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VOLUME 7 , ISSUE 1 ( January-June, 2025 ) > List of Articles

Original Article

A Prospective Interventional Study to Assess Functional Outcomes of Suprapatellar vs Infrapatellar Approaches for Intramedullary Interlocking Nailing in Tibial Shaft Fractures

Santhosh Kumar Kesavan, Dilip Kumar Naidu, Sabari Vaasan L, Rajavel Kalirajan, Gowthaman Nambiraj, Kevin J Dhas

Keywords : Complications, Intramedullary nailing, Radiological results, Suprapatellar and infrapatellar approaches, Surgical and functional outcomes, Tibial shaft fractures

Citation Information : Kesavan SK, Naidu DK, L SV, Kalirajan R, Nambiraj G, Dhas KJ. A Prospective Interventional Study to Assess Functional Outcomes of Suprapatellar vs Infrapatellar Approaches for Intramedullary Interlocking Nailing in Tibial Shaft Fractures. J Orth Joint Surg 2025; 7 (1):27-37.

DOI: 10.5005/jojs-10079-1195

License: CC BY-NC 4.0

Published Online: 15-01-2025

Copyright Statement:  Copyright © 2025; The Author(s).


Abstract

Introduction: Tibial shaft fractures are common orthopedic injuries treated with various modalities, including intramedullary nailing (IMN). Even though infrapatellar nailing (IPN) is commonly done, suprapatellar nailing (SPN) has gained popularity in recent times, with conflicting evidence on their comparative efficacy. Aims and objectives: This prospective interventional study compared the functional outcomes of tibial fractures treated with suprapatellar (SP) vs infrapatellar (IP) intramedullary interlocking nailing (IMIL). The objectives were to assess clinical, radiological, and surgical outcomes and identify complications associated with each approach. Materials and methods: The study includes a total of 80 patients with tibial diaphyseal fractures, divided into group A (SP approach) and group B (IP approach). Clinical outcomes were assessed using the visual analog scale (VAS), Lysholm knee scoring scale (LKSS), and lower extremity functional scale (LEFS). Radiological outcomes were evaluated using the Radiographic Union Scale in Tibial Fractures (RUST score), translational alignment, and angulation. Surgical parameters and complications were recorded, and statistical analysis was performed to compare group outcomes. Results: Group A demonstrated superior functional outcomes based on VAS scores, LKSS, and LEFS at all follow-up intervals (p < 0.05). Radiological outcomes favored group A, with higher RUST scores and better translational alignment (p < 0.05). Both groups showed similar angles and time to union. Conclusion: The SP approach (group A) for tibial shaft fractures exhibited better surgical and functional outcomes compared to the IP approach (group B). SP group patients had lower pain scores, better functional outcomes, and superior radiological healing. The findings indicate that the SP approach may be the preferred method for managing tibial shaft fractures, particularly in the proximal third and distal third shaft fractures, as evidenced by improved patient outcomes compared to the IP group. Nevertheless, additional research involving larger sample sizes and extended follow-up periods is needed to substantiate these findings thoroughly. Clinical significance: For all tibial shaft fractures, the SPN approach proves to have a shorter surgical time and lesser radiation exposure with better functional outcomes. Hence, the SPN approach can be adopted for all tibial diaphyseal fractures.

