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Updated: Mar 25, 2026

Treatment with Locking Intramedullary Nailing for Intertrochanteric Fracture of the Femur Utilizing a New Awl with a Distal Positioner
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Suprapatellar Versus Infrapatellar Tibial Nail Insertion: A Prospective Randomized Control Pilot Study.

Daniel S Chan1, Rafael Serrano-Riera, Rebecca Griffing

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Journal of Orthopaedic Trauma
|February 20, 2016
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Summary

This pilot study found no significant differences in knee pain or function between infrapatellar (IP) and suprapatellar (SP) tibial nail insertion techniques after 12 months. Further research with larger patient groups is recommended.

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Area of Science:

  • Orthopedic surgery
  • Trauma care
  • Biomechanics

Background:

  • Tibial shaft fractures are common injuries requiring surgical intervention.
  • Intramedullary nailing is a standard treatment for tibial fractures.
  • The choice of nail insertion site (infrapatellar vs. suprapatellar) may influence clinical outcomes.

Purpose of the Study:

  • To compare clinical and functional outcomes of the knee joint following infrapatellar (IP) versus suprapatellar (SP) tibial nail insertion in patients with OTA 42 tibial shaft fractures.

Main Methods:

  • Prospective, randomized pilot study involving skeletally mature patients with OTA 42 tibial shaft fractures.
  • Patients were randomized to either IP or SP nail insertion. SP group underwent patella-femoral (PF) joint arthroscopy.
  • Follow-up included radiographs, visual analog scores, pain diagrams, knee function questionnaires (Lysholm, SF-36), and MRI at 12 months.

Main Results:

  • 25 patients completed 12 months of follow-up (14 IP, 11 SP).
  • No significant differences in range of motion, visual analog scores, or Lysholm knee scores between groups.
  • The SF-36 bodily pain component score was superior in the SP group (P=0.035).
  • Articular changes (chondromalacia) were noted in the PF joint in 6/11 SP patients pre-insertion and 3/11 post-insertion; MRI at 1 year showed chondromalacia in 5/11 SP patients, but this did not correlate with arthroscopic findings or PF joint pain.

Conclusions:

  • No significant differences in pain, disability, or knee range of motion between IP and SP tibial intramedullary nail insertion techniques at 12 months.
  • The superior bodily pain score in the SP group warrants further investigation.
  • A larger prospective trial with long-term follow-up is recommended to validate these findings.