Comparison of clinical, radiological and functional outcome between the supra-patellar and infra-patellar techniques of Tibial nailing in Indian population: A prospective, randomized controlled trial.

Abstract

Tibial shaft fractures are common injuries seen particularly because of high velocity trauma. Considerable debate exists between the suprapatellar and infrapatellar approach for nailing of tibial shaft fractures. The aim of this study was to compare the clinical, radiological and functional outcomes and intra-operative fluoroscopy time, total blood loss and operative time between supra-patellar and infra-patellar insertion techniques in the treatment of extra-articular tibial shaft fractures. Sixty patients aged between 18-45 years who presented to our Level I trauma-centre with AO/OTA type 42 fractures were randomized into Suprapatellar (SP) and Infrapatellar (IP) groups. Operative time, intra-operative blood loss and radiation exposure was recorded. Severity of knee pain by VAS score and knee range of motion were documented at 2 weeks, 6 weeks, 3 months, 6 months, 12 months, 18 months and 24 months follow-up. Functional outcomes were measured using Knee Society Score, Lysholm Knee Score and KOOS-PF score and radiological union assessed with radiograph done at 6 weeks, 3 months, 6 months, 12 months, 18 months and 24 months post-operatively. Thirty patients each underwent nailing by suprapatellar and infrapatellar approach. A statistically significant difference favouring the suprapatellar group was noted in the operative time (p-value 0.003) and mean intra-operative blood loss (p-value 0.027). There was no difference between the two groups in terms of knee pain or knee range of motion and the mean functional scores. Suprapatellar nailing of tibial shaft fractures may help to reduce operative time and intra-operative blood loss with similar intra-operative radiation exposure, clinical and functional outcomes compared to infrapatellar nailing.