Functional and radiological outcome of intramedullary nailing in proximal tibial fractures through supra patellar approach
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20242391Keywords:
Intramedullary nailing, Suprapatellar approach, Proximal tibia fracturesAbstract
Background: Proximal third tibial fractures pose complex challenges in orthopaedic trauma care. The choice of surgical approach plays a pivotal role in achieving successful outcomes. This study was conducted to address the significant gap in research regarding the functional and radiological outcomes of the supra patellar approach in intramedullary nailing for proximal tibial fractures.
Methods: This prospective cohort study was conducted on a total of 100 patients presenting with proximal tibial fractures. All patients underwent intramedullary nailing using the supra patellar approach. Functional Outcome was assessed using the lower extremity functional scale (LEFS) at 3 weeks, 3 months, and 6 months and 1-year post-surgery. Union status, alignment, and hardware-related complications were assessed through X-rays at each follow-up point to study the radiological outcome.
Results: At the end of 1-year follow-up, 88% of patients had an excellent LEFS score,10% had a good LEFS score, and 2% had a fair LEFS score. All patients had a radiological union at 1 year follow up with an average radiological union time being 5.6 (±1.8) months.
Conclusions: We advocate for the utilization of suprapatellar nailing as the preferred approach for managing proximal third tibial fractures. This method consistently yields excellent clinical and radiological outcomes while maintaining a minimal complication rate in comparison to other management modalities.
References
Court-Brown CM, Caesar B. Epidemiology of adult fractures: a review. Injury. 2006;37:691-7.
Cole PA, Zlowodzki M, Kregor PJ. Treatment of proximal tibia fractures using the less invasive stabilization system: surgical experience and early clinical results in 77 fractures. J Orthop Trauma. 2004;18:528-35.
Egol KA, Tejwani NC, Capla EL, Wolinsky PL, Koval KJ. Staged management of high-energy proximal tibia fractures (OTA types 41): the results of a prospective, standardized protocol. J Orthop Trauma. 2005;19:448-55.
Matthews DE, McGuire R, Freeland AE. Anterior uni cortical buttress plating in conjunction with an undreamed interlocking intramedullary nail for treatment of very proximal tibial diaphyseal fractures. Orthopedics. 1997;20:647-8.
Nork SE, Barei DP, Schildhauer TA, Agel J, Holt SK, Schrick JL, et al. Intramedullary nailing of proximal quarter tibial fractures. J Orthop Trauma. 2006;20:523-8.
Ricci WM, O’Boyle M, Borrelli J, Bellabarba C, Sanders R. Fractures of the proximal third of the tibial shaft were treated with intramedullary nails and blocking screws. J Orthop Trauma. 2001;15:264-70.
Bone LB, Johnson KD. Treatment of tibial fractures by reaming and intramedullary nailing. J Bone Joint Surg Am. 1986;68:877-87.
Bakhsh WR, Cherney SM, McAndrew CM, Ricci WM, Gardner MJ. Surgical approaches to intramedullary nailing of the tibia: a comparative analysis of knee pain and functional outcomes. Injury. 2016;47:958-61.
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.
Macdonald DR, Caba-Doussoux PC, Carnegie CA, Escriba I, Forward DP, Graf M, et al. Tibial nailing using a suprapatellar rather than an infrapatellar approach significantly reduces anterior knee pain postoperatively: a multicentre clinical trial. Bone Joint J. 2019;101:1138-43.
Naik MA, Arora G, Tripathy SK, Sujir P, Rao SK. Clinical and radiological outcome of percutaneous plating in extra-articular proximal tibia fractures: A prospective study. Injury. 2013;44:1081-6.
Zelle BA, Boni G, Hak DJ. Advances in Intramedullary Nailing: Suprapatellar Nailing of Tibial Shaft Fractures in the Semi extended Position. Orthopedics. 2015;38:751-5.
Chen X, Xu HT, Zhang HJ, Chen J. Suprapatellar versus infrapatellar intramedullary nailing for treatment of tibial shaft fractures in adults. Medicine (United States). 2018;97(32):e11799.
Tornetta P, Collins E. Semi extended Position for Intramedullary Nailing of the Proximal Tibia. Clin Orthop Relat Res. 1996;328:185-9.
Eastman J, Tseng S, Lo E, Li CS, Yoo B, Lee M. Retropatellar Technique for Intramedullary Nailing of Proximal Tibia Fractures: A Cadaveric Assessment. J Orthop Trauma. 2010;24:672-6.
Sanders RW, DiPasquale TG, Jordan CJ, Arrington JA, Sagi HC. Semiextended Intramedullary Nailing of the Tibia Using a Suprapatellar Approach: Radiographic Results and Clinical Outcomes at a Minimum of 12 Months Follow-up. J Orthop Trauma. 2014;28:11.
Chan DS, Serrano-Riera R, Griffing R, Steverson B, Infante A, Watson D, et al. Suprapatellar Versus Infrapatellar Tibial Nail Insertion: A Prospective Randomized Control Pilot Study. J Orthop Trauma. 2016;30:5.
Kulkarni MS, Tummala M, Aroor MN, Vijayan S, Rao SK. Suprapatellar nailing in proximal third tibial fractures – Clinicoradiological outcome. Injury. 2020;51(8):1879-86.
