No Incidence of Postoperative Knee Sepsis With Suprapatellar Nailing of Open Tibia Fractures

Mitchell, Phillip M.; Weisenthal, Benjamin M.; Collinge, Cory

doi:10.1097/bot.0000000000000725

Cited by 25 publications

(24 citation statements)

References 18 publications

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“…Additionally, the extended position of the lower leg allows for easier fluoroscopic imaging [8]. However, some surgeons argue that it will cause other problems such as knee sepsis [16] and injury of the knee structures [17]. Therefore, the meta-analysis was aimed at assessing the clinical efficacy of suprapatellar intramedullary nailing vs infrapatellar intramedullary nailing with regard toknee pain, malalignment, knee function scores, operation time, and fluoroscopy time.…”

Section: Discussionmentioning

confidence: 99%

A meta-analysis of suprapatellar versus infrapatellar intramedullary nailing for the treatment of tibial shaft fractures

Xu¹,

Fu-shun

Xin

et al. 2019

Heliyon

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BackgroundWhether the optimal treatment for tibial shaft fractures is suprapatellar intramedullary nailing or infrapatellar approach is controversial.Materials and methodsPubMed, Embase, Cochrane, Web of science and CNKI, Wan fang Chinese databases were retrieved from their establishment to April 26, 2017. Seven studies (three randomized and four clinical controlled trials) were included in the final analysis. This meta-analysis included 683 patients with tibial shaft fracture (suprapatellar: 341; infrapatellar: 342).ResultsThere was significant difference between suprapatellar and infrapatellar approach surgery in the incidence of knee pain (P = 0.003). The malalignment of the sagittal and coronal plane in suprapatellar surgery was more serious than in the infrapatellar approach (sagittal plane: P < 0.00001; coronal plane:P = 0.07). The infrapatellar approach surgery was more time-consuming than suprapatellar surgery (P = 0.01), with no significant difference in knee function score (P = 0.35).ConclusionsSuprapatellar intramedullary nailing reduced the incidence of knee pain and the average malalignment of fractures compared to infrapatellar intramedullary nailing. It also reduced the operation time and fluoroscopy time. The results of the study should be interpreted with caution due to the heterogeneity of the study designs.

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Section: Discussionmentioning

confidence: 99%

A meta-analysis of suprapatellar versus infrapatellar intramedullary nailing for the treatment of tibial shaft fractures

Xu¹,

Fu-shun

Xin

et al. 2019

Heliyon

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“…External fixation following infection and soft tissue loss requires a significant compliance, but this report demonstrates that a desirable result may be achieved. Recently, definitive fixation via suprapatellar IMN has gained favor [5, 6, 9] due to stationary limb positioning resulting in improved fracture alignment and reduced fluoroscopy time [7, 8]. However, the risk of knee sepsis associated with an intra-articular starting point has not been defined in the setting of contaminated open fractures.…”

Section: Discussionmentioning

confidence: 99%

“…In 2017 and 2018, two studies evaluated the rates of knee sepsis associated with suprapatellar nailing of open tibia fractures [6, 9]. Mitchell et al evaluated 139 open tibia fractures (type II (41%); type III (46%)) treated with suprapatellar nailing and only identified one case of knee sepsis which was attributed to an ascending necrotizing soft tissue infection that ultimately involved the knee joint [6]. Marecek et al evaluated 289 fractures (type II (31%); type III (56%)) treated with either suprapatellar nailing ( n = 147) or infrapatellar nailing ( n = 142).…”

Section: Discussionmentioning

confidence: 99%

“…Stabilization of these fractures is often performed with intramedullary nailing (IMN), a technique that involves implant placement through either a suprapatellar or infrapatellar portal. Comparison of the two approaches demonstrates that suprapatellar nailing (SPN) facilitates improved alignment, particularly in distal or proximal fractures, [5, 6] and less fluoroscopic usage [7, 8]; however, a potential drawback to SPN of open fractures is iatrogenic knee sepsis as the technique requires intra-articular passage of instruments and the final implant. A 2017 study suggested that knee sepsis following suprapatellar nailing of open fractures does not occur [6], but a 2018 retrospective analysis reported two cases, suggesting a small but present risk for joint contamination [9].…”

Section: Introductionmentioning

confidence: 99%

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Knee Sepsis after Suprapatellar Nailing of an Open Tibia Fracture: Treatment with Acute Deformity and External Fixation

Minoughan

Schumaier

Avilucea

2019

Case Reports in Orthopedics

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Case A 31-year-old male was involved in a dirt bike accident and sustained an isolated type II open mid-distal tibia fracture. The patient underwent suprapatellar intramedullary nailing and subsequently developed knee sepsis. Conclusion This patient was managed with irrigation and debridements of the knee, fracture site, and intramedullary canal. A resultant soft-tissue defect over the fracture site obviated primary closure. Creation of an acute deformity stabilized by a Taylor spatial frame allowed primary wound closure. After soft tissue healing occurred, the frame was used to correct the intentional deformity and maintain reduction until full healing occurred.

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“…Moreover, the proposed risks of violating the knee joint, which include damage to articular cartilage or meniscus, have been invalidated in published studies. Septic arthritis of the knee represents a potentially devastating complication associated with a trans-articular start point which is rare [3][4][5][6][7][8][9][10]. The few published instances of knee sepsis after retrograde femoral nailing or antegrade tibial nailing occurred in the setting of exceptional soft tissue compromise (Table 1).…”

Section: Introductionmentioning

confidence: 99%

Acute Septic Arthritis Following Supra-Patellar Nailing of an Open Diaphyseal Tibia Fracture in an Immune Compromised Patient

L¹,

Kimberley²,

Jeffrey³

et al. 2018

J Clin Cases Rep

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The supra-patellar approach represents one approach to intramedullary nailing (IMN) of diaphyseal tibia fractures. Violation of the knee joint utilizing an intra-articular start point represents a risk for septic arthritis of the knee in the post-operative period. Previous retrospective studies of open tibia and femur fractures demonstrated that post-operative knee sepsis is rare, occurs in the chronic phase after injury, and due to extent of soft tissue injury rather than immune compromise. Here, we review current literature on post-operative knee sepsis, and present a case of acute septic arthritis of the knee following supra-patellar nailing of an open tibia fracture in a patient on chronic immune suppression. In this unique case, co-morbid patient factors likely led to this manifestation of a rare complication.

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No Incidence of Postoperative Knee Sepsis With Suprapatellar Nailing of Open Tibia Fractures

Abstract: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Cited by 25 publications

References 18 publications

A meta-analysis of suprapatellar versus infrapatellar intramedullary nailing for the treatment of tibial shaft fractures

A meta-analysis of suprapatellar versus infrapatellar intramedullary nailing for the treatment of tibial shaft fractures

Knee Sepsis after Suprapatellar Nailing of an Open Tibia Fracture: Treatment with Acute Deformity and External Fixation

Acute Septic Arthritis Following Supra-Patellar Nailing of an Open Diaphyseal Tibia Fracture in an Immune Compromised Patient

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