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European Journal of Trauma and Emergency Surgery

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03.11.2020 | Original Article

Comparison between infrapatellar and suprapatellar approaches for intramedullary nailing for the fractures of the tibial shaft

verfasst von: Ke Lu, Yi-jun Gao, Hong-zhen Wang, Chong Li, Rong-xun Qian, Qi-rong Dong

Erschienen in: European Journal of Trauma and Emergency Surgery | Ausgabe 5/2022

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Abstract

Introduction

This study aimed to compare the outcomes at the clinical and functional levels of suprapatellar (SP) and infrapatellar (IP) approaches for intramedullary nailing in treating tibial shaft fracture.

Methods

Patients who underwent tibial shaft fracture intramedullary nailing by the SP approach or IP approach in a trauma center were retrospectively reviewed. The demographics, intraoperative fluoroscopy time, operation time, blood loss, irrigation volume, postoperative X-ray alignment, and complications of patients were compared between the two groups under different approaches. Lysholm knee score, visual analog score (VAS), and incidence of anterior knee pain (AKP) were assessed 1 year after surgery.

Results

The study finally included well-documented 81 patients (38 SP versus 43 IP). The SP group exhibited significantly shorter intraoperative fluoroscopy time than that of the IP group (81.7 ± 14.5 s vs. 122.0 ± 24.3 s, P < 0.001). Both aspects recorded a precise reduction of the fracture: angulation (2.1 ± 1.2° vs 3.1 ± 1.5°, P < 0.05) and translation (0.6 ± 0.8 mm vs 1.4 ± 1.5 mm, P < 0.05) in the coronal plane in the SP group. However, the sagittal plane recorded no such change (P > 0.05). The Lysholm knee score was higher in the SP group than that of the IP group (87 ± 8 vs. 80 ± 15, P < 0.05). The SP group displayed an evidently lower average VAS score than that of the IP approach group (0.3 ± 0.8 vs 1.3 ± 1.4, P < 0.001). Six cases (16%) in the SP group and 16 cases (37%) in the IP group experienced AKP 1-year post-operation (P < 0.05). As far as complications are concerned, neither group showed any significant difference (P > 0.05).

Conclusion

Compared with the IP approach, the application of intramedullary nailing through the SP approach in treating tibial shaft fractures can effectively shorten the intraoperative fluoroscopy time, correct coronal plane angulation and translation deformity, reduce the incidence of AKP and improve postoperative function.

Bone LB, Johnson KD. Treatment of tibial fractures by reaming and intramedullary nailing. J Bone Jt Surg Am. 1986;68(6):877–87. CrossRef

Weller S, Kuner E, Schweikert CH. Medullary nailing according to Swiss study group principles. Clin Orthop Relat Res. 1979;138:45–55.

Lottes JO. Medullary nailing of the tibia with the triflange nail. Clin Orthop Relat Res. 1974;105:53–66. CrossRef

Freedman EL, Johnson EE. Radiographic analysis of tibial fracture malalignment following intramedullary nailing. Clin Orthop Relat Res. 1995;315:25–33.

Josten C, Marquass B, Schwarz C, Verheyden A. Intramedullary nailing of proximal tibial fractures. Complications and risk factors. Unfallchirurg. 2010;113(1):21–8. https://doi.org/10.1007/s00113-008-1554-1. CrossRefPubMed

Cole JD. Distal tibia fracture: opinion: intramedullary nailing. J Orthop Trauma. 2006;20(1):73–4. https://doi.org/10.1097/01.bot.0000196658.55293.e6. CrossRefPubMed

Tornetta P 3rd, Collins E. Semiextended position of intramedullary nailing of the proximal tibia. Clin Orthop Relat Res. 1996;328:185–9. https://doi.org/10.1097/00003086-199607000-00029. CrossRef

Sun Q, Nie X, Gong J, Wu J, Li R, Ge W, et al. The outcome comparison of the suprapatellar approach and infrapatellar approach for tibia intramedullary nailing. Int Orthop. 2016;40(12):2611–7. https://doi.org/10.1007/s00264-016-3187-2. CrossRefPubMed

Gao Z, Han W, Jia H. Suprapatellar versus infrapatellar intramedullary nailing for tibal shaft fractures: a meta-analysis of randomized controlled trials. Medicine (Baltimore). 2018;97(24):e10917. https://doi.org/10.1097/MD.0000000000010917. CrossRef

10.

Williamson M, Iliopoulos E, Williams R, Trompeter A. Intra-operative fluoroscopy time and radiation dose during suprapatellar tibial nailing versus infrapatellar tibial nailing. Injury. 2018;49(10):1891–4. https://doi.org/10.1016/j.injury.2018.07.004. CrossRefPubMed

11.

Yang L, Sun Y, Li G. Comparison of suprapatellar and infrapatellar intramedullary nailing for tibial shaft fractures: a systematic review and meta-analysis. J Orthop Surg Res. 2018;13(1):146. https://doi.org/10.1186/s13018-018-0846-6. CrossRefPubMedPubMedCentral

12.

