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The management of closed mid shaft tibia fractures remains reamed intramedullary statically locked nailing 1,2. Since the first description of intramedullary tibia nails by Gerhard Küntscher 3,4 and through the subsequent introduction of the locked nails by Grosse and colleagues 5,6, infrapatellar and parapatellar access routes have been utilized. The discussion on the correlation between different entry points and the incidence of anterior knee pain has been extensive 7-10. Nailing of a proximal tibia fracture can be complicated by malalignment, typically an apex anterior with valgus angulation, coupled with posterior displacement of the distal fragment 11. The insertion of an intramedullary nail in the tibia utilizing a suprapatellar percutaneous entry point, with the knee in semi extension, appears to mitigate the establishment of malreduction 12,13. Because the suprapatellar route does not interfere with the patellar tendon, it consequently appears to lead to reduced incidence of knee pain and rapid rehabilitation. Originally indicated for proximal tibia fractures, this modification of the classical tibial nailing has been proven effective in all tibial fracture locations. It allows for fast setup of the operating room, with the patient in a supine position on a translucent table. It simplifies the treatment in polytrauma patients with injuries to the soft tissue surrounding the patellar tendon area fractures. It is coupled by excellent and unobstructed intra-operative radiological projections, allowing the maintenance of fracture reduction with minimal manual longitudinal traction and/or percutaneous clamps. Furthermore, the implementation of a reamed, locked intramedullary nail with no Herzog curve, designed specifically for the suprapatellar insertion, with ad hoc instrumentation, cannulas, and trochars, allowing protected passage under the patella in the trochlear femoral groove, is paramount in the nailing of proximal, mid-diaphyseal and distal tibial fractures.
Massimo Morandi (Mon,) studied this question.