Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
European Journal of Trauma and Emergency Surgery
Published in: European Journal of Trauma and Emergency Surgery 1/2020

01-02-2020 | Original Article

Comparison of three different approaches for anterior knee pain after tibia intramedullary nailing

Authors: Cagri Ozcan, Ismail Turkmen, Sami Sokucu

Published in: European Journal of Trauma and Emergency Surgery | Issue 1/2020

Login to get access

Abstract

Purpose

The aim of this study was to compare anterior knee pain and functional outcomes in patients who underwent intramedullary tibial nailing using transpatellar, medial parapatellar or suprapatellar nail entry methods.

Methods

We retrospectively reviewed patients who underwent tibial fracture repair in our clinic between January 2010 and March 2017. After applying the exclusion criteria, 58 patients were included in the study. Patients were divided into 3 groups based on the nailing approach: medial parapatellar, transpatellar or suprapatellar. Age, body mass index, follow-up duration, Kujala Score, Lysholm Knee Score, anterior knee pain, length of hospitalization and surgical duration were assessed.

Results

Of the 58 patients studied, 21 underwent a transpatellar (TP) approach, 16 a medial parapatellar (MP) approach, and 21 a suprapatellar (SP) approach. The mean Kujala Score of patients who had the TP approach was 80 ± 7.15 (72–93) and the average Lysholm Knee Score was 80.23 ± 8.74 (70–95). There was no statistically significant difference between Kujala Scores (p = 0.38) or Lysholm Knee Scores (p 0.06) among the groups; similarly, no statistically significant difference was found among the three groups in terms of anterior knee pain, length of hospitalization or surgical duration (p > 0.05).

Conclusion

The suprapatellar tibia nailing method is as safe and reliable as transpatellar and medial parapatellar methods in terms of effect on postoperative anterior knee pain and functional outcomes.

