Abstract
BackgroundThe use of the suprapatellar approach for intramedullary nailing has recently become popular for the treatment of tibial fractures. This study aimed to investigate the effectiveness of using the Chinese Aircraft-shaped Sleeve (CASS) system on the clinical outcomes of tibial intermedullary nailing using a suprapatellar approach for the treatment of tibial fractures in a cohort of adult Chinese patients.MethodsMagnetic resonance images (MRI) of the knee joints of 212 healthy adults with normal lower limb function from May 2011 to May 2015 were obtained from a level I Chinese regional trauma centre. Sixty inpatients at the same trauma centre who underwent treatment for tibial shaft fractures from June 2015 to June 2018 were enrolled. Tibial intramedullary nailing fixation of tibial shaft fractures via the suprapatellar approach was performed with either a CASS system or a conventional sleeve. The measurements of patellofemoral joint anatomy, the surgical time, the assessments of the patellofemoral joint cartilage conditions, and information of residual debris based on arthroscopic analysis were subsequently collected.ResultsThe mean patellar angle (PA), sulcus angle (SA), sulcus width (SW) and sulcus depth (SD) were 135.40 ± 6.20°, 142.37 ± 5.33°, 33.37 ± 2.73 mm, and 4.29 ± 0.63 mm, respectively. The surgical time until entry reaming commencement and the irrigation time were significantly lower in the CASS group (P < 0.001). The difference in cartilage damage rate between groups was statistically significant (P = 0.031); the difference in residual debris conditions was not statistically significant (P = 0.1967).ConclusionThe use of the CASS system could improve clinical outcomes of intramedullary nailing via suprapatellar approach for patients with a small patellofemoral joint space.
Highlights
The use of the suprapatellar approach for intramedullary nailing has recently become popular for the treatment of tibial fractures
Ensuring debris evacuation from the joint cavity has become a difficult problem that needs to be addressed. In view of these difficult issues associated with the performance of a suprapatellar approach of Intramedullary nailing (IMN) among patients with a relatively small patellofemoral joint space, we present in this study a newly designed protective sleeve system that is based on the anatomical parameters of patellofemoral joints in Chinese individuals and describe appropriate modifications to the conventional surgical procedures
In the Chinese Aircraft-shaped Sleeve (CASS) group, the surgical time until entry reaming commenced in the CASS group was 5.9 ± 1.5 min, compared to 9.8 ± 2.0 min in the conventional sleeve group, which was a significant difference (P < 0.001; Fig. 6a)
Summary
The use of the suprapatellar approach for intramedullary nailing has recently become popular for the treatment of tibial fractures. The original protective sleeve used in the original suprapatellar IMN approach is V-shaped, which is a poor match for Chinese individuals Due to this shape mismatch, when the pressure on the patellofemoral joint is high, the patella slides to one side and the sleeve to the opposite side (Fig. 1), with this instability increasing the difficulty of accurately insert the IM nail. Ensuring debris evacuation from the joint cavity has become a difficult problem that needs to be addressed In view of these difficult issues associated with the performance of a suprapatellar approach of IMN among patients with a relatively small patellofemoral joint space, we present in this study a newly designed protective sleeve system that is based on the anatomical parameters of patellofemoral joints in Chinese individuals and describe appropriate modifications to the conventional surgical procedures.
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