Acta Chir Orthop Traumatol Cech. 2018; 85(2):113-119 | DOI: 10.55095/achot2018/018
Suprapatellar Nailing of Tibial Fractures - Evaluation of Clinical and Radiological ResultsOriginal papers
- 1 Traumacentrum, Krajská nemocnice Liberec
- 2 Traumacentrum, Krajská nemocnice České Budějovice
PURPOSE OF THE STUDY:
The locked nailing of diaphyseal fractures of the tibia currently represents a method of choice for treating the closed diaphyseal fractures, some of the tibial metaphyseal fractures and open tibial diaphyseal fractures classified as grade I and II according to Gustilo-Anderson (GA) classification. The suprapatellar (SP) approach is an alternative technique of insertion of the nail in semi-extension of the lower extremity with easier reduction, namely of multiple fractures and proximal diaphyseal fractures of the tibia in particular.
This study aims to evaluate the group of patients in whom the suprapatellar approach was used and who were followed up for the period of at least 12 months.
MATERIAL AND METHODS:
The prospective study included 55 cases of osteosynthesis of diaphyseal fractures of the tibia with the surgery performed in the period from January 2013 to June 2015, of which in 53 patients (17 women and 36 men) with the mean age of 49.6± 16.7 years the ETN nail by DePuy Synthes® was inserted through a suprapatellar approach. In 38 cases (70.1%) an isolated trauma was involved, 15 patients (29.9%) were treated for multiple injuries or polytrauma. In nine cases (17%) it was an open fracture (2times - GA grade I, 7times - GA grade II). A multiple fracture or a fracture of the proximal third was recorded in 19 cases (34.5%). The functional and radiological results of the treatment were assessed prospectively at 12 months after the surgery using the Lysholm (LS) score.
RESULTS:
The final functional results were successfully assessed in 49 performed osteosyntheses (89.1%). The mean duration of surgery was 72.7± 19.57 min (40-140 min, median 65 min). A total of 48 (98%) fractures healed by primary intention. In five cases (10.2%) a delayed healing occurred and in one case (2 %) non-union was reported, requiring a revision surgery. In three cases (6.1%) complete implant was removed (twice by SP and once by IP approach).
The mean Lysholm score was 93.4 ± 8.39 points (59-100 points, median score of 95 points). An excellent or a good result was observed in 45 patients (91.8%), a satisfactory result in three patients (6.2%), and a poor result in one patient (2%). A statistically significant correlation (p = 0.006) between the LS score values and the age of the patients was confirmed. In patients up to 60 years of age the LS score was 96.2 ± 4.51 points (89-100, median 96), at the age of more than 60 years it was 86.9 ± 11.46 (59-100, median 89).
CONCLUSIONS:
The suprapatellar approach in treating the tibial diaphyseal fractures represents a safe alternative nail insertion technique. If an appropriate surgical technique is applied, the risks inherent in this approach are negligible. The approach allows for an easy reduction of challenging fractures of the proximal third diaphyseal fracture of the tibia and multiple fractures of the tibia and facilitates an easy check of the axial position of the extremity. The functional results of the knee joint are comparable to those achieved with the infrapatellar nailing technique.
The final LS score correlates with the age of the patients.
Keywords: tibial fractures, suprapatellar approach, intramedullary nailing, knee pain
Published: April 1, 2018 Show citation
ACS | AIP | APA | ASA | Harvard | Chicago | Chicago Notes | IEEE | ISO690 | MLA | NLM | Turabian | Vancouver |
References
- Avilucea FR, Triantafillou K, Whiting PS, Perez EA, Mir HR. Suprapatellar intramedullary nail technique lowers rate of malalignment of distal tibia fractures. J Orthop Trauma. 2016;30:557-560.
Go to original source...
Go to PubMed...
- Beltran MJ, Collinge CA, Patzkowski JC, Masini BD, Blease RE, Hsu JR. Intra-articular risks of suprapatellar nailing. Am J Orthop. 2012;41:546-550.
- Bode G, Strohm PC, Südkamp NP, Hammer TO. Tibial shaft fractures - management and treatment options. A review of the current literature. Acta Chir Orthop Traumatol Cech. 2012;79:499-505.
Go to original source...
Go to PubMed...
- Brink O. Suprapatellar nailing of tibial fractures: surgical hints. Curr Orthop Pract. 2016;27:107-112.
Go to original source...
Go to PubMed...
- Cole DJ. Distal tibie fracture: opinion: intramedullary nailing. J Orthop Trauma. 2006;20:73-74.
Go to original source...
Go to PubMed...
- Eastman JG, Tseng SS, Lee MA, Yoo BJ. The retropatellar portal as an alternative site for tibial nail insertion: a cadaveric study. J Orthop Trauma. 2010;24:659-664.
Go to original source...
Go to PubMed...
- Fu B.Locked META intramedullary nailing fixation for tibial fractures via a suprapatellar approach. Indian J Orthop. 2016;50:283-289.
Go to original source...
Go to PubMed...
- Franke J, Hohendorff B, Alt V, Thormann U, Schnettler R. Suprapatellar nailing of tibial fracture - indications and technique. Injury. 2016;47:495-501.
Go to original source...
Go to PubMed...
