Tibial Intramedullary Nailing by Suprapatellar Approach: Is It Quicker and Safer?

Jayaraju, Ullas; Rammohan, R; Awad, Fady; Kaur, Kirandeep; Brock, James A.; Singhal, Anil; Clewer, G.

doi:10.7759/cureus.29915

Cited by 3 publications

(2 citation statements)

References 20 publications

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“…Tibial RM (≥10°) is reported in up to 30% of all patients who are treated with IP nailing 19 , 20 . Currently, the suprapatellar (SP) approach for IM nailing is gaining popularity as a treatment option, given reports of superior functional knee outcomes when compared with IP nailing 1 , 21 , 22 .…”

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Prevalence of Rotational Malalignment After Infrapatellar Versus Suprapatellar Intramedullary Nailing of Tibial Shaft Fractures

Alderlieste,

Cain,

van der Gaast

et al. 2024

JBJS Open Access

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Background: Up to 30% of patients with a tibial shaft fracture sustain iatrogenic rotational malalignment (RM) after infrapatellar (IP) nailing. Although IP nailing remains the management of choice for most patients, suprapatellar (SP) nailing has been gaining popularity. It is currently unknown whether SP nailing can provide superior outcomes with regard to tibial RM. The aim of this study was to compare the differences in the prevalence of RM following IP versus SP nailing. Methods: This retrospective study included 253 patients with a unilateral, closed tibial shaft fracture treated with either an IP or SP approach between January 2009 and April 2023 in a Level-I trauma center. All patients underwent a postoperative, protocolized, bilateral computed tomography (CT) scan for RM assessment. Results: RM was observed in 30% and 33% of patients treated with IP and SP nailing, respectively. These results indicate no significant difference (p = 0.639) in the prevalence of RM between approaches. Furthermore, there were no significant differences in the distribution (p = 0.553) and direction of RM (p = 0.771) between the 2 approaches. With the IP and SP approaches, nailing of left-sided tibial shaft fractures resulted in predominantly internal RM (85% and 73%, respectively), while nailing of right-sided tibial shaft fractures resulted in predominantly external RM (90% and 80%, respectively). The intraobserver reliability for the CT measurements was 0.95. Conclusions: The prevalence of RM was not influenced by the entry point of tibial nailing (i.e., IP versus SP). Hence, the choice of surgical approach should rely on factors other than the risk of RM. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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confidence: 99%

Prevalence of Rotational Malalignment After Infrapatellar Versus Suprapatellar Intramedullary Nailing of Tibial Shaft Fractures

Alderlieste,

Cain,

van der Gaast

et al. 2024

JBJS Open Access

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“…Широко распространённое использование внутрикостных и накостных имплантатов, а также аппаратов наружной фиксации показало, что далеко не всегда современные хирургические методы являются успешными. Несостоятельность лечения связана с ятрогенной травматичностью оперативного вмешательства, значительной продолжительностью наружной фиксации, замедленной костной консолидацией, нарушениями комфортности при использовании аппаратов наружной фиксации [5,6].…”

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Combined osteosynthesis for tibial shaft fracture treatment

Klyshnikov,

Sazonova,

Popkov

2023

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Introduction Widespread use of intramedullary and extramedullary implants, as well as external fixation devices, has demonstrated that current surgical methods are not always successful.The study aimed to assess the efficiency of a combination of transosseous osteosynthesis with intramedullary reinforcement using elastic titanium hydroxyapatite-coated rods (HA-rods) in long bone fracture treatment.Material and methods Medical records of 40 patients aged from 18 to 55 years with closed diaphyseal tibia fractures of A1-A3 type (AO/ASIF) treated with the Ilizarov transosseous osteosynthesis method combined with intramedullary elastic HA-coated wires were analysed. Result Ilizarov fixator removal was performed on average 45.3 ± 14.7 days after surgery. Radiological signs of bone union (immature callus, patterns of periosteal and endosteal stratifications overlapping the fracture line) were visible by week 3 to 4.Discussion Соmbination of the external fixator and intramedullary elastic HA-coated wires overcomes shortcomings of both external and internal means of fixation. External osteosynthesis provides advantages of the Ilizarov method: preservation of blood supply, absence of soft tissue injury, joint function and early weightbearing. Elastic intramedullary wires do not injure a. nutricia and mechanically stimulate endosteal and periosteal bone formation.Conclusion The advantages of combined osteosynthesis provide reduction of Ilizarov apparatus fixation time, reduction in the number of wires and half-pins in the frame assembly, stimulation of bone callus formation and prevention of secondary bone fragment displacement.

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A Prospective Study on the Suprapatellar Approach for Tibial Shaft Fractures: Insights Into Functional and Radiological Outcomes

Malasani,

Jha,

Ganesh

2024

Cureus

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Background: Tibial shaft fractures are among the most common long bone injuries and often can be challenging to manage surgically. While infrapatellar (IP) intramedullary nailing (IMN) has been a widely accepted treatment, its limitations have led to the emergence of alternative approaches, such as suprapatellar nailing (SPN) in a semi-extended knee position. Aim: To evaluate the clinical, radiological, and functional outcomes of tibial shaft fractures treated with an SPN approach in a semi-extended knee position. Methods: A prospective study was conducted at Saveetha Medical College, including 20 patients diagnosed with tibial shaft fractures between August 2021 and December 2022. All patients underwent IMN using a suprapatellar approach after being assessed for surgical fitness and providing informed consent. Clinical and radiological follow-ups were performed over a 12-month period to evaluate knee range of motion, fracture healing, implant positioning, and knee pain, using the Lower Extremity Functional Scale (LEFS) and Visual Analog Scale (VAS). Results: The study cohort consisted of 20 patients, with a male-to-female ratio of 3:1. The majority (70%) were aged between 20 and 40 years. Fractures affected the left tibia in 11 cases and the right in nine cases. Among the fractures, 12 were closed and eight were open, classified according to the Gustilo-Anderson classification as ranging from Grade 1 to Grade 3. The mean surgery duration was 83.5 minutes, with an average blood loss of less than 100 mL. The mean time to fracture union was 12 weeks, and the mean LEFS score recorded was 75.75. Three patients experienced complications, which were managed successfully. Overall, patients demonstrated favorable clinical, radiological, and functional outcomes with minimal knee pain post-surgery. Conclusion: Suprapatellar IMN in the semi-extended position is a viable and effective surgical approach for managing tibial shaft fractures, providing good clinical, radiological, and functional outcomes with minimal complications.

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Tibial Intramedullary Nailing by Suprapatellar Approach: Is It Quicker and Safer?

Cited by 3 publications

References 20 publications

Prevalence of Rotational Malalignment After Infrapatellar Versus Suprapatellar Intramedullary Nailing of Tibial Shaft Fractures

Prevalence of Rotational Malalignment After Infrapatellar Versus Suprapatellar Intramedullary Nailing of Tibial Shaft Fractures

Combined osteosynthesis for tibial shaft fracture treatment

A Prospective Study on the Suprapatellar Approach for Tibial Shaft Fractures: Insights Into Functional and Radiological Outcomes

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