Suprapatellar versus infrapatellar approaches in the treatment of tibia intramedullary nailing: A retrospective cohort study

Abstract Background: Tibial shaft fractures are routinely managed with intramedullary nailing (IMN). An increasingly accepted technique is the suprapatellar (SP) approach. The purpose of this study was to compare the clinical and functional outcomes of knee joint after tibia IMN through an suprapatellar (SP) or traditional infrapatellar (IP) approach. Methods: Retrospective analysis was performed in patients with tibial shaft fractures that were treated with tibia IMN through a SP or IP approach (1/2014-11/2016). The clinical and functional outcomes of knee joint were assessed with the Hospital for Special Surgery (HSS) Knee Score. Further evaluation included the operation time, intraoperative blood loss. Results: A total of 50 patients/fractures (26 IP and 24 SP) with a follow-up for a minimum of 15 months were evaluated. All fractures were OTA 42. No significant differences were found between the two groups in age, gender, side of fractures, operation time, intra-operative blood loss, and follow-up time. No significant difference was seen in HSS score ( P = 0.62) between them. Analysis of all the HSS components scores revealed no significant differences between them concerning the pain ( P = 0.57), the stand and walk ( P = 0.54), the need for walking stick ( P = 0.60) and extension lag ( P = 0.60). The other HSS components showed full scores (IP 10 vs. SP 10) in both approaches, including muscle force, flexion deformity and stability components. The range of motion (ROM) component score was superior in the IP group ( P = 0.04) suggesting a higher ROM. Conclusions: The SP and IP approaches can get equivalent knee functional outcomes in the treatment of tibial shaft fracture concerning the overall HSS knee score. However, for the HSS component, the IP approach was superior to SP approach regarding the ROM.