- Gaines RJ, Rockwood J, Garland J, Ellingson Ch, Demaio M. Comparison of insertional trauma between suprapatellar and infrapatellar portals for tibial nailing. Orthopedics. 2013;36:1155-1158.
Go to original source...
Go to PubMed...
- Gelbke MK, Coombs D, Powell S, DiPasquale TG. 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;24:665-671.
Go to original source...
Go to PubMed...
- Githens M, Bischop J. Complex tibial fractures: tips and triks for intramedullary nail fixation. Clin Med Insights. 2014;5:19-24.
Go to original source...
- Chan DS., Serrano-Riera R, Griffing R, Steverson B, Infante A, Watson D, Sagi HC, Sanders RW. Suprapatellar versus infrapatellar tibial nail insertion: a prospective randomized control pilot study. J Orthop Trauma. 2016;30:130-134.
Go to original source...
Go to PubMed...
- Chen W, Tang DZ, Guo ZM, Shi B, Lin B, Ding ZQ, Lian KJ. Use a simple lower limb outrigger frame in intramedullary nailing fixation of a floating knee. Orthop Traumatol Surg Res. 2014;100:561-564.
Go to original source...
Go to PubMed...
- Jakma T, Reynders-Frederix P, Rajmohan R. Insertion of intramedullary nails from the suprapatellar pouch for proximal tibial shaft fractures. A technical note. Acta Orthop Belg. 2011;77:834-837.
Go to PubMed...
- Jones M, Parry M, Whitehouse M, Mitchell S. Radiologic outcome and patient-reported function after intramedullary nailing: a comparison of the retropatellar and infrapatellar approach. J Orthop Trauma. 2014;28:256-262.
Go to original source...
Go to PubMed...
- Karladani AH, Ericsson PA, Granhed H, Karlsson L, Nyberg P. Tibial intramedullary nails-should they be removed? A retrospective study of 71 patients. Acta Orthop. 2007;78:668-671.
Go to original source...
Go to PubMed...
- Katsoulis E, Court-Brown C, Giannoudis PV. Incidence and aetiology of anterior knee pain after intramedullary nailing of the femur and tibia. J Bone Joint Surg Br. 2006;88:576-580.
Go to original source...
Go to PubMed...
- Kocher MS, Steadman JR, Briggs KK, Sterett WI, Hawkins RJ. Reliability, validity, and responsiveness of the Lysholm knee scale for various chondral disorders of the knee. J Bone Joint Surg Am. 2004;86:1139-1145.
Go to original source...
Go to PubMed...
- Leary J, Werger M, Sagebien C. A novel technique for percutaneous removal of a suprapatellar intramedullary nail. Am J Orthop. 2013;42:136-140.
- Morandi M, Banka T, Gaiarsa GP, Guthrie T, Khail J, Hoegler J. Intramedullary nailing of tibial fractures: review of surgical techniques and descriptionof a percutaneous lateral suprapatellar approach. Orthopedics. 2010;33:172-179.
Go to original source...
Go to PubMed...
- Rothberg DL, Daubs GM, Horwitz DS, Kubiak EN. One-year postoperative knee pain in patients with semi-extended tibial nailing versus control group. Orthopedics. 2013;36:548-53.
Go to original source...
Go to PubMed...
- Ryan SP, Steen B, Tornetta P 3rd. Semi-extended nailing of metaphyseal tibia fractures: alignment and incidence of postoperative knee pain. J Orthop Trauma. 2014;28:263-269.
Go to original source...
Go to PubMed...
- Sanders RW, DiPasquale TG, Jordan CJ, Arrington JA, Sagi HC. 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;28:245-255.
Go to original source...
Go to PubMed...
- Seibert FJ, Schippinger G, Bratschitsch G, Fiedam H, Szyszkowitz R. Karbonrahmen Lagerungs- und Repositionshilfe bei der Unterschenkelmarknagelung in unaufgebohrter Technik. Unfallchirurg. 2000;103:132-136.
Go to original source...
Go to PubMed...
- Sidky A, Buckley RE. Hardware removal after tibial fracture has healed. Can J Surg. 2008;51: 263-268.
- Sun Q, Nie X, Gong J, Wu J, Li R, Ge W, Cai M. The outcome comparison of the suprapatellar approach and infrapatellar approach for tibia intramedullary nailing. Int Orthop. 2016;40:2611-2617.
Go to original source...
Go to PubMed...
- Tornetta P, Collins E. Semiextended position of intramedullary nailing of the proximal tibia. Clin. Orthop. Relat. Res. 1996;185-189.
Go to original source...
Go to PubMed...
- Trlica J, Kočí J, Lochman P, ©mejkal K, Frank M, Holeček L, Hasenöhrlová L, Zahradníček J, Folvarský J, ®vák I, Dědek T. Reamed versus unreamednail in thetreatment of tibia shaft fractures. Eur J Trauma Emerg Surg. 2014;40:489-493.
Go to original source...
Go to PubMed...
- Väistö O, Toivanen J, Kannus P, Järvinen M. Anterior knee pain after intramedullary nailing of fracture of the tibial shaft: an eight-year follow-up of a prospective, randomized study comparing two different nail-insertion techniques. J Trauma. 2008;64:1511-1516.
Go to original source...
Go to PubMed...