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Rotational Alignment in Tibia Diaphyseal Fractures With the Suprapatellar Semiextended versus Standard Upper Entry

Jubin Jamshed1, Viju Daniel Varghese1,2, Chandy Viruthipadavil John1

  • 1Department of Orthopaedics-Unit III, Christian Medical College, Vellore, Tamil Nadu.

Journal of Orthopaedic Trauma
|February 20, 2025
PubMed
Summary

This study found that both suprapatellar and infrapatellar approaches for intramedullary nailing of tibial diaphyseal fractures result in similar rates of rotational malalignment. However, the suprapatellar approach led to less entry site pain post-surgery.

Keywords:
anterior knee paindiaphysealnailingrotational malalignmenttorsion

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Area of Science:

  • Orthopedic Surgery
  • Trauma Care
  • Biomechanics

Background:

  • Tibial diaphyseal fractures are common injuries requiring surgical intervention.
  • Intramedullary nailing is a standard treatment, with varying surgical approaches.
  • Rotational malalignment is a potential complication affecting functional outcomes.

Purpose of the Study:

  • To compare the rate of rotational malalignment between suprapatellar and infrapatellar approaches for tibial diaphyseal fractures treated with intramedullary nailing.
  • To evaluate secondary outcomes including pain, function, and union rates.

Main Methods:

  • A noninferiority, randomized controlled trial was conducted with 50 adult patients.
  • Patients were randomized to either a suprapatellar or infrapatellar approach for intramedullary nailing.
  • Rotational malalignment was assessed via CT scan postoperatively; pain, function, and union rates were also monitored.

Main Results:

  • Rotational malalignment rates were similar between the suprapatellar (32%) and infrapatellar (36%) groups (P = 0.76).
  • No significant association was found between malrotation and fracture characteristics or surgeon seniority.
  • The suprapatellar group reported significantly less entry site pain compared to the infrapatellar group (P = 0.021).

Conclusions:

  • The choice of suprapatellar versus infrapatellar approach does not influence rotational malalignment in tibial diaphyseal fractures treated with intramedullary nailing.
  • The suprapatellar approach is associated with reduced entry site pain, suggesting a potential benefit for patient comfort.