Suprapatellar nailing in complex Tibial Fractures.

Purpose: This study evaluates the functional and radiological outcomes of segmental and comminuted tibial fractures using a suprapatellar approach in semi extended position.

Methods: A total of 62 patients, with a mean age of 40.8 (range: 21-78 yrs) and 43 males and 19 females, were retrospectively evaluated between January 2017 and December 2022. Patients with comminated tibial fracture AO Type 42 C3 (32) and segmental AO Type 42 C2 (21) AO Type 42 C1 (9) were treated with a IMN using the suprapatellar technique. There were 51 closed fractures and 11 grade-one open fractures. All patients were subjected to the suprapatellar nailing technique in the semi-extended position.

Results: Fracture healing 20.4 weeks on average was needed for the fracture to heal in segmental and 21.2 weeks in comminuted fracture. There were two instances of the delayed union in comminuted fractures. In two cases of segmental fracture dynamization is required. One case of non-union required bone grafting in a segmental fracture and in two instances in comminuted fractures to improve union after four months of monitoring. Primary union occurred in 56 patients. After minimum of 10.2 months of follow-up. According to Johner and Wruh's criteria with modifications, out of 62 patients, 47 had excellent results, 10 had good results, and 5 had fair results.

Conclusions: In segmental and comminuted fracture tibia, the suprapatellar IMN technique in a semi-extended position results in a significantly lower rate of malalignment, and good union because of soft tissue friendly bypass surgery.