Suprapatellar tibial nailing: a learning curve analysis
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ORIGINAL ARTICLE
Suprapatellar tibial nailing: a learning curve analysis Epaminondas Markos Valsamis1 · Efthymios Iliopoulos2 · Rachel Williams3 · Alex Trompeter2 Received: 4 March 2019 / Accepted: 20 June 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2019
Abstract Purpose The suprapatellar approach for intramedullary nailing of tibial fractures is gaining popularity with reported improved patient outcomes when compared to infrapatellar techniques. The aim of this study was to investigate the learning curve of the suprapatellar technique using radiation exposure as an outcome measure. Methods Data were analysed from a prospectively collected database over a 3-year period at a Major Trauma Centre in the United Kingdom. 83 study patients with an acute isolated extra-articular fracture of the tibia treated with intramedullary tibial nailing were included. Cases requiring additional intra-operative procedures were excluded. Four consultant trauma surgeons with no previous experience of the suprapatellar technique used this approach for 40 consecutive operations. Six consultant trauma surgeons used the infrapatellar approach for 43 patients and acted as a control group. Patient demographics, fluoroscopy time and radiation dose area product (DAP) were collected for each operation. A segmented linear regression modelling method was employed to analyse learning. Results Fluoroscopy time and DAP per surgeon showed no evidence of a learning curve when using a suprapatellar tibial nailing technique in group or individual analysis. Fluoroscopy time and DAP were stationary in the infrapatellar group analysis, confirming the absence of time-dependent trends over the study period. Conclusions Consultant trauma surgeons experienced no significant learning-related increase in radiation exposure when introducing a suprapatellar technique for intramedullary nailing of uncomplicated tibial fractures. Future work is required to investigate the effects of learning on other outcome measures. Keywords Learning curve · Suprapatellar · Tibial nailing · Fluoroscopy time
Introduction
* Epaminondas Markos Valsamis [email protected] Efthymios Iliopoulos [email protected] Rachel Williams [email protected] Alex Trompeter [email protected] 1
Trauma and Orthopaedics Department, Brighton and Sussex University Hospitals NHS Trust, Eastern Road, Brighton BN2 5BE, UK
2
Trauma and Orthopaedics Department, St George’s University Hospitals NHS Foundation Trust, London SW17 0QT, UK
3
Department of Radiology, St George’s University Hospitals NHS Foundation Trust, London SW17 0QT, UK
Fractures of the tibial diaphysis are typically managed with intramedullary nailing [1]. The suprapatellar approach for semi-extended knee tibial nailing has gained popularity with demonstrable benefits including easier fracture reduction and improved nail insertion accuracy when compared with traditional infrapatellar nailing techniques [2, 3]. Despite this, some studies have raised concern regardi
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