Suprapatellar vs. Infrapatellar Intramedullary Nailing for the Treatment of Distal and Diaphyseal Tibial Fractures: Comparative Analysis and Surgical Technique
Abstract
Introduction: Fractures of the medial and distal tibial segment often occur in young patients with high-energy trauma and older patients with low-energy trauma. The objective of this study is to compare the time of surgery, time of use of fluoroscopy, functional outcomes, and postoperative pain in patients treated with the suprapatellar vs. infrapatellar technique for tibial nailing. Materials and Methods: We carried out a retrospective study between March 2018 and October 2019. All the data was collected from the electronic clinical record (ECR). We included patients with diaphyseal and distal tibial fractures. The variables analyzed were: fluoroscopy and surgery time, pain evaluation, and functional outcomes of the patients using the Lysholm score. Results: 80 patients met all the inclusion criteria. Sociodemographic data were divided into 2 similar groups. The suprapatellar approach was used in 44 patients and the infrapatellar in 36 of them. A statistical difference was obtained in the analysis for the time of surgery, use of fluoroscopy, and pain evaluation in favor of the suprapatellar technique. Conclusions: The results of our study showed shorter surgery and fluoroscopy times with the use of the suprapatellar technique compared with the infrapatellar technique. The suprapatellar technique also yielded better pain results in the visual analog scale.Downloads
References
Franke J, Hohendorff B, Alt V, Thormann U, Schnettler R. Suprapatellar nailing of tibial fractures-Indications and technique. Injury 2016;47(2):495-501. https://doi.org/10.1016/j.injury.2015.10.023
Williamson M, Iliopoulos E, Williams R, Trompeter A. Intra-operative fluoroscopy time and radiation dose during suprapatellar tibial nailing versus infrapatellar tibial nailing. Injury 2018;49(10):1891-4.
https://doi.org/10.1016/j.injury.2018.07.004
Wang C, Chen E, Ye C, Pan Z. Suprapatellar versus infrapatellar approach for tibia intramedullary nailing: A metaanalysis. Int J Surg 2018;51:133-9. https://doi.org/10.1016/j.ijsu.2018.01.026
Lu Y, Wang G, Hu B, Ren C, Sun L, Wang Z, et al. Comparison of suprapatellar versus infrapatellar approaches of intramedullary nailing for distal tibia fractures. J Orthop Surg Res 2020;15(1):422.
https://doi.org/10.1186/s13018-020-01960-8
MacDonald DRW, Caba-Doussoux P, Carnegie CA, Escriba I, Forward DP, Graf M, et al. Tibial nailing using
a suprapatellar rather than an infrapatellar approach significantly reduces anterior knee pain postoperatively: a
multicentre clinical trial. Bone Joint J 2019;101-B(9):1138-43. https://doi.org/10.1302/0301-620X.101B9.BJJ-2018-1115.R2
Gao Z, Han W, Jia H. Suprapatellar versus infrapatellar intramedullary nailing for tibal shaft fractures: A metaanalysis of randomized controlled trials. Medicine (Baltimore) 2018;97(24):e10917.
https://doi.org/10.1097/MD.0000000000010917
Xu H, Gu F, Xin J, Tian C, Chen F. A meta-analysis of suprapatellar versus infrapatellar intramedullary nailing for
the treatment of tibial shaft fractures. Heliyon 2019;5(9):e02199. https://doi.org/10.1016/j.heliyon.2019.e02199
Cui Y, Hua X, Schmidutz F, Zhou J, Yin Z, Yan SG. Suprapatellar versus infrapatellar approaches in the treatment of tibia intramedullary nailing: a retrospective cohort study. BMC Musculoskelet Disord 2019;20(1):573.
https://doi.org/10.1186/s12891-019-2961-x
Isaac M, O’Toole RV, Udogwu U, Connelly D, Baker M, Lebrun CT, et al. Incidence of knee pain beyond 1 year:
suprapatellar versus infrapatellar approach for intramedullary nailing of the tibia. J Orthop Trauma 2019;33(9):438-42. https://doi.org/10.1097/BOT.0000000000001504
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