Marecek GS, Nicholson LT, Broghammer FH, Talerico M, Tougas C, Donegan DJ, et al. Risk of knee sepsis after treatment of open tibia fractures: a multicenter comparison of suprapatellar and infrapatellar approaches. J Orthop Trauma. 2018;32(2):88–92. https://doi.org/10.1097/BOT.0000000000001024. CrossRefPubMed

13.

Xiao C, Hai-Tao X, Hong-Jun Z, Jing C. Suprapatellar versus infrapatellar intramedullary nailing for treatment of tibial shaft fractures in adults. Medicine. 2018;97(32):e11799. CrossRef

14.

Goodnough LH, Campbell ST, Githens MF, Gardner MJ, Bishop JA. Changing practice patterns. Curr Orthop Pract. 2019;30(4):356–60. https://doi.org/10.1097/bco.0000000000000763. CrossRef

15.

Cereijo C, Attum B, Rodriguez-Buitrago A, Jahangir AA, Obremskey W. Intramedullary nail fixation of tibial shaft fractures: suprapatellar approach. JBJS Essent Surg Tech. 2018;8(3):e24. https://doi.org/10.2106/JBJS.ST.17.00063. CrossRefPubMedPubMedCentral

16.

Paley D, Pfeil J. Principles of deformity correction around the knee. Orthopade. 2000;29(1):18–38. https://doi.org/10.1007/s001320050004. CrossRefPubMed

17.

Flandry F, Hunt JP, Terry GC, Hughston JC. Analysis of subjective knee complaints using visual analog scales. Am J Sports Med. 1991;19(2):112–8. https://doi.org/10.1177/036354659101900204. CrossRefPubMed

18.

Sanders RW, Dipasquale TG, Jordan CJ, Arrington JA, Claude HS. 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(5):245. CrossRef

19.

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):150–4. CrossRef

20.

Courtney PM, Boniello A, Donegan D, Ahn J, Mehta S. Functional knee outcomes in infrapatellar and suprapatellar tibial nailing: does approach matter? Am J Orthop (Belle Mead NJ). 2015;44(12):E513–6.

21.

Rothberg DL, Holt DC, Horwitz DS, Kubiak EN. Tibial nailing with the knee semi-extended: review of techniques and indications: AAOS exhibit selection. J Bone Jt Surg Am. 2013;95(16):e116(1-8). https://doi.org/10.2106/JBJS.L.01223. CrossRef

22.

Tornetta P 3rd, Riina J, Geller J, Purban W. Intraarticular anatomic risks of tibial nailing. J Orthop Trauma. 1999;13(4):247–51. https://doi.org/10.1097/00005131-199905000-00004. CrossRefPubMed

23.

Hernigou P, Cohen D. Proximal entry for intramedullary nailing of the tibia. The risk of unrecognised articular damage. J Bone Jt Surg Br Vol. 2000;82(1):33–41. https://doi.org/10.1302/0301-620x.82b1.9818. CrossRef

24.

Lembcke O, Ruter A, Beck A. The nail-insertion point in unreamed tibial nailing and its influence on the axial malalignment in proximal tibial fractures. Arch Orthop Trauma Surg. 2001;121(4):197–200. https://doi.org/10.1007/s004020000200. CrossRefPubMed

25.

Anderson TRE, Beak PA, Trompeter AJ. Intra-medullary nail insertion accuracy: a comparison of the infra-patellar and supra-patellar approach. Injury. 2019;50(2):484–8. https://doi.org/10.1016/j.injury.2018.12.024. CrossRefPubMed

26.

Jones M, Parry M, Whitehouse M, Mitchell S. Radiologic outcome and patient-reported function after intramedullary nailing: a comparison of the retropatellar and infrapatellar approach. J Orthop Trauma. 2014;28(5):256–62. https://doi.org/10.1097/BOT.0000000000000070. CrossRefPubMed

27.

Ryan SP, Steen B, Tornetta P 3rd. Semi-extended nailing of metaphyseal tibia fractures: alignment and incidence of postoperative knee pain. J Orthop Trauma. 2014;28(5):263–9. https://doi.org/10.1097/BOT.0000000000000083. CrossRefPubMed

28.

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(8):523–8. https://doi.org/10.1097/01.bot.0000244993.60374.d6. CrossRefPubMed

29.

Avilucea FR, Triantafillou K, Whiting PS, Perez EA, Mir HR. Suprapatellar intramedullary nail technique lowers rate of malalignment of distal tibia fractures. J Orthop Trauma. 2016;30(10):557–60. https://doi.org/10.1097/BOT.0000000000000631. CrossRefPubMed

30.

Toivanen JA, Vaisto O, Kannus P, Latvala K, Honkonen SE, Jarvinen MJ. Anterior knee pain after intramedullary nailing of fractures of the tibial shaft. A prospective, randomized study comparing two different nail-insertion techniques. J Bone Jt Surg Am. 2002;84(4):580–5. https://doi.org/10.2106/00004623-200204000-00011. CrossRef

31.

