The medial parapatellar approach reports earlier knee recovery than the transpatellar approach for intramedullary nailing of tibial fractures

Abstract

Background A tibial fracture is the most common long bone fracture, and intramedullary nailing is the most widely accepted treatment option for tibial fractures. Several approaches for entry points have been described. Objective The study aims to evaluate the knee functional outcome, range of motion, and anterior knee pain after intramedullary nailing for tibial fractures using the medial parapatellar approach (MPA) compared to the transpatellar approach (TPA). Patients and methods From January 2021 to December 2022, a prospective case–control study was undertaken on patients presented with diaphyseal tibial fractures treated by intramedullary nailing through MPA or TPA, knee range of motion, anterior knee pain, and functional outcome using Lysholm score was used to evaluate the patients after 12 months follow up. Results The study included 80 patients who were allocated into both groups, postoperatively, the mean time for regaining full range of motion was 3.2(±1.2) weeks in the MPA group, and 5.8(±2.2) weeks in the TPA group (P=0.001), the anterior knee pain at the end of follow up was present in five (12.5%) cases in the MPA group, and six (15%) cases in the TPA group, The functional outcome of the knee shows the significant difference after 6 weeks and 3 months the follow-up, at the end of the follow-up, the mean Lysholm knee score was 94 in the MPA group in comparison to 91 in the TPA group with no statistically significant difference between both groups. Conclusion Using the MPA for intramedullary nailing for tibial fractures leads to earlier regaining of knee range of motion and higher knee scores, but with comparable results after 12 months compared to the TPA.