# Comparison of Functional and Radiological Outcomes of Intramedullary Nailing of the Tibia Using Suprapatellar and Infrapatellar Approaches

## TL;DR

This study compares two surgical approaches for tibial fractures and finds similar outcomes in terms of recovery and healing.

## Contribution

The study provides empirical evidence comparing suprapatellar and infrapatellar approaches for tibial intramedullary nailing outcomes.

## Key findings

- Both suprapatellar and infrapatellar approaches resulted in comparable functional and radiological outcomes at three months.
- The infrapatellar approach had shorter surgical times compared to the suprapatellar approach.
- Postoperative pain and complication rates were similar between the two groups.

## Abstract

Background: Tibial shaft fractures are among the most common long bone injuries, frequently resulting from road traffic accidents, falls, and sports injuries. Intramedullary nailing (IMN) has become the gold standard for managing these fractures, but debate persists regarding the optimal surgical approach: suprapatellar (SPN) or infrapatellar (IFN).

Methods: This prospective observational study was conducted at Mahatma Gandhi Memorial (MGM) Medical College and Maharaja Yeshwantrao (MY) Hospital, Indore, between October 2023 and September 2024. Sixty patients with closed or grade 1 compound tibial shaft fractures were enrolled and randomized equally into SPN and IFN groups. Surgical time, postoperative pain (visual analog scale scores), functional outcomes (Lysholm Knee Score), radiological alignment, and complications were assessed at two weeks, six weeks, and three months postoperatively.

Results: The study population showed male predominance (88.33%), with a mean age of 32.1 years (SPN) and 36.2 years (IFN). Road traffic accidents were the leading cause of injury. The SPN group had significantly longer surgical times (77.63 ± 8.50 minutes) compared to the IFN group (68.80 ± 4.43 minutes; p = 0.00000836), though a learning curve was noted. Postoperative pain and functional recovery were similar in both groups across all follow-ups. By three months, the majority of patients in both groups achieved excellent functional outcomes, and radiological alignment was comparable. Minimal complications were observed, with only one case of knee stiffness in the SPN group, successfully managed.

Conclusion: Both SPN and IFN approaches for tibial IMN offer comparable functional and radiological outcomes at three months. Although the SPN approach had a longer operative time initially, it did not significantly affect postoperative pain, fracture healing, or complication rates. Choice of approach may therefore be tailored based on surgeon preference, fracture location, and patient-specific considerations.