Comparison between infrapatellar and suprapatellar approaches for intramedullary nailing for the fractures of the tibial shaft

Introduction This study aimed to compare the outcomes at the clinical and functional levels of suprapatellar (SP) and infrapatellar (IP) approaches for intramedullary nailing in treating tibial shaft fracture. Methods Patients who underwent tibial shaft fracture intramedullary nailing by the SP approach or IP approach in a trauma center were retrospectively reviewed. The demographics, intraoperative fluoroscopy time, operation time, blood loss, irrigation volume, postoperative X-ray alignment, and complications of patients were compared between the two groups under different approaches. Lysholm knee score, visual analog score (VAS), and incidence of anterior knee pain (AKP) were assessed 1 year after surgery. Results The study finally included well-documented 81 patients (38 SP versus 43 IP). The SP group exhibited significantly shorter intraoperative fluoroscopy time than that of the IP group (81.7 +/- 14.5 s vs. 122.0 +/- 24.3 s, P < 0.001). Both aspects recorded a precise reduction of the fracture: angulation (2.1 +/- 1.2 degrees vs 3.1 +/- 1.5 degrees, P < 0.05) and translation (0.6 +/- 0.8 mm vs 1.4 +/- 1.5 mm, P < 0.05) in the coronal plane in the SP group. However, the sagittal plane recorded no such change (P > 0.05). The Lysholm knee score was higher in the SP group than that of the IP group (87 +/- 8 vs. 80 +/- 15, P < 0.05). The SP group displayed an evidently lower average VAS score than that of the IP approach group (0.3 +/- 0.8 vs 1.3 +/- 1.4, P < 0.001). Six cases (16%) in the SP group and 16 cases (37%) in the IP group experienced AKP 1-year post-operation (P < 0.05). As far as complications are concerned, neither group showed any significant difference (P > 0.05). Conclusion Compared with the IP approach, the application of intramedullary nailing through the SP approach in treating tibial shaft fractures can effectively shorten the intraoperative fluoroscopy time, correct coronal plane angulation and translation deformity, reduce the incidence of AKP and improve postoperative function.