複雑な脛骨近位部骨折に対する膝蓋骨上髄内釘と顆部スクリュー併用固定術：症例シリーズにおける技術的経験

Complex intra-articular proximal tibia fractures (Schatzker types V and VI) are difficult to manage due to articular involvement, malalignment, and soft-tissue compromise. Conventional plating techniques carry risks of infection and soft-tissue morbidity. Suprapatellar intramedullary nailing (IMN), combined with condylar screws, offers a minimally invasive option with potential biomechanical and clinical advantages.

A prospective case series was conducted at a tertiary trauma center in Chennai, India, including 10 consecutive adults with Schatzker type V (n = 6) and VI (n = 4) fractures. All patients underwent Suprapatellar IMN in the semi-extended position, reinforced with two lateral-to-medial condylar screws. Patients were followed for 12 months. Radiological union, fracture alignment, and complications were documented. Functional recovery was assessed using the lower extremity functional scale (LEFS) and knee range of motion (ROM).

The mean patient age was 46.9 years (range 29-73), with 8 males and 2 females. The mean operative time was 104.3 ± 14.2 min. All fractures united radiologically at a mean of 14.3 ± 1.8 weeks. At 12 months, the mean LEFS score was 66.6 ± 7.5; 70% of patients achieved minimal limitation (LEFS ≥64). The mean knee ROM was 125° ± 7.8°. No cases of infection, non-union, implant failure, or neurovascular injury were recorded.

Suprapatellar IMN supplemented with condylar screws appears to be a reliable minimally invasive technique for complex proximal tibia fractures, allowing stable fixation, early mobilization, and good functional outcomes. Larger studies are warranted to validate these findings.