Suprapatellar approach for fractures of the tibia: Does the fracture level matter?
Özgür Çiçekli1, Alauddin Kochai1, Erhan Şükür1, Ali Murat Başak2, Alper Kurtoğlu1, Mehmet Türker1
1Department of Orthopedics and Traumatology, Sakarya University Training and Research Hospital, Sakarya, Turkey
2Department of Orthopedics and Traumatology, University of Health Sciences, Gülhane Training and Research Hospital, Ankara, Turkey
Keywords: Anterior knee pain, patellofemoral joint, suprapatellar nailing, tibial fractures.
Objectives: This study aims to evaluate proximal, shaft, and distal tibial fractures treated with suprapatellar (SP) tibial intramedullary nailing (IMN) in terms of alignment, healing, and patellofemoral (PF) pain.
Patients and methods: The study included 58 patients (41 males, 17 females; mean age 42.9 years; range, 18 to 75 years) treated via the SP approach in semiextention. Suprapatellar IMN surgeries were performed by two surgeons. After a minimum of 12 months of follow-up, patients’ genders, ages, limb sides, fracture types, and classifications were recorded. Fracture reduction accuracy, angulation, PF arthritis, healing time, complications, and nonunions were analyzed. Anterior knee pain, visual analog scale (VAS), and Lysholm knee scoring scale were used as clinical measurements.
Results: Seventeen fractures were in the proximal third, while 22 were in the middle third and 19 were in the distal third of the tibia. The mean healing time was 7.14 months (range, 4 to 13 months); differences in healing time between fracture locations were not statistically significant (p=0.83). The mean follow-up duration was 19.83 months (range, 12 to 30 months); there were no statistically significant differences in follow-up times in terms of fracture sites (p=0.51). The VAS score for the knee was 0 in 49 patients (84.5%) and Conclusion: Suprapatellar tibial IMN can be applicable to extraarticular tibial fractures in all locations. Providing easy anatomic reduction in semiextention, convenient fluoroscopic imaging, safety for the PF joint, acceptable anterior knee pain, and satisfactory functional outcomes render SP approach more feasible.