Avilucea, J Orthop Trauma 2016 - Suprapatellar Intramedullary Nail Technique Lowers Rate of Malalignment of Distal Tibia Fractures

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Suprapatellar Intramedullary Nail Technique Lowers Rate of Malalignment of Distal Tibia Fractures

Avilucea, Mir, et al.·J Orthop Trauma·2016·114 citations·Retrospective cohort

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Purpose

To report on the immediate postoperative alignment of distal tibia fractures (within 5 cm of the tibial plafond) treated with suprapatellar intramedullary nail (IMN) insertion compared with the infrapatellar technique. Primary outcomes include alignment on both the anteroposterior and lateral radiographic views.

Methods

Design: Retrospective cohort study.

Setting: Two urban level I trauma centers.

Patients: A total of 266 skeletally mature patients with a distal tibia fracture were treated with an IMN. 132 patients underwent this procedure through a suprapatellar technique.

Intervention: Intramedullary nail placement.

Main Outcome Measures: Alignment.

Results

The 2 treatment groups were evenly matched with respect to age, gender, fracture grade, and the presence of open fracture.
Within the suprapatellar group, the fibula was intact, fixed, and remained fractured in 6 (4.5%), 22 (16.7%), and 104 (78.8%) cases, respectively.
The fibula was intact, repaired, and remained fractured in 9 (6.7%), 32 (23.9%), and 93 (69.4%) cases, respectively, in the infrapatellar group.
There was no difference in the rate of fibular fixation between the groups (P = 0.2).
Primary angular malalignment of ≥5 degrees occurred in 35 (26.1%) patients with infrapatellar IMN insertion and in 5 (3.8%) patients who underwent suprapatellar IMN insertion (P < 0.0001).

Conclusions

This is the largest patient series directly comparing the suprapatellar with infrapatellar IMN insertion technique in the treatment of distal tibia fractures. In the treatment of distal tibia fractures, suprapatellar IMN technique results in a significantly lower rate of malalignment compared with the infrapatellar IMN technique.

Level of evidence: Therapeutic Level III. Copyright remains with the authors and publisher.

Suprapatellar Intramedullary Nail Technique Lowers Rate of Malalignment of Distal Tibia Fractures.

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Suprapatellar Intramedullary Nail Technique Lowers Rate of Malalignment of Distal Tibia Fractures

Avilucea, Mir, et al.·J Orthop Trauma·2016·114 citations·Retrospective cohort

|

Purpose

To report on the immediate postoperative alignment of distal tibia fractures (within 5 cm of the tibial plafond) treated with suprapatellar intramedullary nail (IMN) insertion compared with the infrapatellar technique. Primary outcomes include alignment on both the anteroposterior and lateral radiographic views.

Methods

Design: Retrospective cohort study.

Setting: Two urban level I trauma centers.

Patients: A total of 266 skeletally mature patients with a distal tibia fracture were treated with an IMN. 132 patients underwent this procedure through a suprapatellar technique.

Intervention: Intramedullary nail placement.

Main Outcome Measures: Alignment.

Results

The 2 treatment groups were evenly matched with respect to age, gender, fracture grade, and the presence of open fracture.
Within the suprapatellar group, the fibula was intact, fixed, and remained fractured in 6 (4.5%), 22 (16.7%), and 104 (78.8%) cases, respectively.
The fibula was intact, repaired, and remained fractured in 9 (6.7%), 32 (23.9%), and 93 (69.4%) cases, respectively, in the infrapatellar group.
There was no difference in the rate of fibular fixation between the groups (P = 0.2).
Primary angular malalignment of ≥5 degrees occurred in 35 (26.1%) patients with infrapatellar IMN insertion and in 5 (3.8%) patients who underwent suprapatellar IMN insertion (P < 0.0001).

Conclusions

This is the largest patient series directly comparing the suprapatellar with infrapatellar IMN insertion technique in the treatment of distal tibia fractures. In the treatment of distal tibia fractures, suprapatellar IMN technique results in a significantly lower rate of malalignment compared with the infrapatellar IMN technique.

Level of evidence: Therapeutic Level III. Copyright remains with the authors and publisher.

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