Level of evidence

Level 3 case–control study.
Literature
1.
Bone LB, Johnson KD. Treatment of tibial fractures by reaming and intramedullary nailing. J Bone Jt Surg Am. 1986;68:877–87.CrossRef
2.
Hofmann A, Dietz SO, Pairon P, et al. The role of intramedullary nailing in treatment of open fractures. Eur J Trauma Emerg Surg. 2015;41(1):39–47.CrossRef
3.
Keating JF, Orfaly R, O’Brien PJ. Knee pain after tibial nailing. J Orthop Trauma. 1997;11(1):10–3.CrossRef
4.
Oh CW, Song HR, Roh JY. Bone transport over an intramedullary nail for reconstruction of long bone defects in tibia. Arch Orthop Trauma Surg. 2008;128(8):801–8.CrossRef
5.
6.
Yavuz U, Sökücü S, Demir B, et al. (2014) Comparison of intramedullary nail and plate fixation in distal tibia diaphyseal fractures close to the mortise. Ulus Travma Acil Cerrahi Derg. 20(3):189–93.PubMed
7.
Turkmen I, Saglam Y, Turkmensoy F, et al. Influence of sagittal plane malpositioning of the patella on anterior knee pain after tibia intramedullary nailing. Eur J Orthop Surg Traumatol. 2017;27(1):133–9.CrossRef
8.
Zelle BA, Boni G. Safe surgical technique: intramedullary nail fixation of tibial shaft fractures. Patient Saf Surg. 2015;9:40.CrossRef
9.
Kujala UM, Jaakkola LH, Koskinen SK, et al. Scoring of patellofemoral disorders. Arthroscopy. 1993;9:159–63.CrossRef
10.
Lysholm J, Gillquist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med. 1982;10(3):150–4.CrossRef
11.
Zelle BA. Intramedullary nailing of tibial shaft fractures in the semi-extended position using a suprapatellar portal technique. Int Orthop. 2017;41(9):1909–14.CrossRef
12.
Hernigou P, Cohen DJ. Proximal entry for intramedullary nailing of the tibia: the risk of unrecognised articular damage. Bone Jt Surg Br. 2000;82(1):33–41.CrossRef
13.
Uzümcügil O, Doğan A, Yalçinkaya M, et al. The relationship between anterior knee pain occurring after tibial intramedullary nailing and the localization of the nail in the proximal tibia. Acta Orthop Traumatol Turc. 2009;43:386–9.CrossRef
14.
Morandi M, Banka T, Gaiarsa GP, et al. Intramedullary nailing of tibial fractures: review of surgical techniques and description of a percutaneous lateral suprapatellar approach. Orthopedics. 2010;33:172–9.CrossRef
15.
Weil YA, Gardner MJ, Boraiah S. Anterior knee pain following the lateral parapatellar approach for tibial nailing. Arch Orthop Trauma Surg. 2009;129(6):773–7.CrossRef
16.
Jakma T, Reynders-Frederix P, Rajmohan R. Insertion of intramedullary nails from the suprapatellar pouch for proximal tibia shaft fractures. A technical note. Acta Orthop Belg. 2011;77:834–7.PubMed
17.
Sanders RW, DiPasquale TG, Jordan CJ, et al. Semiextended intramedullary nailing of the tibia using a suprapatellar approach: radiographic results and clinical outcomes at a minimum of 12 months follow-up. J Orthop Trauma. 2014;28:29–39.CrossRef
18.
Jones M, Parry M, Whitehouse M, et al. Radiological outcome and patient reported function following intramedullary nailing: a comparison of the retropatellar and infrapatellar approach. J Orthop Trauma. 2014;28(5):256–62.CrossRef
19.
Gelbke MK, Coombs D, Powell S, et al. Suprapatellar versus infra-patellar intramedullary nail insertion of the tibia: a cadaveric model for comparison of patellofemoral contact pressures and forces. J Orthop Trauma. 2010;24(11):665–71.CrossRef
20.
Courtney PM, Boniello A, Donegan D, et al. (2015) Functıonal knee outcomes in infrapatellar and suprapatellar tibial nailing: does approach matter. Am J Orthop (Belle Mead NJ). 44(12):E513–6.
21.
22.
Wang C, Chen E, Ye C. Suprapatellar versus infrapatellar approach for tibia intramedullary nailing: a meta analysis. Int J Surg. 2018;51:133–9.CrossRef
23.
Sun Q, Nie X, Gong J. The outcome comparison of the suprapatellar approach and infrapatellar approach for tibia intramedullary nailing. Int Orthop. 2016;40(12):2611–7.CrossRef
24.
Chan DS, Serrano-Riera R, Griffing R. Suprapatellar versus infrapatellar tibial nail insertion: a prospective randomized control pilot study. J Orthop Trauma. 2016;30(3):130–4.CrossRef
25.
Mitchell PM, Weisenthal BM, Collinge CA. No incidence of postoperative knee sepsis with suprapatellar nailing of open tibia fractures. J Orthop Trauma. 2017;31(2):85–9.CrossRef
26.
Leary J, Werger M, Sagebien CA. Novel technique for percutaneous removal of a suprapatellar intramedullary nail. Am J Orthop. 2013;42(3):136–40.PubMed
Metadata
Title
Comparison of three different approaches for anterior knee pain after tibia intramedullary nailing
Authors
Cagri Ozcan
Ismail Turkmen
Sami Sokucu
Publication date
01-02-2020
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Trauma and Emergency Surgery / Issue 1/2020
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-018-0988-6

Other articles of this Issue 1/2020

European Journal of Trauma and Emergency Surgery 1/2020 Go to the issue

Editorial

Focus on chest trauma: implications from clinical and experimental studies

Original Article

Comparison of thick- and thin-slice images in thoracoabdominal trauma CT: a retrospective analysis

Original Article

Does lack of thoracic trauma attenuate the severity of pulmonary failure? An 8-year analysis of critically injured patients

Original Article

Are injury admissions on weekends and weeknights different from weekday admissions?

Correction

Correction to: Intramedullary screw fixation for simple displaced olecranon fractures

Original Article

Accuracy of navigated and conventional iliosacral screw placement in B- and C-type pelvic ring fractures