Comparison of transverse and longitudinal incisions in tibia intramedullary nailing: Implications for pain, numbness, and functional recovery.

Abstract

The current standard of care for surgically managed tibia shaft fractures is intramedullary nailing. Chronic postoperative knee pain is the most common complication of the infrapatellar technique in intramedullary nailing. Literature suggests it may be related to infrapatellar nerve injury. This study compares the incidence of anterior knee pain after tibia nail insertion between conventional longitudinal and transverse incisions. This clinical trial study was conducted in our Level I trauma center from February 2022 to August 2024. Patients with closed diaphyseal tibia fractures were included in this study. All the cases were treated with reamed statically locked intramedullary nailing. The patients were randomly allocated to the longitudinal infrapatellar approach group (LIPAG) and transverse infrapatellar approach group (TIPAG). The primary outcomes measured at every follow-up included anterior knee pain by visual analog scale (VAS), numbness by monofilament test, range of motion, quality of life, and union success. Postoperative follow-up was performed at 2, 6, and 12 weeks and 6, and 12 months. In our study, significant improvements in pain, quality of life, and functionality were observed in both groups; however, only the changes in numbness sensation and numbness pattern were significantly different between the two groups. TIPAG demonstrated earlier resolution of numbness compared to the LIPAG, and the numbness region significantly differed between the two groups, with LIPAG demonstrating more lateral numbness and TIPAG demonstrating more inferolateral numbness. However, no significant difference was observed between the two groups regarding operation time, length of stay, union outcome, pain, range of motion, or quality of life. Transverse and longitudinal incisions for tibia IMN give comparable long-term results in pain relief, functional recovery, and quality of life.