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Updated: Oct 28, 2026
Treatment with Locking Intramedullary Nailing for Intertrochanteric Fracture of the Femur Utilizing a New Awl with a Distal Positioner
Published on: June 6, 2025
Changes in patellar height following suprapatellar and infrapatellar tibial nailing: a retrospective comparative
Rodrigo Olivieri1,2, Javiera Hernández3, José Miguel Soto3
1Knee Unit, Orthopaedic Department, Hospital del Trabajador - ACHS Salud, Ramón Carnicer 185, Providencia, Santiago, Chile. rodrigoolivieri@gmail.com.
Purpose:
Patella baja has been described after infrapatellar tibial nailing and may contribute to postoperative knee morbidity; however, whether the nail insertion approach influences postoperative patellar height remains unclear. This study compared longitudinal changes in patellar height (PH) after suprapatellar and infrapatellar intramedullary nailing for tibial shaft fractures. We hypothesized that the suprapatellar approach would better preserve patellar height.
Methods:
A retrospective comparative cohort study included 114 tibial shaft fractures treated with intramedullary nailing between 2016 and 2023, using a suprapatellar (n = 86) or infrapatellar (n = 28) approach. Patellar height was assessed using the Caton-Deschamps Index (CDI) on preoperative and final follow-up radiographs. The primary outcome was the longitudinal change in CDI (ΔCDI). Fracture union, complications, and reoperations were secondary outcomes.
Results:
The mean reduction in CDI was greater following infrapatellar than suprapatellar nailing (ΔCDI - 0.116 ± 0.173 vs. -0.011 ± 0.107; p = 0.001). After adjustment for baseline CDI and follow-up duration, this association remained significant (adjusted β=-0.055; 95% CI - 0.107 to - 0.004; p = 0.035), although sensitivity analyses showed attenuation after additional adjustment for sex. Fracture union rates were similar between approaches (93.0% vs. 92.9%; p = 0.987), with no statistically significant differences in complications or reoperations.
Conclusion:
Infrapatellar tibial nailing was associated with a significant postoperative reduction in PH compared with the suprapatellar approach. This association persisted after adjustment for baseline CDI and follow-up duration but was sensitive to additional adjustment for sex. These findings highlight a potential relationship between nail insertion approach and postoperative PH but do not establish an independent effect of surgical approach.
Level Of Evidence:
Retrospective cohort study (Level III).
