A Prospective Study on the Suprapatellar Approach for Tibial Shaft Fractures: Insights Into Functional and Radiological Outcomes

Abstract

Background: Tibial shaft fractures are among the most common long bone injuries and often can be challenging to manage surgically. While infrapatellar (IP) intramedullary nailing (IMN) has been a widely accepted treatment, its limitations have led to the emergence of alternative approaches, such as suprapatellar nailing (SPN) in a semi-extended knee position. Aim: To evaluate the clinical, radiological, and functional outcomes of tibial shaft fractures treated with an SPN approach in a semi-extended knee position. Methods: A prospective study was conducted at Saveetha Medical College, including 20 patients diagnosed with tibial shaft fractures between August 2021 and December 2022. All patients underwent IMN using a suprapatellar approach after being assessed for surgical fitness and providing informed consent. Clinical and radiological follow-ups were performed over a 12-month period to evaluate knee range of motion, fracture healing, implant positioning, and knee pain, using the Lower Extremity Functional Scale (LEFS) and Visual Analog Scale (VAS). Results: The study cohort consisted of 20 patients, with a male-to-female ratio of 3:1. The majority (70%) were aged between 20 and 40 years. Fractures affected the left tibia in 11 cases and the right in nine cases. Among the fractures, 12 were closed and eight were open, classified according to the Gustilo-Anderson classification as ranging from Grade 1 to Grade 3. The mean surgery duration was 83.5 minutes, with an average blood loss of less than 100 mL. The mean time to fracture union was 12 weeks, and the mean LEFS score recorded was 75.75. Three patients experienced complications, which were managed successfully. Overall, patients demonstrated favorable clinical, radiological, and functional outcomes with minimal knee pain post-surgery. Conclusion: Suprapatellar IMN in the semi-extended position is a viable and effective surgical approach for managing tibial shaft fractures, providing good clinical, radiological, and functional outcomes with minimal complications.