Suprapatellar intramedullary nailing of the tibia

Abstract

Objective: To report our experience with intramedullary fixation and osteosynthesis of the tibia with suprapatellar approach and semiextended positioning. Methods: This study retrospectively assessed 6 patients with tibial fracture treated with suprapatellar intramedullary nail fixation and osteosynthesis from September 2015 to September 2018. Results: There was acceptable bone fixation. Mean healing time was 6 months (range: 4-10 months). Postoperative pain was assessed using a visual analog scale, and the knee was divided into 9 quadrants to help locate the specific site of pain; all participants reported that pain was located at distal quadrants. Knee function was completely restored. Conclusion: Suprapatellar approach with the knee in the semiextended position is a good surgical technique for extra-articular proximal tibial fractures or those associated with soft tissue involvement at the conventional infrapatellar entry site. Thus, this analysis led us to believe that the technique should also be applicable to middle diaphyseal fractures or fractures in general, regardless of their location. Level of Evidence IV, Therapeutic Studies; Case Series.

Suprapatellar nail – the gold standard in the treatment of tibia fractures

“…In our series, five patients presented residual pain at maximum knee flexion in quadrant 3 but without limping, and one in quadrant 5. Sperone et al (31) , in a series of six patients with proximal tibia fracture treated with suprapatellar placement endomedullary nail, divided the knee into three thirds ( extraarticular proximal, purely articular, and extraarticular distal), and each of these thirds was subdivided into internal, middle and external. One patient had pain in the internal extraarticular distal third related to the proximal locking nail, and two patients in the middle distal extraarticular related to the fracture focus, the remaining quadrants reported no pain.…”