Authors : Dr. Saurabh Suman, Dr. Gaurav Vatsa
DOI : 10.9790/0853-2302066065
Volume : 23
Issue : 2
Year : 2024
Page No : 60-65
Backgroun d Tibial shaft fractures are common, with proximal third fractures comprising a smaller but significant subset. The rise in high velocity road traffic injuries has contributed to an increase in these fractures, predominantly affecting economically active adult males. These fractures often present with severe soft tissue injuries and bone comminution, posing challenges for treatment. Intrame dullary nailing has been a successful method for tibial shaft fractures, but applying this technique to proximal third fractures presents difficulties due to deforming forces. The standard approach for intramedullary nailing in the tibia is infrapatellar, but this can lead to complications such as rotational deformities or malalignment. To address these challenges, the suprapatellar approach was introduced, offering potential advantages such as reduced postoperative knee pain and prevention of degenerative knee disorders. However, concerns remain regarding potential intra articular injury Material and Methods: This study aimed to compare the clinical and radiological outcomes of suprapatellar and infrapatellar approaches for proximal third tibia fractures. Forty patients were divided into two groups, with one group undergoing suprapatellar nailing and the other infrapatellar nailing. Clinical outcomes were assessed using the Lower Extremity Functional Scale (LEFS) at 6 weeks, 3 months, 6 months, and 12 month s, while radiological outcomes were evaluated based on time to union. Results: The results showed that suprapatellar nailing had superior clinical outcomes at 3, 6, and 12 months compared to infrapatellar nailing. Radiologically, the average time to union was shorter in the suprapatellar group along with the number of delayed union and non union cases . These findings support the use of the suprapatellar approach for proximal third tibia fractures. Conclusion: T his study provides evidence for the clinical and radiological advantages of the suprapatellar approach over the infrapatellar approach for proximal third tibia fractures. Larger prospective studies with longer follow ups are needed to further validate these findings and establish treatment protocols.