A comparative analysis of the infrapatellar and suprapatellar approaches for intramedullary nail fixation in tibia fractures

Abstract

Objective: Intramedullary nailing is a commonly used method for fixing tibia fractures due to its benefits. However, it can lead to complications such as malalignment and knee pain. The traditional infrapatellar approach is associated with higher malalignment rates, while a suprapatellar approach has shown lower rates. Knee pain, particularly at the site of nail insertion, is a common issue reported by patients. Different approaches have been compared, but no significant difference has been found in terms of chronic knee pain. To assess clinical, radiographic, and functional outcomes after intramedullary nail (IMN) fixation of tibia fractures with an infrapatellar approach compared to a suprapatellar approach. Methods: Retrospective study: Level 1 trauma centre. Patients with 30 tibia fractures were treated with intramedullary nailing between 2022 and 2023. A retrospective chart review of tibia fractures was conducted. The clinical and functional outcomes of tibia fractures treated with IMN were compared between groups treated with an infrapatellar approach versus a suprapatellar approach. Multivariate models were created to control for confounding demographic, comorbidity, and injury-related confounders. Results: Outcome measures included non-union, malunion, and infection. Subjective functional patient outcomes were assessed using pain interference (Pi) and physical function (PF) Patient-Reported Outcome Measurements Systems scores (PROMIS). There were 14 patients treated with infrapatellar nailing (46%) and 16 patients treated with suprapatellar nailing (54%). On multivariate analysis, suprapatellar nailing was independently associated with decreased risk of malunion and decreased risk of postoperative knee pain. There was no difference in the rate of non-union infection or Patient Reported Outcome Measurements Systems pain interference or physical function scores. Conclusion: Suprapatellar IMN fixation of tibial shaft fractures is independently associated with a lower risk of malunion and postoperative knee pain compared to the infrapatellar approach. However, there are no functional differences between approaches.