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  1. Thompson JH, Koutsogiannis P, Jahangir A. Tibia Fractures Overview. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023.
  2. Blachut PA, O'Brien PJ, Meek RN, et al. Interlocking intramedullary nailing with and without reaming for the treatment of closed fractures of the tibial shaft. A prospective, randomized study. J Bone Jt Surg Am 1997;79(5):640–646. DOI: 10.2106/00004623-199705000-00002
  3. Larsen P, Elsoe R, Hansen SH, et al. Incidence and epidemiology of tibial shaft fractures. Injury 2015;46(4):746–750. DOI: 10.1016/j.injury.2014.12.027
  4. Weiss RJ, Montgomery SM, Ehlin A, et al. Decreasing incidence of tibial shaft fractures between 1998 and 2004: information based on 10,627 Swedish inpatients. Acta Orthop 2008;79(4):526–533. DOI: 10.1080/17453670710015535
  5. Johal H, Bhandari M, Tornetta 3rd P. Cochrane in CORR®: intramedullary nailing for tibial shaft fractures in adults (review). Clin Orthop Relat Res 2017;475:585–591. DOI: 10.1007/s11999-016-5202-8
  6. Casstevens C, Le T, Archdeacon MT, et al. Management of extra-articular fractures of the distal tibia: intramedullary nailing versus plate fixation. J Am Acad Orthop Surg 2012;20(11):675–683. DOI: 10.5435/JAAOS-20-11-675
  7. Thwaites S, Thewlis D, Hall K, et al. Investigating and defining outcomes of suprapatellar versus infrapatellar intramedullary nailing of tibial shaft fractures: a protocol for a pilot randomised controlled trial. Pilot Feasibility Stud 2022;8(1):110. DOI: 10.1186/s40814-022-01057-5
  8. Toivanen JAK, Vaisto O, Kannus P, et al. 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;84:580–585. DOI: 10.2106/00004623-200204000-00011
  9. Chan DS, Serrano-Riera R, Griffing R, et al. Suprapatellar versus infrapatellar tibial nail insertion: a prospective randomized control pilot study. J Orthop Trauma 2016;30:130–134. DOI: 10.1097/BOT.0000000000000499
  10. Chen X, Xu HT, Zhang HJ, et al. Suprapatellar versus infrapatellar intramedullary nailing for treatment of tibial shaft fractures in adults. Medicine (Baltimore) 2018;97(32):e11799. DOI: 10.1097/MD.0000000000011799
  11. Sahni G, Singh S, Kavia A, et al. Suprapatellar versus infrapatellar approach for intramedullary nailing in tibial shaft fractures: a prospective interventional study. J Clin Diagn Res 2023;17(1):RC01–RC04. DOI: 10.7860/JCDR/2023/55398.17258
  12. Flandry F, Hunt JP, Terry GC, et al. Analysis of subjective knee complaints using visual analog scales. Am J Sports Med 1991;19(2):112–118. DOI: 10.1177/036354659101900204
  13. Lysholm J, Gillquist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med 1982;10(3):150–154. DOI: 10.1177/036354658201000306
  14. Dingemans SA, Kleipool SC, Mulders MAM, et al. Normative data for the lower extremity functional scale (LEFS). Acta Orthop 2017;88(4):422–426. DOI: 10.1080/17453674.2017.1309886
  15. Leow JM, Clement ND, Tawonsawatruk T, et al. The radiographic union scale in tibial (RUST) fractures: reliability of the outcome measure at an independent centre. Bone Joint Res 2016;5(4):116–121. DOI: 10.1302/2046-3758.54.2000628
  16. Sadhanandham VK. Anterior knee pain after intramedullary nailing of fractures of the tibial shaft. Clin Res Orthop 2019;2(1):1–2.
  17. Department of Health. The Ionising Radiation (Medical Exposure) Regulations 2000. IR(ME)R Together with Notes on Good Practice. London: TSO; 2000. Available from: http://www.opsi.gov.uk/si/si2000/20001059.htm. [Accessed January 2018].
  18. Lone AH, Rather AA, Bhat AN, et al. Suprapatellar versus infrapatellar approach for intramedullary nailing in tibial shaft fractures. Int J Res Med Sci 2023;11(11):4072–4076. DOI: 10.18203/2320-6012.ijrms20233377
  19. Williamson M, Iliopoulos E, Williams R, et al. Intra-operative fluoroscopy time and radiation dose during suprapatellar tibial nailing versus infrapatellar tibial nailing. Injury 2018;49:1891–1894. DOI: 10.1016/j.injury.2018.07.004
  20. Křivohlávek M, Šrám J, Pazour J, et al. Suprapatellar nailing of tibial fractures—evaluation of clinical and radiological results. Acta Chir Orthop Traumatol Cech 2018;85(2):113–119.
  21. Loganathan D, Jeyarajan S, Sivaraman B, et al. Functional outcome of tibial fractures treated by interlocking nailing through suprapatellar approach—a prospective and retrospective study. Int J Sci Res 2021;10(6):54–55.
  22. Al-Azzawi M, Davenport D, Shah Z, et al. Suprapatellar versus infrapatellar nailing for tibial shaft fractures: a comparison of surgical and clinical outcomes between two approaches. J Clin Orthop Trauma 2021;17:1–4. DOI: 10.1016/j.jcot.2021.01.009
  23. Lu K, Gao YJ, Wang HZ, et al. Comparison between infrapatellar and suprapatellar approaches for intramedullary nailing for the fractures of the tibial shaft. Eur J Trauma Emerg Surg 2022;48:3651–3657. DOI: 10.1007/s00068-020-01531-w
  24. Franke J, Hohendorff B, Alt V, et al. Suprapatellar nailing of tibial fractures—indications and technique Injury 2016;47:495–501. DOI: 10.1016/j.injury.2015.10.023
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