Comparison of suprapatellar and infrapatellar tibial nailing: more anatomic entry point and fracture reduction via the suprapatellar approach

Abstract

Background: The aim of this study was to compare clinical and radiographical results of two groups of patients treated with intramedullary nailing for tibial fractures via suprapatellar and infrapatellar routes. Materials and Methods: This retrospective study enrolled 74 patients operated via suprapatellar or infrapatellar tibial nailing with a minimum of 24 months follow-up. Main outcome measurements were sex, age, limb sight, fracture classification, open or closed fracture, patellofemoral arthritis, and Insall-Salvati (IS) ratios, preoperatively. Postoperative entry point accuracy, sagittal plane angulation, IS ratios, patellofemoral joint arthritis, tibial slope, and Kujala and Lysholm knee scores were evaluated. Results: The suprapatellar approach was used in 33 patients and the infrapatellar approach was used in 41. The distance of entry point in the suprapatellar group was significantly closer to the lateral tibial spine in the coronal plane, anterior tibial edge in the sagittal plane, and anterior corner in the sagittal plane than in the infrapatellar group (p = 0.003, p = 0.001, and p = 0.001, respectively). Postoperative tibial slopes and sagittal plane angulation in the suprapatellar group were significantly more accurate than those in the infrapatellar group (p < 0.001 and p < 0.001, respectively). IS ratios, patellofemoral joint arthritis, and Kujala and Lysholm knee scores were not statistically different. Conclusion: More accurate tibial entry points and better sagittal alignment were achieved with suprapatellar tibial nailing than with infrapatellar tibial nailing. Suprapatellar tibial intramedullary nailing is a safe procedure for patellofemoral joints and does not increase anterior knee pain. The type of approach did not influence clinical outcomes in this study.