Abstract
BackgroundThe conventional infrapatellar approach to intramedullary nailing of tibial fractures adopts the supine high-flexion knee position. However, this has disadvantages including difficulty in obtaining the proximal tibial anteroposterior view during intraoperative fluoroscopy, prolonged duration of fluoroscopy. Accordingly, the present study investigated the utility of the lateral position in the infrapatellar approach to intramedullary nailing of tibial shaft fractures.MethodsThe present study was a retrospective analysis of 112 patients who sustained closed tibial shaft fractures and treated with intramedullary nailing via the infrapatellar approach. Patients were divided into two groups according to surgical position: lateral or supine. The demographic and clinical data were collected and analyzed.ResultsThere were 54 patients in the lateral and 58 in the supine position groups. The duration of surgery and fluoroscopy was shorter in the lateral group than the supine group (p < 0.05). Blood loss during surgery was lower in the lateral compared with supine position group (p < 0.05). The malunion rate was lower in the lateral position group as compared with the supine position group (p < 0.05); moreover, fewer surgical assistants were needed than in the supine group (p < 0.05). There were no significant differences in fracture healing time, other complications between the two groups (p > 0.05).ConclusionsThe lateral position was a more convenient choice for intramedullary nailing of tibial shaft fractures via infrapatellar approach.
Highlights
The conventional infrapatellar approach to intramedullary nailing of tibial fractures adopts the supine high-flexion knee position
The duration of the operation and the fluoroscopy time are significantly shorter in lateral position group, (72.98(14.21) minutes vs. 82.09(14.92) minutes, p = 0.001), (33.81(5.91) seconds vs. 68.53(8.69) seconds, p = 0.000), respectively
There was less blood loss during surgery in the lateral position group than in the supine group (95.65(14.51) ml vs. 121.90(44.54) ml, p = 0.000); the number of assistants required for surgery was smaller in the lateral group (p = 0.000); and the malunion rate was lower in the lateral group (p = 0.045)
Summary
The conventional infrapatellar approach to intramedullary nailing of tibial fractures adopts the supine high-flexion knee position. This has disadvantages including difficulty in obtaining the proximal tibial anteroposterior view during intraoperative fluoroscopy, prolonged duration of fluoroscopy. The present study investigated the utility of the lateral position in the infrapatellar approach to intramedullary nailing of tibial shaft fractures. For surgical treatment of closed tibial shaft fractures, intramedullary nailing is the first-line surgical option[2,3,4,5]. Proper positioning can facilitate the procedure and exposure, shorten operation time, and improve treatment efficiency. Significant advances have been made in intramedullary nailing of tibial shaft fractures in
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