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Decrease surgery time by using an alternative lateral parapatellar approach for tibia shaft fracture nailing.

Andreas Ladurner1, Yves P Acklin2, Thomas S Mueller2

  • 1Department of Trauma Surgery, Kantonsspital Graubünden, Loestrasse 170, 7000, Chur, Switzerland. andreasladurner@gmx.net.

Archives of Orthopaedic and Trauma Surgery
|March 9, 2019
PubMed
Summary
This summary is machine-generated.

The lateral parapatellar approach for tibia shaft fractures significantly reduces surgical and fluoroscopy times compared to medial or transpatellar methods. This technique offers a more efficient option for intramedullary nailing in tibia fractures.

Keywords:
ApproachImage intensifier timeIntramedullary nailOperation timeTibia fractureTreatment

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Area of Science:

  • Orthopedic Surgery
  • Traumatology
  • Surgical Techniques

Background:

  • Medial parapatellar and transpatellar approaches are standard for tibia shaft fracture osteosynthesis.
  • These traditional methods, using a dependent lower leg position, complicate fracture reduction, fixation, and intraoperative imaging.
  • A lateral parapatellar approach in a semi-extended position has shown promise for proximal tibia fractures.

Purpose of the Study:

  • To present the lateral parapatellar approach for tibia shaft fractures at our institution.
  • To evaluate the feasibility and outcomes of this technique compared to medial parapatellar and transpatellar approaches.

Main Methods:

  • Retrospective review of 73 patients with tibia shaft fractures treated via intramedullary nailing between 2009 and 2012.
  • Comparison of operative and fluoroscopy times between lateral parapatellar, transpatellar, and medial parapatellar approaches.
  • Analysis of patient demographics and injury patterns.

Main Results:

  • Surgical time was significantly shorter with the lateral parapatellar approach (96 ± 29 min) versus transpatellar (126 ± 30 min) and medial parapatellar (105 ± 29 min) methods.
  • Image intensifier (fluoroscopy) time was also shorter for the lateral parapatellar approach (211 ± 189 s) compared to transpatellar (347 ± 204 s) and medial parapatellar (241 ± 222 s) approaches.
  • Patient characteristics were similar across all groups.

Conclusions:

  • The lateral parapatellar approach for extra-articular semi-extended tibial nailing is associated with reduced surgical duration.
  • While fluoroscopy time was shorter with the lateral approach, the difference was not statistically significant across all groups.
  • The lateral parapatellar approach offers a potentially more efficient surgical option for tibia shaft fracture fixation.