Infrapatellar Versus Suprapatellar Nailing for Fractures of the Tibia (INSURT Study): A Multicentered Randomized...

Area of Science:

• Orthopedic Surgery
• Trauma Care
• Biomechanics

Background:

• Tibial fractures are common injuries requiring surgical intervention.
• Intramedullary nailing is a standard treatment for tibial fractures.
• The choice of nail insertion approach (suprapatellar vs. infrapatellar) may impact patient outcomes.

Purpose of the Study:

• To compare post-operative knee pain and functional outcomes between suprapatellar and infrapatellar tibial nail insertion.
• To evaluate the effect of nail insertion approach on weight-bearing capacity during kneeling.

Main Methods:

• A multi-centered, randomized controlled trial (Level I evidence) was conducted.
• 254 patients (18-65 years) with OTA/AO type 42 and 43A tibial fractures were randomized.
• Primary outcome: Visual Analog Scale (VAS) for knee pain after kneeling; Secondary outcomes: Aberdeen Kneeling/Standing Tests, Lysholm, EQ-5D, WPAI.

Main Results:

• Suprapatellar nailing showed statistically significant lower VAS scores for knee pain at multiple time points up to one year, but the difference was not clinically significant.
• Patients in the suprapatellar group demonstrated significantly greater weight-bearing capacity through the operative knee on the Aberdeen Kneeling Test up to two years post-surgery.

Conclusions:

• No clinically significant difference in knee pain (VAS) or patient-reported outcome measures (PROMs) between the two approaches.
• Suprapatellar nailing facilitates superior weight-bearing through the operative knee post-surgery.
• Informed patient counseling regarding kneeling ability and nail insertion technique is recommended.