No Incidence of Postoperative Knee Sepsis With Suprapatellar Nailing of Open Tibia Fractures

To evaluate the incidence of knee sepsis after suprapatellar (SP) nailing of open tibia fractures.

Retrospective; Setting: ACS level 1 trauma center.

We reviewed 139 open tibia fractures that underwent SP nailing as definitive treatment over a 5-year period (January 1, 2011 to January 1, 2016). Most patients (90%, n = 126) underwent intramedullary nailing at the time of their initial surgery. We defined knee sepsis as intra-articular infection requiring operative debridement, either open or arthroscopically, within 1 month's time.

Open tibia fractures treated with an SP tibial nail.

Demographic data, fracture characteristics, Gustilo and Anderson classification of open fractures, and occurrence of knee sepsis.

In 139 open tibia fractures, there were no cases of knee sepsis in the 30 days after treatment with an SP intramedullary nail. Eighty-seven percent of our cohort had Gustilo and Anderson type II (41%) or type III (46%) open fractures. Most open fractures (83%) underwent primary wound closure during the index procedures. Twenty-five limbs (18%) had evidence of infection at the open fracture site of their open fracture necessitating operative intervention and/or antibiotics: none, however, developed knee sepsis.

Although the SP approach carries intra-articular risks, we found a low risk of knee sepsis using this technique in the treatment of open tibia fractures. Our data suggest that there is no greater risk of intra-articular infection using an SP portal as compared with an infrapatellar one.

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.