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Comparative Study
. 2020 Sep 17;15(1):422.
doi: 10.1186/s13018-020-01960-8.

Comparison of suprapatellar versus infrapatellar approaches of intramedullary nailing for distal tibia fractures

Yao Lu  1   2 , Gen Wang  3 , Bin Hu  4 , Cheng Ren  1 , Liang Sun  1 , Zhimeng Wang  1 , Changjun He  5 , Hanzhong Xue  1 , Zhong Li  1 , Kun Zhang  1 , Teng Ma  6   7 , Qian Wang  8
Affiliations
Comparative Study

Comparison of suprapatellar versus infrapatellar approaches of intramedullary nailing for distal tibia fractures

Yao Lu et al. J Orthop Surg Res. .

Abstract

Background: This study aimed to analyze and compare the clinical and functional outcomes of distal tibia fractures treated with intramedullary nailing (IMN) using the suprapatellar (SP) and infrapatellar (IP) surgical approaches.

Methods: A retrospective analysis was performed in 63 patients with distal fractures that were treated with IMN between August 2014 and August 2018. A total of 27 and 36 patients underwent IMN using the SP and IP techniques, respectively. The surgical time, blood loss, closed reduction rate, rate of adjuvant reduction technique, fracture healing time, and complications were reviewed in this study. Anterior knee pain was assessed using the visual analog scale. The Lysholm Knee Scoring Scale and American Orthopaedic Foot and Ankle Society (AOFAS) scale were used as clinical measurements.

Results: A total of 63 patients, with a minimum follow-up of 12 months, were evaluated. The average surgical time, blood loss, rate of adjuvant reduction technique, closed reduction rate, fracture healing time, and Lysholm Knee Scoring Scale score were insignificantly different (P > 0.05) between the two groups. However, the SP approach was superior to the IP approach in terms of pain score, AOFAS score, and fracture deformity rate (P < 0.05).

Conclusions: In the treatment of distal tibia fractures, the SP IMN technique is associated with a significantly higher functional outcome, lower knee pain, and lower rate of fracture deformity than the IP IMN technique.

Keywords: Distal tibia fracture; Internal fixation; Intramedullary nail.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
a Suprapatellar skin incision approximately 3 cm proximal to the superior pole of the patella. b Protective trocar placement with the knee in the semiextended position
Fig. 2
Fig. 2
Starting point under fluoroscopic guidance
Fig. 3
Fig. 3
Radiographs of a case of union after closed reduction using the suprapatellar approach were presented. a, b Preoperative anteroposterior (AP) and lateral views. c, d Computed tomography views, fracture involving the ankle joint. e, f AP and lateral views postoperatively. g, h AP and lateral views 6 months postoperatively
Fig. 4
Fig. 4
Radiographs of a case of union after closed reduction using the infrapatellar approach were presented. a, b Preoperative anteroposterior (AP) and lateral views. c, d AP and lateral views postoperatively. e, f AP and lateral views 5 months postoperatively
See this image and copyright information in PMC

Comment in

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