Dr. Abhilash Srivastava, Department of Orthopaedics, D.Y. Patil Hospital, Navi Mumbai, Maharashtra, India. E-mail: charlie.srivastava009@gmail.com
Introduction: Segmental tibial fractures, defined by two distinct fracture lines creating an intermediate cortical segment, represent high-energy injuries with significant management challenges. Traditional infrapatellar nailing often falls short due to difficulties in maintaining alignment and a high incidence of anterior knee pain.
Technique: This article outlines the suprapatellar approach for intramedullary nailing in segmental tibial fractures, highlighting surgical nuances, anatomical rationale, and advantages in challenging fracture configurations.
Conclusion: Suprapatellar nailing offers improved alignment control, reduced anterior knee morbidity, and superior intraoperative ergonomics, making it a preferred technique in segmental tibial injuries.
Keywords: Suprapatellar nailing, High energy trauma, Segmental tibia fracture
References
- 1. Study to Prospectively Evaluate Reamed Intramedullary Nails in Patients with Tibial Fractures Investigators; Bhandari M, Guyatt G, Tornetta P 3rd, Schemitsch EH, Swiontkowski M, Sanders D, Walter SD. Randomized trial of reamed and unreamed intramedullary nailing of tibial shaft fractures. J Bone Joint Surg Am. 2008 Dec;90(12):2567-78. doi: 10.2106/JBJS.G.01694. PMID: 19047701; PMCID: PMC2663330. [Google Scholar]
- 2. Wang Z, Xiong X, Lu Z, Gao Y. A systematic review and meta-analysis comparing suprapatellar versus infrapatellar approach intramedullary nailing for tibal shaft fractures. Eur J Trauma Emerg Surg. 2024 Apr;50(2):383-394. doi: 10.1007/s00068-023-02384-9. Epub 2023 Nov 21. PMID: 37989960; PMCID: PMC11035435. [Google Scholar]
- 3. Chen Yuan Yang1,2, Soon Tzeh Tay3 and Liang Tseng Kuo3,4. The suprapatellar approach to intramedullary nailing of the tibia: A review of the literature. J Orthop Trauma 2016;30:572-77. [Google Scholar]
- 4. Gadegone W, Gadegone P, Lokhande V. Suprapatellar nailing in complex Tibial Fractures. SICOT J. 2023;9:37. doi: 10.1051/sicotj/2023025. Epub 2023 Dec 20. PMID: 38133637; PMCID: PMC10741379. [Google Scholar]
- 5. Yang L, Sun Y, Li G. Comparison of suprapatellar and infrapatellar intramedullary nailing for tibial shaft fractures: a systematic review and meta-analysis. J Orthop Surg Res. 2018 Jun 14;13(1):146. doi: 10.1186/s13018-018-0846-6. PMID: 29898758; PMCID: PMC6001044. [Google Scholar]