LETTER TO EDITOR

Year : 2022  |  Volume : 5  |  Issue : 3  |  Page : 195-196

Tips and tricks of suprapatellar nailing of tibial fractures and its indications

Ashutosh Kumar¹, Rishabh Kumar¹, Anand Shankar¹, Rakesh Kumar¹, Wasim Ahmed^2
1 Department of Trauma and Emergency, IGIMS, Patna, Bihar, India
² Department of Orthopaedics, IGIMS, Patna, Bihar, India

Correspondence Address:
Wasim Ahmed
Department of Orthopaedics, Indira Gandhi Institute of Medical Sciences, Patna, Bihar
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jodp.jodp_19_22

1. Intramedullary nailing is the standard procedure for surgical treatment of closed tibial shaft fracture. The intramedullary nailing with infrapatellar approach is frequently followed by postoperative malalignment while very less in suprapatellar nailing, whereas plating is associated with higher rates of postoperative infection^[1]
2. The author shows complication in plating as mechanical failure (12.9%) and some secondary complications (22.2%). While secondary complications included nonunion (3.7%), superficial infection (5.6%), deep vein thrombosis (3.7%), delayed union (3.7%), and soft-tissue debridement (5.6%). While nailing has very less complication^[2]
3. Indications for suprapatellar nailing of the tibia



1. A proximal tibial fracture located entirely in the metaphysis (AO/OTA classification 41-A2 and A3) is the classical indication for suprapatellar nailing of the tibia
2. Infrapatellar soft-tissue damage in a tibia fracture. Perfect fracture reduction can be achieved in nearly every case by positioning the extremity in slight flexion
3. The traumatized soft-tissue envelope is intact in suprapatellar nailing, hence the chances of infections are very less.^[3]



4. There are a few, less common indications for treating tibia fractures by the suprapatellar nailing technique:^[4]



1. Flexion deficit of the knee joint
2. Patella baja
3. Ossification in the patellar tendon
4. Additional nerve and/or blood vessel damage
5. A two-stage surgical procedure after flap reconstruction.



5. Suprapatellar intramedullary nailing is a safe method for treating extra-articular proximal tibia fractures, which permits flxation of the fragments without malalignment and without any additional flxation tools. Surgical access is located away from the fracture site, thus avoiding further damage to the soft-tissue mantle.^[5]

References

1.	Shekhar S, Pranjal A. Clinical and radiological evaluation of proximal tibia fracture fixed with variable angle proximal tibial interlocking plate: A prospective observational study. J Orthop Dis Traumatol 2022;5:8-13.     [Full text]
2.	Oh JK, Sahu D, Hwang JH, Cho JW, Oh CW. Technical pitfall while reducing the mismatch between LCP PLT and upper end tibia in proximal tibia fractures. Arch Orthop Trauma Surg 2010;130:759-63.
3.	Orfaly R, Keating JE, O'Brien PJ. Knee pain after tibial nailing: Does the entry point matter? J Bone Joint Surg Br 1995;77:976-7.
4.	Pommer AW, Hahn MP, Da'vid A, Muhr G. Fixation of proximal tibia fractures by a retrograde nail: a biomechanical investigation” Archives of Orthopaedic and Trauma Surgery 2000;120:212-4.
5.	Ricci WM, O'Boyle M, Borrelli J, Bellabarba C, Sanders R. Fractures of the proximal third of the tibial shaft treated with intramedullary nails and blocking screws. J Orthop Trauma 2001;15:264-70.