Comparative Analysis of Suprapatellar and Infrapatellar Nailing in Tibial Fracture: A Randomized Clinical Study

Area of Science:

• Orthopedic Surgery
• Traumatology
• Biomedical Engineering

Background:

• Tibial fractures are common long-bone injuries requiring surgical intervention.
• The conventional infrapatellar (IP) approach for intramedullary nailing (IMN) presents challenges like difficulty in maintaining reduction and post-operative knee pain.
• The suprapatellar (SP) approach is an alternative aiming to improve intraoperative limb positioning, reduction maintenance, and patient outcomes.

Purpose of the Study:

• To compare functional outcomes, radiological results, and complication rates between the SP and IP approaches for tibial shaft IMN.
• To evaluate the efficacy of the SP approach in reducing post-operative knee pain and improving functional recovery.
• To assess the impact of surgical approach on fracture healing and alignment.

Main Methods:

• A randomized controlled trial involving 85 patients with tibial shaft fractures.
• Patients were allocated to either the SP (n=40) or IP (n=45) group for closed reduction and IMN.
• Functional outcomes (VAS, Lysholm scores) and radiological outcomes (RUST, alignment) were assessed at multiple post-operative time points up to 6 months.

Main Results:

• No significant differences in age, gender, fracture type, or AO classification between groups.
• The SP group showed significantly lower Visual Analog Scale (VAS) pain scores and higher Lysholm functional scores at 6 weeks, 12 weeks, and 6 months (P < 0.001).
• Post-operative complications, particularly anterior knee pain, were significantly lower in the SP group (5%) compared to the IP group (26.7%).

Conclusions:

• The SP approach for tibial IMN provides superior early functional outcomes and reduced anterior knee pain compared to the IP approach.
• Radiological healing and alignment are not compromised by the SP approach.
• The SP approach is recommended for tibial shaft fractures, especially when early mobilization and patient comfort are prioritized.