Comparison of Patient-Reported Outcomes After Suprapatellar Versus Infrapatellar Nailing Techniques for Tibial Shaft Fractures: A Systematic Review and Meta-analysis

Sepehri, Aresh; You, Daniel; Lobo, Akshay A; Schneider, Prism; Lefaivre, Kelly A.; Guy, Pierre

doi:10.1097/bot.0000000000002303

Cited by 6 publications

(3 citation statements)

References 48 publications

(82 reference statements)

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“…The superior Lysholm scores in the suprapatellar group are consistent with a previous meta-analysis comparing the SP and IP approaches for tibia shaft intramedullary nailing [ 15 , 17 , 19 ]. The difference in Lysholm score might result from anterior knee pain, which could be significantly reduced using the SP approach [ 5 , 18 ].…”

Section: Discussionsupporting

confidence: 89%

Suprapatellar vs infrapatellar approaches for intramedullary nailing of distal tibial fractures: a systematic review and meta-analysis

2023

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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 used the Newcastle Ottawa Scale to assess study quality and a random-effects meta-analysis to synthesize the outcomes. We used the mean difference (MD) or standardized mean difference (SMD) with the 95% confidence interval (CI) for continuous data and the odds ratio (OR) with the 95% CI for dichotomous data. Results Four studies with 586 patients (302 in the SP group and 284 in the IP group) were included in this systematic review. The SP group may have had little or no difference in pain and slightly better knee function (MD 3.90 points, 95% CI 0.83 to 5.36) and better ankle function (MD: 8.25 points, 95% CI 3.35 to 13.15) than the IP group 12 months after surgery. Furthermore, compared to the IP group, the SP group had a lower risk of malalignment (OR: 0.22, 95% CI 0.06 to 0.75; number needed to treat (NNT): 6), a lower risk for open reduction (OR: 0.58, 95% CI 0.35 to 0.97; NNT: 16) and a shorter surgical time (MD: − 15.14 min, 95% CI − 21.28 to − 9.00). Conclusions With more advantages, the suprapatellar approach may be the preferred nailing technique over the infrapatellar approach when treating distal tibial fractures. Level of evidence: Level III, systematic review of non-randomized studies.

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Section: Discussionsupporting

confidence: 89%

Suprapatellar vs infrapatellar approaches for intramedullary nailing of distal tibial fractures: a systematic review and meta-analysis

2023

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“…A meta-analysis of 1,196 patients undergoing intramedullary nailing for a tibial shaft fracture showed significantly better patient-reported outcome measures after intramedullary nail fixation when the suprapatellar approach was used compared with the infrapatellar approach, as well as greater reduction accuracy and less fluoroscopy time with the suprapatellar approach. Although the results supported the routine use of the suprapatellar approach, the systematic review and meta-analysis included mostly Level-III studies, lowering the certainty 15 .…”

Section: Hipmentioning

confidence: 85%

What’s New in Orthopaedic Trauma

Flanagan

Vallier

2023

Journal of Bone and Joint Surgery

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“…Despite the correlation between Lysholm and VAS, due to the higher level of heterogeneity resulting from variability in follow-up time, the author stated that their long-term results still need to be confirmed and evaluated in further studies. Sepehri [ 15 ] found in a recent meta-analysis that the SP group performed better in Lysholm and intraoperative fluoroscopy time, but showed no such differences in operative time.…”

Section: Discussionmentioning

confidence: 99%

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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Comparison of Patient-Reported Outcomes After Suprapatellar Versus Infrapatellar Nailing Techniques for Tibial Shaft Fractures: A Systematic Review and Meta-analysis

Abstract: Supplemental Digital Content is Available in the Text.

Cited by 6 publications

References 48 publications

Suprapatellar vs infrapatellar approaches for intramedullary nailing of distal tibial fractures: a systematic review and meta-analysis

Suprapatellar vs infrapatellar approaches for intramedullary nailing of distal tibial fractures: a systematic review and meta-analysis

What’s New in Orthopaedic Trauma

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

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