Abstract
BackgroundTibial shaft fractures are routinely managed with intramedullary nailing (IMN). An increasingly accepted technique is the suprapatellar (SP) approach. The purpose of this study was to compare the clinical and functional outcomes of knee joint after tibia IMN through an suprapatellar (SP) or traditional infrapatellar (IP) approach.MethodsRetrospective analysis was performed in patients with tibial shaft fractures that were treated with IMN through a SP or IP approach between 01/01/2014 and 31/12/2016. The clinical and functional outcomes of the knee were assessed with the Hospital for Special Surgery (HSS) Knee Score. Secondary outcomes included the operation time and intraoperative blood loss.ResultsA total of 50 patients/fractures (26 IP and 24 SP) with a minimum follow-up of 15 months were evaluated. All fractures were OTA 42. No significant differences were found between the two groups in age, gender, side of fractures, operation time, intra-operative blood loss, and follow-up time. No significant difference was seen in HSS score (P = 0.62) between them. Sub analysis of all the HSS components scores revealed no significant differences between pain (P = 0.57), the stand and walk (P = 0.54), the need for walking stick (P = 0.60) and extension lag (P = 0.60). The other HSS components showed full scores (IP 10 vs. SP 10) in both approaches, including muscle force, flexion deformity and stability components. The range of motion (ROM) component score was superior in the IP group (P = 0.04) suggesting a higher ROM.ConclusionsBoth SP and IP approach results in equivalent overall HSS knee scores. However, for the HSS component, the IP approach was superior to SP approach regarding the ROM.
Highlights
Tibial shaft fractures are routinely managed with intramedullary nailing (IMN)
Sub analysis of all the Hospital for Special Surgery (HSS) components scores demonstrated that there were no significant differences between the pain component (IP 28.46 ± 2.75 vs. SP 28.98 ± 2.07; P = 0.57) as well as stand and walk component (IP 21.54 ± 2.35 vs. SP 21.54 ± 1.61; P = 0.54)
This study provides the clinical rationale that the SP and IP approaches can get similar knee functional outcomes in the treatment of tibial shaft fracture
Summary
Tibial shaft fractures are routinely managed with intramedullary nailing (IMN). An increasingly accepted technique is the suprapatellar (SP) approach. The purpose of this study was to compare the clinical and functional outcomes of knee joint after tibia IMN through an suprapatellar (SP) or traditional infrapatellar (IP) approach. The insertion of an intramedullary nail (IMN) with interlocking screws is reported to be a successful surgical approach for treating tibial shaft fractures and allows for early functional rehabilitation [3, 4]. Traditional infrapatellar approach for tibia IMN is a popular surgical procedure used in the treatment of tibial shaft fractures. IMN insertion through infrapatellar (IP) approach remained technically challenging due to quadriceps muscle force resulting in proximal fracture fragments displacement with the knee in flexion, and an increased risk of valgus and procurvatum deformities following tibial nailing [5, 6]. Chronic anterior postoperative knee pain is one of the most frequent complications after IMN insertion, the incidence was reported varying from 10 to 80% [7].
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