Comparison of suprapatellar versus infrapatellar approaches of intramedullary nailing for distal tibia fractures

Abstract

Background: This study aimed to analyze and compare the clinical and functional outcomes of distal tibia fractures treated with intramedullary nailing (IMN) using the suprapatellar (SP) and infrapatellar (IP) surgical approaches.Methods: A retrospective analysis was performed in 63 patients with distal fractures that were treated with IMN between August 2014 and August 2018. A total of 27 and 36 patients underwent IMN using the SP and IP techniques, respectively. The surgical time, blood loss, closed reduction rate, rate of adjuvant reduction technique, fracture healing time, and complications were reviewed in this study. Anterior knee pain was assessed using the visual analog scale. The Lysholm Knee Scoring Scale and American Orthopaedic Foot and Ankle Society (AOFAS) scale were used as clinical measurements.Results: A total of 63 patients, with a minimum follow-up of 12 months, were evaluated. The average surgical time, blood loss, rate of adjuvant reduction technique, closed reduction rate, fracture healing time, and Lysholm Knee Scoring Scale score were insignificantly different (P>0.05) between the two groups. However, the SP approach was superior to the IP approach in terms of pain score, AOFAS score, and fracture deformity rate (P<0.05).Conclusions: In the treatment of distal tibia fractures, the SP IMN technique is associated with a significantly higher functional outcome, lower knee pain, and lower rate of fracture deformity than the IP IMN technique.

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

“…Chan et al 19 and Sun et al 23 found no significant differences between the 2 IMN groups. Lu et al 25 reported a significant difference with 3.7% malunion rate in the SP group and 25% malunion rate in the IP group ( P = 0.034). Although Metcalf et al reported a malunion rate of 6 of 107 in the SP group and 19 of 102 in the IP group, only 3 patients overall required revision surgery for malunion across both groups, 1 in the SP and 2 in the IP group.…”

“…The most common PROM was the Lysholm Knee Score, which was reported by 7 studies. [19][20][21][22][23][24][25] Three studies used the Kujala Score 18,20,22 and 3 studies used a visual analogue scale for pain 19,21,23 to report patient outcomes. In total, 11 different PROMs were reported across all studies (see Table, Supplemental Digital Content 5, http://links.lww.com/JOT/B623).…”

“…Eight studies reported on operative time ranging from 60.0 to 147.0 minutes. 20,[22][23][24][25][26][27] The operative time between the IP (n = 465) and SP (n = 409) groups approached statistical significance with a mean difference of 4.76 minutes (95%…”

Response to comments on: Comparison of suprapatellar versus infrapatellar approaches of intramedullary nailing for distal tibia fractures

“…Thanks very much for your interest in the article "Comparison of suprapatellar versus infrapatellar approaches of intramedullary nailing for distal tibia fractures" [1]. We agree with Dr. Lu's opinion that the description of the ideal starting point and Fig.…”

Minimally-Invasive Plate or Intramedullar Nail in the Management of Distal Extra-Articular Tibial Fracture, What Is Better?

“…29 Lu et al found less malalignment with the suprapatellar method in distal tibia fractures. 30 Therefore, we preferred the suprapatellar method.…”