38 Anterior Knee Pain Assessment in Tibial Nailing: A Comparative Retrospective Study of Suprapatellar and Infrapatellar Approaches

Aim To assess whether there is a statistically significant difference between incidence of anterior knee pain in supra-patellar vs infra-patellar tibial nailing techniques. Method This retrospective study, conducted at a UK trauma centre, data was analysed using ICD-10 and OPCS codes to identify patients with tibial fractures who underwent IM nail fixation. Among 312 patients, 206 met inclusion criteria, excluding those with unavailable records, limited follow-up, and paediatric patients using flexible nails. Two groups, "Suprapatellar Nailing" and "Infrapatellar Nailing," were compared for anterior knee pain incidence via clinical follow-up data. Statistical analysis tested the null hypothesis i.e., "Infrapatellar nailing causes more documented anterior knee pain than suprapatellar nailing." Results Out of 206 patients, 140 were males and 66 were females with mean age of 43 years (Range 16-91). 60.2% (n=124) were treated with infrapatellar nailing as compared to suprapatellar nailing 39.8% (n=82). Anterior knee pain was reported in 14.2% (n=17) of infrapatellar cohort as compared to 14.6% (n=12) in the suprapatellar cohort. Chi square statistic with yates’ correction is 0.0124, with a p value of 0.91. The result is not significant (p > 0.05). Conclusions The 14.4% mean incidence of anterior knee pain in both groups is relatively low compared to existing literature. Despite the need for a large sample size to establish statistical significance, our study indicates no significant difference in anterior knee pain incidence between infrapatellar and suprapatellar nailing techniques, suggesting equivocal outcomes in skilled hands. We recommend a multicentre study, particularly given the increasing use of suprapatellar nailing, to achieve statistical significance.