Comparison between functionality and quality of reduction between suprapatellar vs infrapatellar approaches in the treatment of diaphyseal and distal tibial fractures

Llano, Lionel; Soruco, María Liliana; Zamboni, Danilo Taype; Sancineto, Carlos; Barla, Jorge; Carabelli, Guido

doi:10.1007/s00590-022-03230-1

Cited by 5 publications

(8 citation statements)

References 9 publications

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“…We observed a lower rate of coronal malalignment and a lower overall rate of malalignment in the SP group than in the IP group. These findings are consistent with several previous studies comparing the SP and IP techniques 40,41 . In contrast, 2 recent studies, including 1 randomized controlled trial, found no difference in malalignment between the SP and IP approaches 10,42 .…”

Section: Discussionsupporting

confidence: 94%

“…This study evaluated a range of technical parameters, clinical outcomes, and PROs in a large, homogeneous patient cohort, treated with a uniform protocol, and compared SP and IP groups that were well-matched in their baseline demographic and injury-related characteristics. Malalignment was assessed using a validated technique 28 employed in prior studies 10,40 . PROs were obtained for the majority of patients in both groups at mid-term follow-up.…”

Section: Discussionmentioning

confidence: 99%

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Outcome Following Intramedullary Nailing of Tibial Diaphyseal Fractures

Makaram,

Sheppard,

Leow

et al. 2023

Journal of Bone and Joint Surgery

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Background: The primary aim of this study was to compare the radiographic parameters (nail insertion-point accuracy [NIPA] and fracture malalignment) of patients who had undergone tibial intramedullary nailing via the suprapatellar (SP) and infrapatellar (IP) approaches. The secondary aims were to compare clinical outcomes and patient-reported outcomes (PROs) between these approaches. Methods: All adult patients with an acute tibial diaphyseal fracture who underwent intramedullary nailing at a single level-I trauma center over a 4-year period (2017 to 2020) were retrospectively identified. The nailing approach (SP or IP) was at the treating surgeon’s discretion. Intraoperative and immediate postoperative radiographs were reviewed to assess NIPA (mean distance from the optimal insertion point) and malalignment (≥5°). Medical records and radiographs were reviewed to evaluate the rates of malunion, nonunion, and other postoperative complications. The Oxford and Lysholm Knee Scores (OKS and LKS) and patient satisfaction (0 = completely dissatisfied, 100 = completely satisfied) were obtained via a postal survey at a minimum of 1 year postoperatively. Results: The cohort consisted of 219 consecutive patients (mean age, 48 years [range, 16 to 90 years], 51% [112] male). There were 61 patients (27.9%) in the SP group and 158 (72.1%) in the IP group. The groups did not differ in baseline demographic or injury-related variables. SP nailing was associated with superior coronal NIPA (p < 0.001; 95% confidence interval [CI] for IP versus SP, 1.17 to 3.60 mm) and sagittal NIPA (p < 0.001; 95% CI, 0.23 to 0.97 mm) and with a reduced rate of malalignment (3% [2 of 61] versus 11% [18 of 158] for IP; p = 0.030). PROs were available for 118 of 211 patients (56%; 32 of 58 in the SP group and 86 of 153 in the IP group) at a mean of 3 years (range, 1.2 to 6.5 years). There was no difference between the SP and IP groups in mean OKS (36.5 versus 39.6; p = 0.246), LKS (71.2 versus 73.5; p = 0.696), or satisfaction scores (81.4 versus 79.9; p = 0.725). Conclusions: Compared with IP nailing, SP nailing of tibial shaft fractures was associated with superior NIPA and a reduced rate of intraoperative malalignment but not of malunion at healing. However, the superior NIPA may not be clinically important. Furthermore, there were no differences in PROs at mid-term follow-up. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionsupporting

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Outcome Following Intramedullary Nailing of Tibial Diaphyseal Fractures

Makaram,

Sheppard,

Leow

et al. 2023

Journal of Bone and Joint Surgery

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“…Six studies [ 21 , 26 , 27 , 34 , 41 , 43 ] reported fluoroscopy exposure during the procedure. Among them, Gao [ 41 ] only reported the fluoroscopy number and not time, and Llano [ 34 ] only reported the interquartile range of fluoroscopy time. Thus, their studies were excluded from this meta-analysis.…”

Section: Resultsmentioning

confidence: 99%

“…The mean time of use of fluoroscopy was 94,5 s in the SP group compared with 204,5 s in the IP group. There was a significant difference ( p < 0.001) [ 34 ] (Fig. 6 ).…”

Section: Resultsmentioning

confidence: 99%

“…We included more and newer studies [ 22 , 29 – 31 , 34 , 40 – 43 ] for this meta-analysis and systematic review, 20 observational studies and 3 RCTs. According to our latest findings, the SP group performed better in entrance alignment and intraoperative fluoroscopy time, and had significantly superior Lymsholm scores and anterior knee VAS scores to the IP group, while we did not find similar results in terms of operative time and intraoperative blood loss.…”

Section: Discussionmentioning

confidence: 99%

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A systematic review and meta-analysis comparing suprapatellar versus infrapatellar approach intramedullary nailing for tibal shaft fractures

Wang,

Xiong,

et al. 2023

Eur J Trauma Emerg Surg

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Background The application of the suprapatellar (SP) approach has challenged the traditional infrapatellar (IP) approach in the surgery treatment of tibial shaft fractures, yet the advantages and disadvantages still remain controversial. We included more high-quality studies for this meta-analysis and systematic review to evaluate the clinical outcomes and prognosis of both approaches and thus to provide new ideas for surgeons. Method We searched literatures from PubMed, Cochrane Library, Web of Science, and EMBASE databases from January 2000 to December 2022. We extracted general information including sample size, gender, proportion of open fracture, follow-up time, and outcome indicators including entrance accuracy, fluoroscopy time, operation time, intraoperative blood loss, Lysholm score, VAS pain score, range of motion (ROM) function score, reposition accuracy, and revision cases. Cochrane Collaboration's tool and the Newcastle–Ottawa Scale were used to evaluate literature qualities. Meta-analysis was performed using RevMan 5.4 software. Results A total of 23 studies were generated that qualified for inclusion, 17 of which were used for meta-analysis. This study found statistically significant differences in coronal plane entrance accuracy, fluoroscopy time, Lysholm score, and VAS pain score. Conclusion The results of our meta-analysis showed that the SP approach was significantly better than the IP approach in angle and distance entrance accuracy of coronal plane, angle entrance accuracy of sagittal plane, fluoroscopy time, Lysholm score, and VAS pain score. There were no significant differences in sagittal angle accuracy, operative time, intraoperative blood loss, and ROM score.

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