The semi-extended infrapatellar intramedullary nailing of distal tibia fractures: a randomized clinical trial

Abstract

Background Malalignment is a common event during the intramedullary nailing (IMN) of distal tibia fractures (DTFs). Although it is reported that the semi-extended IMN techniques such as suprapatellar (SP) and parapatellar (PP) approaches may be superior in preventing malalignment, the application of these techniques is concerning owing to the intra-articular involvement. We thus developed an extra-articular semi-extended infrapatellar (SEIP) approach which utilizes the infrapatellar (IP) space while maintaining the knee in a semi-extended position. However, there are no studies on the safety and efficacy of SEIP in treating DTFs. Therefore, in this study, the SEIP technique was examined, particularly in terms of the potential alignment improvement of DTFs, and this technique was compared with the traditional hyperflexed infrapatellar (HFIP) procedure. Materials and methods This randomized clinical trial (RCT) compared IMN malalignment while correcting extraarticular and nondisplaced intra-articular DTFs between April 2018 and June 2021 using the HFIP and SEIP techniques at a level I trauma center in China. The study participants were clinically and radiographically examined for at least 12 months of follow-ups. Intraoperative fluoroscopy time, operation time, blood loss, hospitalization duration, functional ankle score, and complications were assessed as well. Results Among the 88 recruited participants, 45 (51%) underwent traditional HFIP IMN and 43 (49%) underwent SEIP IMN. Malalignment occurred in 9 patients (20.0%) from the HFIP cohort and in 2 patients (4.7%) from the SEIP cohort (P value = 0.030). In addition, the SEIP IMN technique significantly reduced the intraoperative fluoroscopy time, operation time, and improved the postoperative ankle function compared to the HFIP IMN technique. However, the intraoperative blood loss, hospitalization duration, infection, delay union, and nonunion remained the same between the two cohorts. Conclusions In summary, we demonstrated that the SEIP IMN provides markedly enhanced alignment of extraarticular and nondisplaced intra-articular DTFs compared to the traditional HFIP IMN procedure. The described technique represents an effective option for IMN of DTFs. Level of evidence Level 2. Trial registration The Chinese Clinical Trial Registry, ChiCTR2100043673. Registered 26 February 2021, retrospectively registered, http://www.chictr.org.cn/showprojen.aspx?proj=122263

Novel Triangular Anchor Reduction Forceps versus Towel Forceps for Long Oblique or Spiral Distal Tibial Fractures: A Comparative Study

“…The overall complication rate after repositioning with a scarf clamp was 37%, while the overall complication rate after triangular anchor repositioning was 7%, with a signi cant difference between the two groups (P < 0.05). However, interestingly, the various complications were not signi cantly different between the two groups (P > 0.05), which was also reported in a study by Lu et al [14] . Therefore, the use of triangular anchor repositioning forceps can reduce the incidence of complications after intramedullary nailing for long oblique or spiral distal tibial fractures and greatly improve the outcome of intramedullary nailing.…”

A retrospective investigation on clinical and radiographic outcomes of distal tibial fractures after intramedullary nailing using the lateral parapatellar extra-articular approach

“…However, it has not been reported in existing evidence. Lu et al [ 26 ] demonstrated another semi-extended nailing technique using an infrapatellar extraarticular approach that does not require the dissection of the retinaculum, thus eliminating the chance of patellar instability. Nonetheless, nailing using this approach requires a newly designed intramedullary nail and special instrument, which might limit the routine use of this approach.…”