Clinical and Functional Outcomes of Patellar Tendon Splitting versus Medial Parapatellar Approach in Intramedullary Nailing for Tibial Shaft Fractures: A Prospective Comparative Study

Background: Tibial shaft fractures represent a substantial proportion of long-bone injuries encountered in orthopedic practice.Intramedullary nailing (IMN) is the established gold standard for definitive management; however, debate persists regarding which surgical approach-patellar tendon splitting (PTS) or medial parapatellar (PP)-yields superior clinical outcomes.This study was undertaken to compare postoperative pain, functional recovery, range of motion, operative efficiency, and complications between the two approaches. Materials and methods:A prospective comparative study of 40 patients with tibial shaft fractures was conducted at Rajarajeswari Medical College and Hospital, Bengaluru (April 2024-September 2025).20 patients were allocated to each group using the sealed envelope method.Visual analog scale (VAS) scores, Lysholm knee scores, knee range of motion (ROM), operative time, time to radiological union, and complications were evaluated at 6 weeks, 12 weeks, and 6 months postoperatively. Results:The PP group demonstrated significantly lower VAS pain scores at all follow-up intervals (p < 0.001), superior Lysholm knee scores at 6 months (89.55 ± 5.24 vs 84.40 ± 4.65, p = 0.002), greater knee flexion (151.60 ± 11.22 vs 145.00 ± 5.37, p = 0.023), and reduced extension lag (1.55 ± 1.40 vs 2.90 ± 1.55, p = 0.006).Operative time was shorter (90.05 ± 8.30 vs 95.60 ± 7.64 min, p = 0.034) and radiological union was earlier (14.10 ± 1.45 vs 16.35 ± 1.53 weeks, p < 0.001) in the PP group.Excellent outcomes were achieved in 35% of PP patients vs 5% in the PTS group (p = 0.041).Complication rates were comparable between groups. Conclusion:The medial parapatellar approach confers significant advantages in anterior knee pain, functional recovery, range of motion, and surgical efficiency over the patellar tendon splitting approach.It should be considered the preferred technique for tibial intramedullary nailing when anatomically feasible.