Intramedullary Nailing with a Suprapatellar Approach and Condylar Bolts for the Treatment of Bicondylar Fractures of the Tibial Plateau

Abstract

Background:Bicondylar tibial plateau fractures have been treated with either plating or external fixation techniques, with conflicting results. A recently introduced technique involving the combined use of intramedullary nailing via a suprapatellar approach and condylar bolts could represent a new pathway toward better treatment of this severe injury.Methods:The present report describes a retrospective and prospective study of all 17 patients (age range, 25 to 75 years) who were admitted under the author’s care for the treatment of a closed, bicondylar tibial plateau fracture between 2013 and 2015. All patients consented to undergo fixation of the fracture with intramedullary nailing through a suprapatellar approach and with use of condylar bolts. The reconstructed articular surface was supported with freeze-dried allograft that had been previously soaked in concentrated bone marrow. The patients were followed at regular intervals, and the results were assessed with the Knee injury and Osteoarthritis Outcome Score (KOOS).Results:All patients were followed for at least 1 year (average and standard deviation, 25.23 ± 8.95 months; range, 12 to 46 months). All fractures united clinically and radiographically between 10 and 22 weeks (average, 15.1 ± 2.91 weeks), with no instances of neurovascular complication, infection, or implant failure. One patient underwent early revision of the fixation because of unsatisfactory reduction of the articular surface, and 1 patient had secondary fracture displacement. One condylar bolt was removed after fracture healing because of irritation at the insertion site. However, all patients regained knee motion without physiotherapy and all were fully weight-bearing by the fifth postoperative month.Conclusions:The short and intermediate-term results associated with the use of the proposed technique appear to be satisfactory. However, the effectiveness of the technique should be reassessed with long-term studies as well as comparative studies involving other fixation techniques.Level of Evidence:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Our experience in suprapatellar nailing: Surgical techniques

“…It can be an excellent alternative to other modalities of management as it overcomes the shortcomings of the classical approach. Now a days it is also attempted in intra articular proximal tibial fracture with simple extension (Garnavos 2017) [19] . It results in excellent clinical outcomes.…”

“…This approach overcomes the issues of reduction in 90-degree flexion with posterior malalignment of the distal fragment. Extra articular fracture with simple intra articular extension can be managed by nailing through suprapatellar approach after fixing the condyles with screw 19 . Suprapatellar nailing with midline incision of the quadriceps tendon was done by sanders et al, which overcomes the problems of reduction with knee in 90 degree flexion and posteriorly displaced distal fragment.…”

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

“…Позасуглобові ППВВК (41-А2, 41-А3, 42 за класифікацією АО) можуть бути ліковані методом БІОС, також описано успішне використання блокуючого інтрамедулярного остеосинтезу при простих внутрішньосуглобових переломах (41-С1 і 41-С2 за класифікацією АО) [8,9]. Досліджень, що визначають мінімальну відстань від суглобової поверхні до лінії перелому, при якому можливе використання БІОС, немає, складні внутрішньосуглобові переломи з імпресією суглобової поверхні прийнято вважати показаннями до накісткового остеосинтезу, хоча за даними Garnavos C., 2017 [10], БІОС показав високу ефективність навіть при даному типі переломів.…”

“…Reported are also the cases of successful IM nailing in cases of plain intraarticular fractures (41-C1 and 41-C2 according to AO) [8,9]. There are no special publications on study of a distance between a joint surface and a fracture line, at which IM nailing might be possible; complex intra-articular fractures with joint surface impressed are commonly considered as indication for plate osteosynthesis, although according to Garnavos C., 2017 [10], IM nailing has demonstrated high efficacy even for this fracture type.…”