Suprapatellar nailing in complex Tibial Fractures

Area of Science:

• Orthopedic Surgery
• Traumatology
• Biomedical Engineering

Background:

• Tibial fractures, particularly segmental and comminuted types, present significant challenges in achieving optimal functional and radiological outcomes.
• Minimally invasive surgical techniques are increasingly favored to reduce soft tissue damage and improve healing.
• The suprapatellar approach for tibial intramedullary nailing (IMN) is an alternative to traditional infrapatellar methods.

Purpose of the Study:

• To evaluate the functional and radiological outcomes of treating segmental and comminuted tibial fractures using the suprapatellar IMN technique.
• To assess the efficacy and safety of this approach in achieving fracture union and minimizing complications.
• To compare outcomes with established methods for tibial fracture management.

Main Methods:

• Retrospective evaluation of 62 patients (43 males, 19 females; mean age 40.8 years) with AO Type 42 C1-C3 tibial fractures treated between 2017 and 2022.
• All patients underwent suprapatellar IMN in a semi-extended position for closed (51) and grade-one open (11) fractures.
• Fracture healing, union rates, complications, and functional outcomes (Johner and Wruh's criteria) were assessed post-operatively.

Main Results:

• Average healing time was 20.4 weeks for segmental and 21.2 weeks for comminuted fractures.
• Primary union was achieved in 56 patients, with delayed union in two comminuted fractures.
• Excellent or good results were observed in 57 out of 62 patients (92%) after a minimum 10.2-month follow-up.

Conclusions:

• The suprapatellar IMN technique in a semi-extended position is effective for treating segmental and comminuted tibial fractures.
• This approach demonstrates a low rate of malalignment and promotes good fracture union.
• The soft-tissue-friendly nature of the suprapatellar bypass surgery contributes to favorable outcomes.