Comparative study of range of motion and anterior knee pain in parapatellar versus trans patellar approach in tibia nailing

Authors

  • Nikhil Pralhad Deokar Department of Orthopedics, Kristhna Institute of Medical Sciences, Karad, Maharashtra, India
  • Kiran L. Gaonkar Department of Orthopedics, Kristhna Institute of Medical Sciences, Karad, Maharashtra, India
  • Siddharth Daruwala Department of Orthopedics, Kristhna Institute of Medical Sciences, Karad, Maharashtra, India
  • Anshuraj Jagdale Department of Orthopedics, Kristhna Institute of Medical Sciences, Karad, Maharashtra, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20223310

Keywords:

Trans patellar, Parapatellar, Tibia fractures, Interlocking tibia nailing

Abstract

Background: Tibial shaft fractures are common traumatic fractures especially in road traffic accidents. Intramedullary interlocking nailing is considered treatment of choice tibial diaphyseal fractures, minimizing soft tissue injury and permitting early weight bearing and fracture healing. Anterior knee pain and reduced range of motion are some common complications that patients have to face in post-operative period.

Methods: The 60 patients of both sex with traumatic diaphyseal tibial shaft fractures were included in this study out of which 30 were operated with interlocking tibia nailing with trans patellar (tendon splitting) approach while 30 were operated with medial parapatellar approach for tibia nail insertion. Range of motion at knee joint (in degrees) and anterior knee pain (on visual analogue scale) was evaluated on post-operative day 1, 2 weeks, 1 month, 3-month post operatively and compared for both groups.

Results: Mean anterior knee pain was significantly lower in parapatellar approach group at 2 weeks, 1 month and 3 months while there was no significant difference on post-operative day 1. Mean range of motion at knee joint was more in parapatellar approach group on post-operative day 1 and 2 weeks while there was no significant difference in range of motion after 2 weeks.

Conclusions: In our study medial parapatellar approach is superior than tendon splitting approach with comparatively greater range of motion and lesser anterior knee pain. Thus, medial parapatellar approach should be encouraged for interlocking tibia nailing.

References

Bhandari M, Adili A, Leone J, Lachowski RJ, Kwok DC. Early versus delayed operative management of closed tibial fractures. Clin Orthop Relat Res. 1999;368:230-9.

Court-Brown CM, Christie J, McQueen MM. Closed intramedullary tibial nailing. Its use in closed and type I open fractures. J Bone Joint Surg Br. 1990;72:605-11.

Kuntscher GB. The Kuntscher method of intramedullary fixation. J Bone Joint Surg Am. 1958;40:17-26.

Lefaivre KA, Guy P, Chan H. Long-term follow-up of tibial shaft fractures treated with intramedullary nailing. J Orthop Trauma. 2008;22:525-9.

Cartwright-Terry M, Snow M, Nalwad H. The severity and prediction of anterior knee pain post tibial nail insertion. J Orthop Trauma. 2007;21:381-5.

Vaisto O, Toivanen J, Kannus P, et al. Anterior knee pain and thigh muscle strength after intramedullary nailing of tibial shaft fractures: a report of 40 consecutive cases. J Orthop Trauma. 2004;18:18-23.

Dogra AS, Ruiz AL, Marsh DR. Late outcome of isolated tibial fractures treated by intramedullary nailing: the correlation between disease-specific and generic outcome measures. J Orthop Trauma. 2002;16:245-9.

Toivanen JA, Vaisto O, Kannus P. Anterior knee pain after intramedullary nailing of fractures of the tibial shaft. A prospective, randomized study comparing two different nail-insertion techniques. J Bone Joint Surg Am. 2002;84:580-5.

Keating JF, Orfaly R, O’Brien PJ. Knee pain after tibial nailing. J Orthop Trauma. 1997;11:10-3.

Court-Brown CM, Gustilo T, Shaw AD. Knee pain after intramedullary tibial nailing: its incidence, etiology, and outcome. J Orthop Trauma. 1997;11:103-5.

Orfaly R, Keating JE, O’Brien PJ. Knee pain after tibial nailing: does the entry point matter? J Bone Joint Surg Br. 1995;77:976-7.

Court-Brown CM, Christie J, McQueen MM. Closed intramedullary tibial nailing. Its use in closed and type I open fractures. J Bone Joint Surg Br. 1990;72:605-11.

Habernek H, Kwasny O, Schmid L. Complications of interlocking nailing for lower leg fractures: a 3-year follow up of 102 cases. J Trauma. 1992;33:863-9.

Court-Brown CM. Reamed intramedullary tibial nailing: an overview and analysis of 1106 cases. J Orthop Trauma. 2004;18:96-101.

Khan MN, Hafeez A, Faraz A, Naveed E, Ilyas MW, Rasool MU, et al. Comparison of Medial Parapatellar and Transpatellar Tendon Approach in Intramedullary Interlocking Nailing for Tibial Fracture: A Retrospective Analysis. Cureus. 2021;13(8):e17404.

Sadeghpour A. Comparison of trans patellar approach and medial parapatellar tendon approach in tibial intramedullary nailing for treatment of tibial fractures. J Pak Med Assoc. 2011;61(6).

Downloads

Published

2022-12-28

Issue

Section

Original Research Articles