Comparison of clinical and radiological results after a minimum one-year follow-up of tibial fractures operated via suprapatellar or infrapatellar intramedullary nailing: A retrospective study

Objectives: In this study, we aimed to evaluate the clinical and radiological results after a minimum one-year follow-up of suprapatellar (SP) and infrapatellar (IP) nail applications for the treatment of tibial fractures. Patients and methods: Between September 2019 and September 2021, a total of 80 patients treated for tibial fractures were retrospectively analyzed. The patients were divided into two equal groups including 40 patients in each group. The first group (32 males, 8 females; mean age: 36.4 +/- 13.2 years; range, 19 to 64 years) consisted of those who were operated using intramedullary nailing (IMN) through the SP approach (SP Group). The second group (25 males, 15 females; mean age: 34.4 +/- 13.6 years; range, 15 to 64 years) consisted of patients operated with IMN using an IP approach (IP Group). Data including the location of the fracture, duration of surgery, need for additional interventions for fracture reduction, union time, duration of follow-up, delayed union, nonunion, malunion, and infection rates were recorded. During the final follow-up, we evaluated the results for range of motion (ROM), Visual Analog Scale (VAS), score, Lysholm score, and Knee Society Score (KSS) postoperative functional outcome measure. Results: The mean duration of follow-up in the SP and IP groups were 17.6 +/- 2.3 (range, 13 to 21) and 19.9 +/- 1.3 (range, 15 to 41) months, respectively (p= 0.236). The mean duration of surgery was significantly shorter in the SP group than in the IP group (73.2 +/- 19.9 [45 to 160] min in the SP group and 152.0 +/- 28.5 [100 to 240] min in the IP group) (p=0.0001). There was no significant difference between the groups regarding duration of postoperative hospital stay, union time, and decrease in hemoglobin levels. There was no significant difference between the groups regarding Lysholm scores, KSS functional outcome scores, VAS, ROM, and thigh and calf diameter difference measured at the final follow- up. A Poller screw or provisional Kirschner wire was used for 14 (35%) of 16 diametaphyseal fractures in the IP group. No additional technique was used for any patient in SP group (p= 0.001). Conclusion: The SP application of an IMN for diaphyseal tibial fractures yields an easy and practical application, having easy reduction with shorter operative time and no need for additional techniques to achieve reduction. However, the clinical and radiological outcomes of both techniques are similar after a one-year follow-up.