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International Orthopaedics

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01-12-2016 | Original Paper

The outcome comparison of the suprapatellar approach and infrapatellar approach for tibia intramedullary nailing

Authors: Qi Sun, XiaoYang Nie, JinPeng Gong, JieZhou Wu, RenLong Li, Wei Ge, Ming Cai

Published in: International Orthopaedics | Issue 12/2016

Abstract

Objectives

This paper aimed to compare the outcome of suprapatellar and infrapatellar approaches for the tibia intramedullary nailing.

Methods

From February 2010 to August 2013, a total of 162 skeletally mature participants with tibia shaft fractures were identified and divided into suprapatellar approach group (SPAG) and infrapatellar approach group (IPAG) randomly. Fluoroscopy time, length of hospital stay, operative time, blood loss and complications were recorded. Visual analog score (VAS), Lysholm knee score and range of motion (ROM) were reviewed at one, three, six, 12 and 24 months post-operatively. All patients were required to complete short form 36 questionnaire (SF-36) at six, 12 and 24 months postoperatively.

Results

The follow–ups lasted two years at least. No significant differences were in major complication rate, operation time, blood loss, the ROM of injured extremity and length of hospital stay between SPAG and IPAG. Nevertheless, the fluoroscopy time was significantly lower in SPAG. VAS pain scores were lower in SPAG at six, 12 and 24 months post-operatively. A higher Lysholm knee score was observed in SPAG at six and 24 months post-operatively. Besides, a better overall physical components score was observed in SPAG except at six months post-operatively.

Conclusions

The suprapatellar approach was superior to infrapatrellar approach for the treatment of tibia shaft fracture. Therefore, we recommend the suprapatellar approach as a preferable approach in tibia intramedullary nailing.

Larsen P, Lund H, Laessoe U, Graven-Nielsen T, Rasmussen S (2014) Restrictions in quality of life after intramedullary nailing of tibial shaft fracture: a retrospective follow-up study of 223 cases. J Orthop Trauma 28(9):507–512. doi:10.1097/bot.0000000000000031 CrossRefPubMed

Weiss RJ, Montgomery SM, Ehlin A, Al Dabbagh Z, Stark A, Jansson KA (2008) Decreasing incidence of tibial shaft fractures between 1998 and 2004: information based on 10,627 Swedish inpatients. Acta Orthop 79(4):526–533. doi:10.1080/17453670710015535 CrossRefPubMed

Court-Brown CM, Caesar B (2006) Epidemiology of adult fractures: a review. Injury 37(8):691–697. doi:10.1016/j.injury.2006.04.130 CrossRefPubMed

Rodrigues FL, de Abreu LC, Valenti VE, Valente AL, da Costa Pereira Cestari R, Pohl PH, Rodrigues LM (2014) Bone tissue repair in patients with open diaphyseal tibial fracture treated with biplanar external fixation or reamed locked intramedullary nailing. Injury 45(Suppl 5):S32–S35. doi:10.1016/s0020-1383(14)70018-x CrossRefPubMed

Inan M, Halici M, Ayan I, Tuncel M, Karaoglu S (2007) Treatment of type IIIA open fractures of tibial shaft with Ilizarov external fixator versus unreamed tibial nailing. Arch Orthop Trauma Surg 127(8):617–623. doi:10.1007/s00402-007-0332-9 CrossRefPubMed

Kaftandziev I, Pejkova S, Saveski J (2006) Operative treatment of III grade open fractures of the tibial diaphysis. Prilozi / Makedonska akademija na naukite i umetnostite, Oddelenie za bioloski i medicinski nauki = contributions / Macedonian academy of sciences and arts. Section Biol Med Sci 27(1):121–131

Bhandari M, Zlowodzki M, Tornetta P 3rd, Schmidt A, Templeman DC (2005) Intramedullary nailing following external fixation in femoral and tibial shaft fractures. J Orthop Trauma 19(2):140–144CrossRefPubMed

Jones M, Parry M, Whitehouse M, Mitchell S (2014) Radiologic outcome and patient-reported function after intramedullary nailing: a comparison of the retropatellar and infrapatellar approach. J Orthop Trauma 28(5):256–262. doi:10.1097/bot.0000000000000070 CrossRefPubMed

Lefaivre KA, Guy P, Chan H, Blachut PA (2008) Long-term follow-up of tibial shaft fractures treated with intramedullary nailing. J Orthop Trauma 22(8):525–529. doi:10.1097/BOT.0b013e318180e646 CrossRefPubMed

10.

Toivanen JA, Vaisto O, Kannus P, Latvala K, Honkonen SE, Jarvinen MJ (2002) Anterior knee pain after intramedullary nailing of fractures of the tibial shaft. A prospective, randomized study comparing two different nail-insertion techniques. J Bone Joint Surg Am 84-a(4):580–585CrossRefPubMed

11.

