Cartilaginous defect of the lateral trochlea following suprapatellar nailing of an open tibial shaft fracture: a case report

A Retrospective Study With 2-Year Follow-up Comparing Semi-Extended Tibia Nailing Techniques: The Suprapatellar Versus the Extra-Articular Lateral Parapatellar Approach

Background

The quest for optimal approaches to treating tibial shaft fractures in orthopedic surgery remains a topic of debate.

Purpose

We sought to compare the patellofemoral and radiological outcomes of 2 surgical techniques for treating tibial shaft fractures: the suprapatellar and extra-articular lateral parapatellar (ELP) approaches, both used in intramedullary tibial nailing in a semi-extended position.

Methodology

This retrospective analysis examined 73 adult patients treated for tibial shaft fracture from January 2018 to December 2023, divided into 2 groups: 42 in the suprapatellar group and 31 in the ELP group. Evaluation metrics included radiographic outcomes, clinical results, and complication rates, focusing on anterior knee pain (measured by visual analog scale) and knee function (Kujala and Lysholm scores).

Results

No significant differences were found in union rate, nail apex distance, reoperation rate, or malalignment between the 2 approaches. However, the ELP approach was associated with significantly better clinical outcomes, with higher Lysholm scores and reduced anterior knee pain. Additionally, the suprapatellar approach (SP) was associated with a higher incidence of painful hemarthrosis during hospitalization.

Conclusion

While this retrospective comparison found both techniques to be effective in treating tibial shaft fractures, the ELP approach was associated with superior functional outcomes as assessed by higher Lysholm scores and Kujala scores, less anterior knee pain, and a lower risk of painful hemarthrosis compared to the SP approach. Further study is warranted.

Suprapatellar tibial nailing: intraoperative arthroscopic evaluation and results at a minimum of 12 months follow-up

To arthroscopically evaluate the intra-articular structures before and after placement of an intramedullary tibial nail using the suprapatellar approach and to assess the 1-year results. All patients with a tibial fracture that underwent intramedullary tibial nailing using the suprapatellar approach with a minimal follow-up of 12 months were included. Diagnostic intraoperative knee arthroscopy was performed before and immediately after insertion of the IMN. A radiological and clinical evaluation and VAS score of the patients was collected postoperatively. In total, 36 patients were included. The mean follow-up period was 14.9 ± 4.9 months. The mean age of the patients was 45.5 ± 18.8 years. The mean visual analog scale (VAS) score at 12 months was 1.0 ± 1.5. The complication rate was 19.4% and the reoperation rate was 16.7%. Union of the fractures was achieved in 33 patients (91.6%) after primary surgery after a mean of 6.1 ± 1.8 months. A change in the patellofemoral cartilage after insertion of the nail was seen in 1 patient. The suprapatellar procedure for tibia fractures resulted in excellent VAS scores and union rates at 1-year follow up, with a complication of articular damage to the PF joint in 2.8%.