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- Title
Efficacy of suprapatellar nailing in tibia fractures with knee in semiextended position.
- Authors
Manjunath, Bharath; Agarwal, Nikunj; Manjunath, Sumana; Mallikarjunaswamy, Manoj Bhagirathi; C. V., Maruthi
- Abstract
Fractures of tibia are primarily caused by high-energy trauma, and are one of the most common diaphyseal fractures in adults, accounting for about 13.7% of all fractures. most serious long bone fractures, it has the potential to go into non-union, malunion and long-term dysfunction leading to socio economic unrest and poor mental and physical health. At present, there are several treatment methods for tibial shaft fractures, such as open reduction and internal fixation with plates, external fixation, and intramedullary nailing. Intramedullary nailing is the gold standard treatment option for midshaft tibial fractures open or closed irrespectively. Standard Tibial nailing entry portals used are the infrapatellar and parapatellar approaches. Suprapatellar tibial nailing is a recent advance in the surgical technique for treatment of tibial shaft fractures. An infrapatellar and patellar tendon splitting entry to the tibia with the knee joint flexed 90 degrees seems to be the preferred entry for tibial nailing. If the indications for nailing of proximal and distal tibial fractures are extended, this is a challenge for surgical techniques. With proximal fractures, there is a tendency for anterior malalignment of the proximal fragment from pull of the patellar tendon, and this pull is increased further when the knee is flexed during nailing.5With nailing in a conventional manner, there is a risk of poor repositioning, suboptimal reaming, and a poor placement of the nail with added risk posterior perforation of nail. Also, the extended position of the lower leg allows for easier fluoroscopic imaging. The suprapatellar technique decreases the risk of perforation of posterior cortex by placing the starting point in line with the medullary canal. This technique also helps to reduce Varus and Valgus deformity by using the femoral trochlear groove as a guide to the starting point which maintains the mechanical axis of the lower extremity. The purpose of this article is to Functional outcomes of suprapatellar approach in mid shaft tibial fractures by Lower extremity functional score (LEFS). To assess Radiological outcomes of suprapatellar approach in mid shaft tibial fractures by the Radiological Union in Tibia Score (RUST) over a period of 12 months. Study design: Prospective study Methodology: 40 patients with closed or open (type 1 and 2) tibial fractures were treated using the suprapatellar approach. Functional outcome was measured using the Lower extremity functional score and radiological outcome was measured using the Radiological union in tibia score at immediate and last follow up intervals. Results: Our study group comprised of 40 patients between the ages 20 to 60 years. LEFS showed a statistically significant improvement from 23.35 at 6 weeks to 69.25 at 12 months and. In our study analysis out of 40 patients, 22 patients had excellent LEFS score, 14 patients had good LEFS score and 4 patients had fair LEFS score. Also, in our study 100% patients achieved union by 20 weeks with a mean RUST score of 7.4 at 6 weeks compared to a mean RUST score of 14.15 at 12 months. Conclusion: Suprapatellar nailing has shown shorter fluoroscopy less manoeuvrability and operative time, excellent to fair functional outcome of lower limb and reduced incidence of valgus and varus malalignment postoperatively. Suprapatellar nailing is a promising technique of tibial fracture fixation with satisfactory radiological and functional outcomes postoperatively.
- Subjects
TIBIAL plateau fractures; COMPOUND fractures; TIBIAL fractures; OPEN reduction internal fixation; KNEE joint; TIBIA; INTRAMEDULLARY fracture fixation
- Publication
Journal of Cardiovascular Disease Research (Journal of Cardiovascular Disease Research), 2023, Vol 14, Issue 5, p1919
- ISSN
0975-3583
- Publication type
Article