Hernigou P, Cohen D (2000) Proximal entry for intramedullary nailing of the tibia. The risk of unrecognised articular damage. J Bone Joint Surg Br 82(1):33–41CrossRefPubMed

12.

Gaines RJ, Rockwood J, Garland J, Ellingson C, Demaio M (2013) Comparison of insertional trauma between suprapatellar and infrapatellar portals for tibial nailing. Orthopedics 36(9):e1155–e1158. doi:10.3928/01477447-20130821-17 CrossRefPubMed

13.

Sanders RW, DiPasquale TG, Jordan CJ, Arrington JA, Sagi HC (2014) 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 28(Suppl 8):S29–S39. doi:10.1097/01.bot.0000452787.80923.ee CrossRefPubMed

14.

Bhandari M, Guyatt G, Tornetta P 3rd, Schemitsch E, Swiontkowski M, Sanders D, Walter SD (2008) Study to prospectively evaluate reamed intramedually nails in patients with tibial fractures (S.P.R.I.N.T.): study rationale and design. BMC Musculoskelet Disord 9:91. doi:10.1186/1471-2474-9-91 CrossRefPubMed

15.

Kuhn S, Appelmann P, Pairon P, Mehler D, Rommens PM (2014) The retrograde tibial nail: presentation and biomechanical evaluation of a new concept in the treatment of distal tibia fractures. Injury 45(Suppl 1):S81–S86. doi:10.1016/j.injury.2013.10.025 CrossRefPubMed

16.

Chan DS, Serrano R, Griffing R, Steverson B, Infante A, Watson D, Sagi HC, Sanders RW (2015) Supra- versus Infra-patellar tibial nail insertion: a prospective, randomized control pilot study. J Orthop Trauma. doi:10.1097/bot.0000000000000499

17.

Leliveld MS, Verhofstad MH (2012) Injury to the infrapatellar branch of the saphenous nerve, a possible cause for anterior knee pain after tibial nailing? Injury 43(6):779–783. doi:10.1016/j.injury.2011.09.002 CrossRefPubMed

18.

Straub RK, Cipriani DJ (2012) Influence of infrapatellar and suprapatellar straps on quadriceps muscle activity and onset timing during the body-weight squat. J Strength Conditioning Res Nat Strength Conditioning Assoc 26(7):1827–1837. doi:10.1519/JSC.0b013e318234e81d CrossRef

19.

Gelbke MK, Coombs D, Powell S, DiPasquale TG (2010) Suprapatellar versus infra-patellar intramedullary nail insertion of the tibia: a cadaveric model for comparison of patellofemoral contact pressures and forces. J Orthop Trauma 24(11):665–671. doi:10.1097/BOT.0b013e3181f6c001 CrossRefPubMed

20.

Sanders RW, Dipasquale TG, Jordan CJ, Arrington JA, Sagi HC (2014) 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 28(5):245–255CrossRefPubMed

21.

Courtney PM, Boniello A, Donegan D, Ahn J, Mehta S (2015) Functional knee outcomes in infrapatellar and suprapatellar tibial nailing: does approach matter? Am J Orthop (Belle Mead, NJ) 44(12):E513–E516

22.

Song SY, Chang HG, Byun JC, Kim TY (2012) Anterior knee pain after tibial intramedullary nailing using a medial paratendinous approach. J Orthop Trauma 26(3):172–177. doi:10.1097/BOT.0b013e3182217fe6 CrossRefPubMed

23.

Aksahin E, Yilmaz S, Karasoy I, Duran S, Yuksel HY, Dogan O, Yildirim AO, Bicimoglu A (2015) Sagittal patellar tilt and concomitant quadriceps hypotrophy after tibial nailing. Knee Surg Sports Traumatol Arthroscopy Off J ESSKA. doi:10.1007/s00167-015-3533-8

24.

Rothberg DL, Holt DC, Horwitz DS, Kubiak EN (2013) Tibial nailing with the knee semi-extended: review of techniques and indications: AAOS exhibit selection. J Bone Joint Surg Am 95(16):e116. doi:10.2106/jbjs.l.01223, 111-118CrossRefPubMed

25.

Moghaddam-Alvandi A, Zimmermann G, Hammer K, Bruckner T, Grutzner PA, von Recum J (2013) Cigarette smoking influences the clinical and occupational outcome of patients with tibial shaft fractures. Injury 44(11):1670–1671. doi:10.1016/j.injury.2012.08.017 CrossRefPubMed

Title: The outcome comparison of the suprapatellar approach and infrapatellar approach for tibia intramedullary nailing
Authors: Qi Sun
XiaoYang Nie
JinPeng Gong
JieZhou Wu
RenLong Li
Wei Ge
Ming Cai
Publication date: 01-12-2016
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 12/2016
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-016-3187-2

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

The outcome comparison of the suprapatellar approach and infrapatellar approach for tibia intramedullary nailing

Abstract

Objectives

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

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