Suprapatellar Versus Infrapatellar Tibial Nail Insertion- A Prospective, Randomised Control Pilot Study

BACKGROUND standard for treating tibial shaft fractures are by intramedullary nails currently. After the procedure, one of the most complication is knee pain, after consolidation even more chronically. Chronic knee pain can affect more than 50% of cases, which was said by most authors. Alternative routes of inserting the nail is used, which includes by means of lateral paratendon, medial patellar paratendon or transtendon to avoid the symptom. aim of the study is to study the clinical and functional outcomes of suprapatellar versus infrapatellar tibial nail insertion. AND METHODS is a prospective study, which was done from January 2014 to February 2015 and 50 patients who were skeletally mature selected and randomised into IP and SP nail insertion groups. They were also given informed consent and only after they , they were taken into the study. The technique of nail insertion was revealed to both the surgeon and the patient at time. Criteria- Pregnant women, patients with intra-articular involvement, periprosthetic fractures, nonunions, ipsilateral , previous knee injuries, history of gout, rheumatoid, osteoarthritis, spinal injury and incarceration. SP insertion was percutaneously with the help of a special cannula system. total of 50 patients were selected in this study. 31 SP and 19 IP. 10 SP and 2 IP did not show up for follow up examinations, only 38 patients were present for 12 months. At last, there were 21 SP and 17 IP patients. The time from when the index was done to follow up was 14.6 months, i.e. it ranged from 12-28 months. 12 were males and 9 were females with , 9 were males and 8 were females in infrapatellar. Average age of suprapatellar was 42 and that of infrapatellar 44. Open fractures were 5 and closed fractures were 33. VAS score was 0.78 in suprapatellar and 1.87 in infrapatellar. Data of external features and extension and flexion were almost equal for both suprapatellar and infrapatellar. on the data obtained above, it can be concluded that suprapatellar and infrapatellar approach are equivalent regarding fracture healing and alignment, knee pain and functional disability.