Intramedullary nailing via suprapatellar approach versus locked plating of proximal extra-articular tibial fractures:...

Currently, nailing through the suprapatellar approach and minimally invasive plating have been generally accepted in the management of displaced proximal tibial fractures. This investigation was aimed at comparing these two treatment methods in terms of their effectiveness and safety.

We randomized 328 patients into one of two groups: one underwent intramedullary nailing via the suprapatellar approach (IMN group), while the other underwent locking compressive plate (LCP group) placement. The primary outcome was the Iowa Knee Score at 12 months. The clinical history, amount of intra-operative blood loss, rate of fracture healing, and post-operative complications were assessed as secondary outcomes. Participants were assessed at one, two, three, six and 12 months after surgery.

Follow-up data for a year were available for 152 and 154 patients in the IMN group and LCP group, respectively. No intergroup difference was detected with regard to the Iowa Knee Scores (91 ± 8.2 in the IMN group and 90 ± 7.3 in the LCP group, respectively (p = 0.26)), at 12 months. Duration of operation (83.5 ± 35.3 min), amount of blood loss (55 ± 43 mL), duration of fluoroscopy (53.7 ± 3.9 s), and cases with difficult reduction (n = 46) in the IMN group did not differ significantly from those in the LCP group (80.1 ± 43.6 min; 65 ± 56 mL; 48 ± 12 s; 32) (p < 0.05). The two groups had similar post-operative complications and rate of fracture union, with the pre-injury activity level being restored in most patients. Removal of the implants was performed in 31.6% and 63.0% of the cases in the IMN and LCP groups, respectively, indicating a significant intergroup difference.

Both IMN through the suprapatellar approach and minimally invasive LCP were found to yield no significant intergroup difference of clinical outcomes in the treatment of proximal, extra-articular tibial fractures. However, the requirement of implant removal was more relevant to LCP.