A Prospective Study on Tibial Shaft Fractures Treated with Suprapatellar Approach

Shamith Chandar; Maddula Venkataramana Rao; Vijayakumar Druva; Raghavendra Dorai

doi:10.4103/jwas.jwas_176_23

A Prospective Study on Tibial Shaft Fractures Treated with Suprapatellar Approach

J West Afr Coll Surg. 2024 Oct-Dec;14(4):412-416. doi: 10.4103/jwas.jwas_176_23. Epub 2024 Jul 18.

Authors

Shamith Chandar¹, Maddula Venkataramana Rao¹, Vijayakumar Druva¹, Raghavendra Dorai¹

Affiliation

¹ Department of Orthopedics, SS Institute of Medical Sciences and Research Centre, Davangere, Karnataka, India.

Abstract

Background: Tibial diaphysis represents the primary location for tibial fractures, accounting for 80% of such cases, often accompanied by fibular fractures. In terms of surgical management, the recommended technique for addressing both displaced and undisplaced tibial shaft fractures in adults is intramedullary nail fixation. Additionally, there is a growing consideration for suprapatellar nailing, which involves performing the procedure with the knee in a semi-extended position, as a potentially safe and efficacious alternative.

Objectives: To evaluate the clinical and functional union amongst tibial shaft fracture cases, managed by nailing in the suprapatellar approach, and to study the complications associated with it.

Materials and methods: Our study with prospective observational design was conducted for 18 months on 30 patients with tibial shaft fractures. Following comprehensive laboratory assessments and confirmation of surgical fitness, the patients underwent surgical intervention through a specialised suprapatellar approach employing expert tibial nailing.

Results: The mean age of the subjects was 42.83 ± 11.47 years, and the majority were males (70.0%). Notably, there was a statistically significant reduction in Visual Analogue Scale scores and a concurrent increase in Lysholm Knee Scoring Scale scores during the follow-up period, indicating substantial enhancements in both clinical and functional outcomes. Delayed union was the complication observed in three individuals. We found that the younger the age of the subjects, the earlier the surgery after an injury, the better the functional outcome.

Conclusion: Expert tibial nailing with a suprapatellar approach was successful in yielding clinical and functional union amongst the subjects with tibial shaft fractures. In addition, delayed union was the complication observed in the approach, which was evident in a few cases.

Keywords: Expert tibial nailing; functional union; suprapatellar approach; tibial shaft fractures.