Suprapatellar versus Infrapatellar Approach for Intramedullary Nailing in Tibial Shaft Fractures: A Prospective Interventional Study

Abstract

Introduction: Tibial diaphyseal fractures are the most prevalent type of tibia fracture. A well known surgical method for treating tibial shaft fractures was the traditional infrapatellar approach for tibia Intramedullary Nailing (IMN). However, due to increased valgus and procurvatum deformities, IMN insertion through the infrapatellar route poses problems. Recently, suprapatellar nailing in the semi-extended position has been promoted as a safe and effective surgical treatment. Aim: To compare the clinical and functional outcomes of tibial shaft fractures treated with IMN utilising the Suprapattelar (SP) and Infrapatellar Methods (IP). Materials and Methods: A prospective interventional study was conducted on 40 patients, in the Department of Orthopaedics, in Government Medical College, Patiala ,Punjab, India from November 2019 to May 2021. The patients were divided into two groups on the basis of tibial shaft fractures treated with IMN utilising the S.P and those treated with I.P techniques during a two year period (20 in each group) with six months followup. Group A patients were treated with IMN in tibia through suprapatellar technique and group B Patients were treated with IMN in tibia via infrapatellar approach. The outcomes of IMN in tibial shaft fractures via SP and IP approach were compared in terms of fluoroscopy time, average surgical time, anterior knee pain using Visual Analogue Scale (VAS) score, average blood loss, fracture union time and functional outcome (in terms of the lower extremity functional Score). For statistical analysis student t-test and chi-square test was used, p-value <0.05 was considered as significant. Results: There were significant differences between SP and IP IMN in terms of fluoroscopy duration (94.25 vs 129.40 seconds, p-value-0.001), anterior knee pain (VAS score) (19.65 vs 29.85, p-value-0.001), average blood loss (49.30 vs 62.45 mL, p- value 0.001), and functional result (75.45 vs 70.05, p-value=0.001). The fracture union time between the two groups was non significant (90.50 vs 90.30 days, p-value=0.876). Conclusion: In terms of fluoroscopy time, anterior knee pain, average blood loss, and knee ratings, the SP technique was superior to the IP strategy.