrapatellar group (n = 513), the need for fasciotomies was stated in 67 patients, 31 patients (6.0%) perioperatively and in 36 patients (7.0%) postoperatively. The rate of fasciotomies (0/101 versus 67/513 cases) differed significantly (p < 0.001). There were no significant differences in the fracture morphology or patient demographics between the study groups.
Conclusions
The suprapatellar technique is recommended over the infrapatellar approach in the treatment of tibial shaft fractures. The rate of peri- and postoperative compartment syndrome and the need for fasciotomies was significantly lower with the suprapatellar technique. The major cause of increased rate of peri- or postoperative acute compartment syndrome with infrapatellar IMN technique is presumably associated with the positioning of the patient during the operation.
Level of evidence
3.
<i>Objective: </i>The objective of this study was to analyse and compare of the clinical effects of two surgical methods in the treatment of Zhang-Hou fracture; <i>Method</i>: A total of 34 patients with Zhang-Hou fracture diagnosed in our hospital from 2020.08 to 2022.06 were reviewed. Among them, 17 patients were treated with tibial intramedullary nail internal fixation and 17 patients with traditional steel plate internal fixation. The blood loss, operation time, fracture healing time, excellent rate of affected limb function and postoperative complications were compared between the two groups. <i>Result</i>: The operation time, intraoperative blood loss and fracture healing time were shorter in the intramedullary nail group, and the excellent rate of limb function in the intramedullary nail group was higher than that in the plate group 6 months after operation, but there was no significant difference between the two groups 12 months after operation. All the patients in the intramedullary nail group hadn’t serious complications after operation. Among the 17 patients in the plate group, 1 patient had wound infection and 1 patient had delayed fracture healing. <i>Conclusion</i>: In the clinical treatment of Zhang-Hou fracture, tibial intramedullary nail internal fixation not only has the advantages of short operation time, less trauma and quick recovery after operation, but also has better functional recovery of the affected limb and less postoperative complications. However, clinicians' learning curve of tibial intramedullary nail internal fixation is relatively long.
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