Clinical, Functional and Radiological Results of Suprapatellar Nailing in Proximal Tibia Fractures: Case Series

Vipin Tyagi, Rahul Kakran*, Ashish Kumar Agarwal and Vinay Sharma

Department of Orthopaedics, Yashoda Hospital, Nehuru Nagar, Ghaziabad, UP, India

*Corresponding Author: Rahul Kakran, Department of Orthopaedics, Yashoda Hospital, Nehuru Nagar, Ghaziabad, UP, India.

Received: January 19, 2024; Published: February 24, 2024

Abstract

Introduction

• Proximal tibial and segmental fractures may pose technical difficulties when attempting to obtain reduction and alignment using a standard infrapatellar approach with the knee in a flexed position and there is an increased risk of a varus malunion and procarvatum in proximal tibia fractures, when a lateral parapatellar portal is used.
• Suprapatellar approach has been added to the semi-extended knee position for nailing, which has been reported to not only improve reduction during nailing, but also decrease the long-term problem of anterior knee pain after treatment and various other complications.

Aim

• Primary aim- To evaluate the efficacy of supra patellar nailing in proximal tibia fracture by analyzing clinical (anterior knee pain and range of movement), functional and radiological outcomes (tibial alignment).
• Secondary aim- To assess intraoperative and postoperative complications of fracture treated by supra patellar nailing.

Objective

• To evaluate clinical outcomes of supra patellar nailing in proximal tibia fracture by using visual analogy scale score for anterior knee pain and range of movement of knee joint.
• To evaluate the functional outcome of supra patellar nailing in proximal tibia fracture by using Lysholm knee scoring system.
• To evaluate the radiological reduction quality of supra patellar nailing in proximal tibia fractures by assessing the tibial alignment.
• To assess complications of supra patellar nailing in proximal tibia fracture.

Method In this Ambispective observational study, we included 11 patients with proximal tibia fractures who needed supra patellar nailing as per the Indications. The patients were selected according to the inclusion and exclusion criteria. The patients were operated between 2023 and 2024 at Yashoda Superspeciality Hospital, Nehru Nagar, Ghaziabad. Result

• 11 patients were available for follow up at a minimum of 3 months after the index procedure
• After 15 days of operation, mean VAS was 1.72. Mean Lysholm pain component was 3.6. Mean Lysholm knee score was 46.18. Mean affected side arc of motion was 8.18-86.81 . Mean normal side arc of motion was 0-133.6
• After 1 month of operation, mean VAS was 0.54. Mean Lysholm pain component was 20. Mean Lysholm knee score was 63.5. Mean affected side arc of motion was 5-115 . Mean normal side arc of motion was 0-133.
• The mean degree of angular deformation (coronal plane alignment) was 0.32° ± 0.4° valgus. The mean degree of angular deformation (sagittal plane alignment) was -1.07° ± 1.2° posterior bow.

Conclusion

• This paper critically document clinical, functional and radiographic results using the percutaneous supra patellar portal with the semiextended approach for intra medullary nailing of the tibia. Our 3 months results indicate that the procedure resulted in excellent tibial alignment and knee range of motion. Even more interesting was the absence of anterior tibial pain often found when a tibial nail is inserted in a standard fashion.

Keywords: Clinical; Radiological; Suprapatellar; Nailing; Proximal Tibia Fractures

References

1. Donald G and Seligson D. “Treatment of tibial shaft fractures by percutaneous Kuntscher nailing. Technical difficulties and a review of 50 consecutive cases”. Clinical Orthopaedics and Related Research 178 (1983):64-73.
2. Zelle BA., et al. “Advances in intramedullary nailing: suprapatellar nailing of tibial shaft fractures in the semiextended position”. Orthopedics 38 (2015): 751-755.
3. Gelbke MK., et al. “Suprapatellar versus infrapatellar intramedullary nail insertion of the tibia: a cadaveric model for comparison of patellofemoral contact pressures and forces”. Journal of Orthopaedic Trauma 24 (2010): 665-671.
4. Nork SE., et al. “Intramedullary nailing of proximal quarter tibial fractures”. Journal of Orthopaedic Trauma 20 (2006): 523-528.
5. Ricci WM., et al. “Fractures of the proximal third of the tibial shaft treated with intramedullary nails and blocking screws”. Journal of Orthopaedic Trauma 15 (2001): 264-270.
6. Tornetta P III., et al. “Intraarticular anatomic risks of tibial nailing”. Journal of Orthopaedic Trauma 13 (1999): 247-251.
7. Hernigou P and Cohen D. “Proximal entry for intramedullary nailing of the tibia. The risk of unrecognized articular damage”. The Journal of Bone and Joint Surgery Volume of British 82 (2000): 33-41.
8. Court-Brown CM., et al. “Knee pain after intramedullary nailing: its incidence, etiology, and outcome”. Journal of Orthopaedic Trauma 11 (1997): 103-105.
9. Buehler KC., et al. “A technique for intramedullary nailing of proximal third tibia fractures”. Journal of Orthopaedic Trauma 11 (1997): 218-223.
10. Courtney PM., et al. “Functional knee outcomes in infrapatellar and suprapatellar tibial nailing: does approach matter?” American Journal of Orthopedics (Belle Mead, N.J.) 44 (2015): E513-E516.
11. Yasuda T., et al. “Semiextended approach for intramedullary nailing via a patellar eversion technique for tibial-shaft fractures: evaluation of the patellofemoral joint”. Injury 48 (2017): 1264- 1268.

Citation

Citation: Rahul Kakran., et al. “Clinical, Functional and Radiological Results of Suprapatellar Nailing in Proximal Tibia Fractures: Case Series".Acta Scientific Orthopaedics 7.3 (2024): 67-75.

Copyright

Copyright: © 2024 Rahul Kakran., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.