Abstract
BackgroundOptimal surgical approach for tibial shaft fractures remains controversial. We perform a meta-analysis from randomized controlled trials (RCTs) to compare the clinical efficacy and prognosis between infrapatellar and suprapatellar intramedullary nail in the treatment of tibial shaft fractures.MethodsPubMed, OVID, Embase, ScienceDirect, and Web of Science were searched up to December 2017 for comparative RCTs involving infrapatellar and suprapatellar intramedullary nail in the treatment of tibial shaft fractures. Primary outcomes were blood loss, visual analog scale (VAS) score, range of motion, Lysholm knee scores, and fluoroscopy times. Secondary outcomes were length of hospital stay and postoperative complications. We assessed statistical heterogeneity for each outcome with the use of a standard χ2 test and the I2 statistic. The meta-analysis was undertaken using Stata 14.0.ResultsFour RCTs involving 293 participants were included in our study. The present meta-analysis indicated that there were significant differences between infrapatellar and suprapatellar intramedullary nail regarding the total blood loss, VAS scores, Lysholm knee scores, and fluoroscopy times.ConclusionSuprapatellar intramedullary nailing could significantly reduce total blood loss, postoperative knee pain, and fluoroscopy times compared to infrapatellar approach. Additionally, it was associated with an improved Lysholm knee scores. High-quality RCTs were still required for further investigation.
Highlights
Optimal surgical approach for tibial shaft fractures remains controversial
To the best of our knowledge, it was the first meta-analysis from Randomized controlled trials (RCT) to compare the clinical and functional outcomes of the knee joint after infrapatellar versus suprapatellar tibial nail insertion
The most important finding of the present meta-analysis was that suprapatellar approach of intramedullary nail (IMN) was associated with a significant reduction in total blood, visual analog scale (VAS) scores, and fluoroscopy times compared with infrapatellar approach
Summary
Optimal surgical approach for tibial shaft fractures remains controversial. We perform a metaanalysis from randomized controlled trials (RCTs) to compare the clinical efficacy and prognosis between infrapatellar and suprapatellar intramedullary nail in the treatment of tibial shaft fractures. The intramedullary nail (IMN) fixation is reported to be a successful surgical procedure for the treatment of tibial shaft fracture and shows improved outcome in functional recovery [3]. The traditional infrapatellar is the common surgical approach to insert an IMN for the tibial shaft fracture. The semiextended approach for tibial IMN insertion was first introduced in 2000 and was modified into suprapatellar approach [7]. It has more simple access to entry point at proximal tibia, facilitates fracture reduction, and avoids patellar
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