Functional Outcomes in Suprapatellar Intramedullary Nailing for the Treatment of Tibial Shaft Fractures

Introduction: The purpose of this study was to evaluate the functional outcomes of suprapatellar intramedullary nailing for the treatment of tibial shaft fractures.Material and Methods: The present retrospective study included 10 cases aged more than 20 years, who were operated for tibial shaft fractures over last 3 years with suprapatellar tibial nailing. Patients were retrospectively followed up with all their previous surgical records and radiographs.Results: The mean age was 41.57±16.51 with a range of 20-72 years. Mean operating time was 81±10.15 minutes. Mean blood loss was 110±20.5 ml. Mean time for union was 15.15±1.35 weeks. No deep infection was noted. 1 patient had anterior knee pain. The mean Lysholm knee score was 87.91 ± 5.75.Conclusion: The suprapatellar approach is good and safe technique for nailing in the tibial fractures.

Comparison of clinical efficacy of suprapatellar and infrapatellar intramedullary nailing in treating tibial shaft fractures

Objectives: To compare clinical efficacies of suprapatellar and infrapatellar intramedullary nailing approaches in treating tibial shaft fractures. Methods: Patients (n=110) admitted with tibial shaft fractures in our hospital from January 2017 to June 2020, who underwent procedures with internal fixation intramedullary nails, were retrospectively divided into suprapatellar and infrapatellar approach groups (n=55 each) based on the surgical method used for fracture repair. The clinical and functional outcomes of the knee were assessed six months after the surgery Results: Six months after the operation, the pooled value for excellent and good efficacy rates in the suprapatellar approach group, as indicated by Hospital for Special Surgery (HSS) Knee scoring system, was 90.91%, which was significantly higher than that in the infrapatellar approach group (76.36%). The degree of pain (visual analogue scale (VAS) score) of the patients in the suprapatellar approach group was over 2-fold lower than in the infrapatellar approach group (P < 0.001).The Lysholm knee score, range of motion (ROM), SF-36p, and SF-36M scores in the suprapatellar approach group were significantly higher than those in the infrapatellar approach group (P < 0.001). Conclusion: Suprapatellar approach had significantly higher clinical efficiency than infrapatellar approach, and can significantly reduce the degree of pain, promote the recovery of patients with knee joint involvement, improve the physical and psychological well-being, reduce the number of cases of postoperative delayed healing. doi: https://doi.org/10.12669/pjms.37.7.4766 How to cite this:Zhu Z, Wang Z, Zhou P, Wang X, Guan J. Comparison of clinical efficacy of suprapatellar and infrapatellar intramedullary nailing in treating tibial shaft fractures. Pak J Med Sci. 2021;37(7):---------. doi: https://doi.org/10.12669/pjms.37.7.4766 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

FUNCTIONAL OUTCOME OF TIBIAL FRACTURES TREATED BY INTERLOCKING NAILING THROUGH SUPRAPATELLAR APPROACH – A PROSPECTIVE AND RETROSPECTIVE STUDY

The aim of this prospective study is to analyse the functional and radiological outcome of tibial fractures treated by intramedullary nailing through supra patellar approach.15 patients with tibial fractures were operated by intramedullary nailing through suprapatellar approach. Oxford knee scoring system was done to evaluate the functional outcome. Serial radiographs were taken to assess the fracture union at 2 weeks, 6 weeks and 12 weeks. Fifteen patients (male 11 female 4) with fracture both bones leg i Results : ncluded in our study. The most common cause was motor vehicle accidents (9 cases), self limiting fall (4 cases), assault (2 cases). The mean age was 45 years. All fractures united at a mean period of 3.5 months. To conclude, Suprapatellar tibial nailing has the benets of decreased operating time, good ouroscopy visualisation, minimal blood loss and ability to achieve and maintain good reduction throughout the procedure.

Infrapatellar versus suprapatellar approach for intramedullary nailing of the tibia: a systematic review and meta-analysis

Background Intramedullary nailing (IMN) is a conventional technique for the treatment of tibial shaft fractures. It has been suggested that the suprapatellar (SP) approach holds advantages over the traditional infrapatellar (IP) approach. Current literature lacks adequate data to provide robust clinical recommendations. This meta-analysis aims to determine the efficacy of infrapatellar versus suprapatellar techniques for IMN. Methods An up-to-date literature search of the Embase, Medline, and registry platform databases was performed. The search was conducted using a predesigned search strategy and all eligible literature was critically appraised for methodological quality via the Cochrane’s collaboration tool. Fluoroscopy time, operative time, pain score, knee function, deep infection, non-union and secondary operation rates were all considered. Conclusion A total of twelve studies were included in the meta-analysis. The results of this analysis show that suprapatellar nailing is associated with reduced post-operative pain scores and improved functional outcomes. The data suggest no significant difference in terms of operative times, fluoroscopy times, rates of deep infection, non-union or secondary procedures when compared to infra-patellar techniques. Further studies are required to confirm these findings and assess long-term results.

SUPRAPATELLER NAILING IN PROXIMAL TIBIA FRACTURES

The treatment of extraarticular proximal tibia fractures is characterized by the difficulties in obtaining the proper reduction and high rate of complications due to the typical soft-tissue injuries. The literature data on the use of suprapatellar approach for intramedullary nailing of exraarticuar fractures of the proximal tibia are analyzed in the article with special attention to the surgical technique of fracture reduction and nail application. Current data shows that the suprapatellar approach is safe when performed properly and has no adverse influence on the knee joint. The reduction of the fracture and intraoperative radiologic control are simplified by this technique, but additional reduction tools shall be available.

DETERMINATION OF THE EFFICACY OF SUPRAPATELLAR APPROACH FOR INTRAMEDULLARY NAILING OF PROXIMAL TIBIAL FRACTURES

Summary. The topicality of the research is predetermined by the high frequency of adverse functional results after PTF (proximal tibial fractures) treatment, like deforming osteoarthritis, contractures, knee joint instability developing fairly often in the distant period and occurring in 5.8% to 28% of cases; disability rate up to 5.9-9.1%. The mater of a traditional approach to an intramedullary nail insertion point versus the suprapatellar one for FPRTB intramedullary nailing is still under discussion. Objective: To specify the efficacy of suprapatellar approach for IM nailing in patients with PTF. Materials and methods: prospective and retrospective analysis of the efficiency of 30 PTF patients’ treatment at the clinic of the State Institution “ITO NAMN of Ukraine” and at the traumatology department of KNMP “Globinskaya CRН” within 2016-2017, using both suprapatellar and traditional accesses. Their outcomes have been evaluated after their fractures consolidation (1 year after the start of the treatment) according to the Neer-Grantham-Shelton scale. Results. The IM nailing from the suprapatellar access has shown itself to be the most efficient method for proximal tibial fractures management. The share of excellent results reached 60%, demonstrating statistically significant difference (p ≤ 0.01) from those of patients cured from a traditional access; there were only 20% of satisfactory results. No poor results were reported. Practical importance: the study proves the expediency of suprapatellar access in IM nailing of PTF and the need for wider implementation of the method within the territory of Ukraine. Conclusions. Considering the low injury rate and ensuring potentially better bone fragments reposition, the suprapatellar access in IM nailing is the most efficient method for PTF management.