Prospective study on functional and radiological outcome of suprapatellar approach for intramedullary nailing using semi extended knee position in tibial shaft fractures

Abstract

Fractures of the tibia are one of the most common orthopedic injuries occurring most often in younger patients. Tibial fractures are frequently associated with high energy trauma mechanisms. Intramedullary nailing is one amongst the preferred treatment modalities for mid shaft tibial fractures. Standard Tibial nailing entry portals used are the infrapatellar and parapatellar approaches. Suprapatellar tibial nailing is a recent advance in the surgical technique for treatment of tibial shaft fractures. This method has shown reduced operative and fluoroscopy time and lesser pain incidence in previous studies. The semi extended position of the knee also allows for countering the deforming effect of the musculature pull of the quadriceps mechanism and also easier fluoroscopy imaging. The suprapatellar technique decreases the risk of perforation of posterior cortex by placing the starting point in line with the medullary canal. This technique also helps to reduce Varus and Valgus deformity by using the femoral trochlear groove as a guide to the starting point which maintains the mechanical axis of the lower extremity.Objectives of the study: To assess Functional outcomes of suprapatellar approach in mid shaft tibial fractures by Lower extremity functional score (LEFS).To assess Radiological outcomes of suprapatellar approach in mid shaft tibial fractures by the Radiological Union in Tibia Score (RUST).Study design: Prospective interventional studyStudy period: October 2019 to May 2021Source of data: Patients admitted with closed mid shaft tibial fractures as an inpatient in the Department of Orthopaedics, Victoria hospital and Bowring and Lady Curzon hospitals attached to BMCRI were included in the study satisfying the inclusion and exclusion criteriaMethodology: 20 patients with closed or open (type 1 and 2) mid shaft tibial fractures were treated using the suprapatellar approach. Functional outcome was measured using the Lower extremity functional score and radiological outcome was measured using the Radiological union in tibia score at immediate and last follow up intervals.Results: Our study group comprised of 20 patients between the ages 20 to 60 years. LEFS showed a statistically significant improvement from 23.35 at 6 weeks to 69.25 at 12 months. In our study analysis out of 20 patients, 11 patients had excellent LEFS score, 7 patients had good LEFS score and 2 patients had fair LEFS score. Also in our study 100% patients achieved union by 20 weeks with a mean RUST score of 7.4 at 6 weeks compared to a mean RUST score of 14.15 at 12 months.Conclusion: Suprapatellar nailing has shown shorter fluoroscopy less manoeuvrability and operative time, excellent to fair functional outcome of lower limb and reduced incidence of valgus and varus malalignment postoperatively. Suprapatellar nailing is a promising technique of tibial fracture fixation with satisfactory radiological and functional outcomes postoperatively.