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Related Experiment Video

Updated: Jan 22, 2026

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Suprapatellar tibial nailing: a learning curve analysis.

Epaminondas Markos Valsamis1, Efthymios Iliopoulos2, Rachel Williams3

  • 1Trauma and Orthopaedics Department, Brighton and Sussex University Hospitals NHS Trust, Eastern Road, Brighton, BN2 5BE, UK. markosvalsamis@gmail.com.

European Journal of Trauma and Emergency Surgery : Official Publication of the European Trauma Society
|July 1, 2019
PubMed
Summary
This summary is machine-generated.

Surgeons experienced no increased radiation exposure when learning the suprapatellar tibial nailing technique. This approach for tibial fractures shows a safe learning curve regarding radiation dose area product (DAP).

Keywords:
Fluoroscopy timeLearning curveSuprapatellarTibial nailing

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Area of Science:

  • Orthopedic surgery
  • Trauma surgery
  • Medical imaging

Background:

  • The suprapatellar approach for tibial fracture intramedullary nailing is increasingly favored due to potential patient outcome benefits over infrapatellar methods.
  • Investigating the learning curve of new surgical techniques is crucial for safe implementation and understanding surgeon adaptation.
  • Radiation exposure is a key metric for evaluating the efficiency and safety of surgical procedures, particularly those involving fluoroscopy.

Purpose of the Study:

  • To assess the learning curve associated with the suprapatellar approach for tibial fracture intramedullary nailing.
  • To quantify radiation exposure, specifically fluoroscopy time and dose area product (DAP), as a measure of the suprapatellar technique's learning curve.
  • To compare the learning curve of the suprapatellar technique against the established infrapatellar approach.

Main Methods:

  • Prospective data collection over 3 years at a UK Major Trauma Centre.
  • Inclusion of 83 patients with acute isolated extra-articular tibial fractures treated with intramedullary nailing.
  • Analysis of 40 consecutive suprapatellar nailing cases by surgeons new to the technique, compared to 43 infrapatellar cases (control group), measuring fluoroscopy time and DAP.

Main Results:

  • No significant learning curve was identified for the suprapatellar technique, as indicated by stable fluoroscopy time and DAP per surgeon.
  • Individual and group analyses of the suprapatellar approach showed no time-dependent increase in radiation exposure.
  • The control infrapatellar group also demonstrated stable fluoroscopy time and DAP, confirming the absence of time-related trends in that cohort.

Conclusions:

  • Introducing the suprapatellar technique for uncomplicated tibial fractures does not lead to a significant learning-related increase in radiation exposure for consultant trauma surgeons.
  • The findings suggest that the suprapatellar approach can be adopted without an initial rise in radiation burden.
  • Further research is warranted to explore the impact of the learning curve on other surgical outcome measures beyond radiation exposure.