Lefaivre KA, Guy P, Chan H, Blachut PA. Long-term follow-up of tibial shaft fractures treated with intramedullary nailing. J Orthop Trauma. 2008;22(8):525–9. https://doi.org/10.1097/BOT.0b013e318180e646. CrossRefPubMed

32.

Katsoulis E, Court-Brown C, Giannoudis PV. Incidence and aetiology of anterior knee pain after intramedullary nailing of the femur and tibia. J Bone Jt Surg Br Vol. 2006;88(5):576–80. https://doi.org/10.1302/0301-620X.88B5.16875. CrossRef

33.

Court-Brown CM, Gustilo T, Shaw AD. Knee pain after intramedullary tibial nailing: its incidence, etiology, and outcome. J Orthop Trauma. 1997;11(2):103–5. https://doi.org/10.1097/00005131-199702000-00006. CrossRefPubMed

34.

Devitt AT, Coughlan KA, Ward T, McCormack D, Mulcahy D, Felle P, et al. Patellofemoral contact forces and pressures during intramedullary tibial nailing. Int Orthop. 1998;22(2):92–6. https://doi.org/10.1007/s002640050216. CrossRefPubMedPubMedCentral

35.

Mochida H, Kikuchi S. Injury to infrapatellar branch of saphenous nerve in arthroscopic knee surgery. Clin Orthop Relat Res. 1995;320:88–94.

36.

Poehling GG, Pollock FE Jr, Koman LA. Reflex sympathetic dystrophy of the knee after sensory nerve injury. Arthroscopy. 1988;4(1):31–5. https://doi.org/10.1016/s0749-8063(88)80008-2. CrossRefPubMed

37.

Weninger P, Schultz A, Traxler H, Firbas W, Hertz H. Anatomical assessment of the Hoffa fat pad during insertion of a tibial intramedullary nail—comparison of three surgical approaches. J Trauma. 2009;66(4):1140–5. https://doi.org/10.1097/TA.0b013e318169cd4d. CrossRefPubMed

38.

Vaisto O, Toivanen J, Paakkala T, Jarvela T, Kannus P, Jarvinen M. Anterior knee pain after intramedullary nailing of a tibial shaft fracture: an ultrasound study of the patellar tendons of 36 patients. J Orthop Trauma. 2005;19(5):311–6. PubMed

39.

Vaisto O, Toivanen J, Kannus P, Jarvinen M. Anterior knee pain and thigh muscle strength after intramedullary nailing of a tibial shaft fracture: an 8-year follow-up of 28 consecutive cases. J Orthop Trauma. 2007;21(3):165–71. https://doi.org/10.1097/BOT.0b013e31803773cd. CrossRefPubMed

40.

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(5):245–55. CrossRef

41.

Lu K, Zhou TT, Gao YJ, Wang HZ, Wu ZQ, Wang Y, et al. Application of the Chinese Aircraft-shaped Sleeve system in the treatment of tibial shaft fractures using a suprapatellar approach for tibial intramedullary nailing: a randomised controlled trial. J Orthop Surg Res. 2018;13(1):286. https://doi.org/10.1186/s13018-018-0995-7. CrossRefPubMedPubMedCentral

42.

Gelbke MK, Coombs D, Powell S, DiPasquale TG. Suprapatellar versus infra-patellar intramedullary nail insertion of the tibia: a cadaveric model for comparison of patellofemoral contact pressures and forces. J Orthop Trauma. 2010;24(11):665–71. https://doi.org/10.1097/BOT.0b013e3181f6c001. CrossRefPubMed

43.

Zamora R, Wright C, Short A, Seligson D. Comparison between suprapatellar and parapatellar approaches for intramedullary nailing of the tibia. Cadaveric Study Injury. 2016;47(10):2087–90. https://doi.org/10.1016/j.injury.2016.07.024. CrossRefPubMed

44.

Tajima K, Shimizu C, Ohno S, Nishida Y, Udagawa K, Sasaki J. A heart-shaped sleeve simplifies intramedullary tibial nail insertion when using the suprapatellar approach. Keio J Med. 2018;67(1):10–6. https://doi.org/10.2302/kjm.2017-0001-OA. CrossRefPubMed

45.

Rehman N, Trompeter A, Guthrie H, Goddard M. Heterotopic Ossification following Suprapatellar Intramedullary Nailing. J Orthop Case Rep. 2019;9(2):15–7. https://doi.org/10.13107/jocr.2250-0685.1348.CrossRefPubMedPubMedCentral

Titel: Comparison between infrapatellar and suprapatellar approaches for intramedullary nailing for the fractures of the tibial shaft
verfasst von: Ke Lu
Yi-jun Gao
Hong-zhen Wang
Chong Li
Rong-xun Qian
Qi-rong Dong
Publikationsdatum: 03.11.2020
Verlag: Springer Berlin Heidelberg
Erschienen in: European Journal of Trauma and Emergency Surgery / Ausgabe 5/2022
Print ISSN: 1863-9933
Elektronische ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-020-01531-w

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Comparison between infrapatellar and suprapatellar approaches for intramedullary nailing for the fractures of the tibial shaft

Abstract

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Methods

Results

Conclusion

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