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Treatment with Locking Intramedullary Nailing for Intertrochanteric Fracture of the Femur Utilizing a New Awl with a Distal Positioner
Published on: June 6, 2025
A Randomized Controlled Trial: Functional and Radiological Outcome in Closed Tibia Shaft Fracture Managed with
Govind Kumar Gupta1, Ankit Kumar1, Ritika Kumari2
1Department of Orthopaedics, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India.
Annals of African Medicine
|July 31, 2026
Summary
Suprapatellar interlocking nailing (SPILN) is more efficient and leads to better functional outcomes for tibial shaft fractures than infrapatellar interlocking nailing (IPILN). SPILN offers advantages without compromising fracture healing or alignment.
Area of Science:
- Orthopedic surgery
- Trauma surgery
- Biomechanics
Background:
- Intramedullary nailing is standard for tibial shaft fractures.
- Suprapatellar (SPILN) vs. infrapatellar (IPILN) interlocking nailing approaches are debated.
- This RCT compares functional and radiological outcomes of SPILN and IPILN.
Purpose of the Study:
- To compare the functional and radiological outcomes of SPILN versus IPILN for closed tibial shaft fractures.
- To evaluate operative efficiency, including operative time, fluoroscopy time, and blood loss.
- To assess knee function and fracture healing using validated scores.
Main Methods:
- Randomized controlled trial (RCT) of 40 patients with closed tibial shaft fractures (AO/OTA 42A-B).
- Patients randomly assigned to SPILN (n=20) or IPILN (n=20).
- Outcomes assessed via Lysholm knee score, RUST score, operative time, fluoroscopy time, blood loss, and alignment at 3, 6, 9, and 12 months.
Main Results:
- SPILN group showed significantly shorter operative time, lower fluoroscopy time, and reduced blood loss (P < 0.001).
- SPILN achieved consistently higher Lysholm scores at all follow-up points (P < 0.001).
- No significant difference in RUST scores or union rates; SPILN demonstrated superior sagittal plane alignment (P = 0.01).
Conclusions:
- SPILN provides superior intraoperative efficiency and functional outcomes compared to IPILN.
- SPILN does not compromise radiological healing or overall alignment.
- SPILN may be the preferred technique for closed tibial shaft fractures in high-volume trauma centers.
