Suprapatellar versus infrapatellar approach for tibia intramedullary nailing: A meta-analysis

Area of Science:

• Orthopedic Surgery
• Trauma Surgery
• Biomechanics

Background:

• Intramedullary nailing (IMN) is a standard surgical procedure for tibia fractures.
• The choice of entry portal (suprapatellar vs. infrapatellar) may influence surgical outcomes.
• Evidence comparing these approaches requires synthesis.

Purpose of the Study:

• To conduct a meta-analysis comparing the efficacy of suprapatellar versus infrapatellar approaches for tibia intramedullary nailing (IMN).

Main Methods:

• Systematic literature search across multiple databases (PubMed, Embase, Cochrane Library, CNKI, Wanfang).
• Quality assessment using Cochrane collaboration's tool and Newcastle-Ottawa scale.
• Meta-analysis performed using RevMan 5.3 software.

Main Results:

• Eight studies (2 RCTs, 6 retrospective cohort) were included.
• No significant differences in operation time, coronal alignment, infection, nonunion, or reoperation rates.
• Suprapatellar approach demonstrated shorter fluoroscopy time, less pain (VAS), better sagittal alignment, and lower angular malalignment.
• RCT subgroup analysis indicated superior knee function scores with the suprapatellar approach.

Conclusions:

• The suprapatellar approach may offer advantages for tibia IMN, including reduced fluoroscopy, pain, and improved functional recovery and fracture reduction.
• No increased risk of postoperative complications was identified with the suprapatellar approach.
• Further randomized controlled trials (RCTs) are recommended to strengthen these findings.