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Treatment with Locking Intramedullary Nailing for Intertrochanteric Fracture of the Femur Utilizing a New Awl with a Distal Positioner
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The Learning Curve of Suprapatellar Nailing: Adoption Over Time Can Decrease Operative Time and Radiation Exposure.

Jerad D Allen1, Paul E Matuszewski, Shea M Comadoll

  • 1Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky College of Medicine, Lexington, KY.

Journal of Orthopaedic Trauma
|June 20, 2020
PubMed
Summary
This summary is machine-generated.

Suprapatellar nailing (SPN) for tibial shaft fractures significantly reduces operative time and radiation exposure compared to infrapatellar nailing (IPN). This benefit increases with surgeon experience, making SPN a valuable technique for orthopedic surgeons.

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Area of Science:

  • Orthopedic Surgery
  • Trauma Management
  • Surgical Techniques

Background:

  • Tibial shaft fractures are common injuries requiring surgical intervention.
  • Intramedullary nailing is a standard treatment, with suprapatellar nailing (SPN) and infrapatellar nailing (IPN) being two common approaches.
  • The learning curve associated with new surgical techniques can impact efficiency and safety.

Purpose of the Study:

  • To compare operative time and radiation exposure between SPN and IPN for tibial shaft fractures.
  • To evaluate the effect of surgical experience over time on the outcomes of SPN.

Main Methods:

  • Retrospective analysis of 341 adult patients with extra-articular tibial shaft fractures treated with intramedullary nailing.
  • Patients were treated with either SPN or IPN based on surgeon discretion.
  • Key outcome measures included operative time, fluoroscopy time, and radiation dose.

Main Results:

  • Overall, SPN was associated with significantly lower operative time (110 vs. 130 minutes), fluoroscopy time (143 vs. 159 minutes), and radiation dose (6.5 vs. 8.6 mGy) compared to IPN.
  • Early cases of SPN showed no significant difference in these parameters compared to IPN.
  • Later SPN cases demonstrated significantly reduced operative time, fluoroscopy time, and radiation dose, indicating a learning curve effect.

Conclusions:

  • Suprapatellar nailing (SPN) leads to decreased operative times and radiation exposure for tibial shaft fractures compared to infrapatellar nailing (IPN).
  • The benefits of SPN become more pronounced as surgeons gain experience with the technique.
  • Surgeons should consider the learning curve and potential advantages when adopting SPN for tibial fracture treatment.