Determination of the Efficacy of Suprapatellar Approach for Intramedullary Nailing of Proximal Tibial Fractures

Abstract

Summary. The topicality of the research is predetermined by the high frequency of adverse functional results after PTF (proximal tibial fractures) treatment, like deforming osteoarthritis, contractures, knee joint instability developing fairly often in the distant period and occurring in 5.8% to 28% of cases; disability rate up to 5.9-9.1%. The mater of a traditional approach to an intramedullary nail insertion point versus the suprapatellar one for FPRTB intramedullary nailing is still under discussion. Objective: To specify the efficacy of suprapatellar approach for IM nailing in patients with PTF. Materials and methods: prospective and retrospective analysis of the efficiency of 30 PTF patients’ treatment at the clinic of the State Institution “ITO NAMN of Ukraine” and at the traumatology department of KNMP “Globinskaya CRН” within 2016-2017, using both suprapatellar and traditional accesses. Their outcomes have been evaluated after their fractures consolidation (1 year after the start of the treatment) according to the Neer-Grantham-Shelton scale. Results. The IM nailing from the suprapatellar access has shown itself to be the most efficient method for proximal tibial fractures management. The share of excellent results reached 60%, demonstrating statistically significant difference (p ≤ 0.01) from those of patients cured from a traditional access; there were only 20% of satisfactory results. No poor results were reported. Practical importance: the study proves the expediency of suprapatellar access in IM nailing of PTF and the need for wider implementation of the method within the territory of Ukraine. Conclusions. Considering the low injury rate and ensuring potentially better bone fragments reposition, the suprapatellar access in IM nailing is the most efficient method for PTF management.