Comparison of suprapatellar versus infrapatellar approaches of intramedullary nailing for distal tibia fractures
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(2020) 15:422
RESEARCH ARTICLE
Open Access
Comparison of suprapatellar versus infrapatellar approaches of intramedullary nailing for distal tibia fractures Yao Lu1,2†, Gen Wang3†, Bin Hu4†, Cheng Ren1, Liang Sun1, Zhimeng Wang1, Changjun He5, Hanzhong Xue1, Zhong Li1, Kun Zhang1, Teng Ma1,2* and Qian Wang1*
Abstract Background: This study aimed to analyze and compare the clinical and functional outcomes of distal tibia fractures treated with intramedullary nailing (IMN) using the suprapatellar (SP) and infrapatellar (IP) surgical approaches. Methods: A retrospective analysis was performed in 63 patients with distal fractures that were treated with IMN between August 2014 and August 2018. A total of 27 and 36 patients underwent IMN using the SP and IP techniques, respectively. The surgical time, blood loss, closed reduction rate, rate of adjuvant reduction technique, fracture healing time, and complications were reviewed in this study. Anterior knee pain was assessed using the visual analog scale. The Lysholm Knee Scoring Scale and American Orthopaedic Foot and Ankle Society (AOFAS) scale were used as clinical measurements. Results: A total of 63 patients, with a minimum follow-up of 12 months, were evaluated. The average surgical time, blood loss, rate of adjuvant reduction technique, closed reduction rate, fracture healing time, and Lysholm Knee Scoring Scale score were insignificantly different (P > 0.05) between the two groups. However, the SP approach was superior to the IP approach in terms of pain score, AOFAS score, and fracture deformity rate (P < 0.05). Conclusions: In the treatment of distal tibia fractures, the SP IMN technique is associated with a significantly higher functional outcome, lower knee pain, and lower rate of fracture deformity than the IP IMN technique. Keywords: Distal tibia fracture, Intramedullary nail, Internal fixation
Background Distal tibia fracture is a common clinical wound that usually results from high-energy injuries [1, 2]. Open reduction and internal fixation with plates and screws is the common method to treat distal tibia fractures [3–5]. However, plate fixation management of these fractures has often resulted in complications such as infections, delayed unions or nonunions, and implant failures [6–8]. * Correspondence: [email protected]; [email protected] † Yao Lu, Gen Wang and Bin Hu contributed equally to this work. 1 Department of Orthopaedic Surgery, HongHui Hospital, Xi’an Jiaotong University, 555 Youyi East Road, Xi’an 710054, Shaan’xi Province, China Full list of author information is available at the end of the article
In recent years, intramedullary nailing (IMN) and minimally invasive plate osteosynthesis (MIPO) have become common fixation methods for distal tibia fractures [9, 10]. Our previous study of a meta-analysis based on 13 randomized controlled trials (RCTs) with 924 patients revealed that IMN for distal tibia fractures is associated with a lower risk of wound complications and a shorter time to union than those for MIPO [11]. IMN insertion compris
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