Functional Knee Outcomes in Infrapatellar and Suprapatellar Tibial Nailing: Does Approach Matter?

We conducted a study to determine differences in knee pain in patients who underwent either traditional infrapatellar nailing or suprapatellar nailing. From a single institution, we identified patients who had an isolated tibial shaft fracture (Orthopaedic Trauma Association type 42 A-C) surgically fixed with an intramedullary nail between 2009 and 2012. Each patient was contacted by telephone by an investigator blinded to surgical exposure, and the Oxford Knee Score (OKS) questionnaire was administered. Operative time and quality of reduction on postoperative radiographs were compared between the 2 approaches. Twenty-four patients underwent infrapatellar nailing, and 21 patients had a suprapatellar nail placed with approach-specific instrumentation. Mean OKS (maximum, 48 points) was 40.1 for the infrapatellar group and 36.7 for the suprapatellar group (P = .293). Compared with the infrapatellar approach, suprapatellar nailing improved radiographic reduction in the sagittal plane (2.90° vs 4.58°; P = .044) and required less operative fluoroscopy time (81 vs 122 s; P = .003). We found no difference in OKS between the infrapatellar and suprapatellar approaches. Although further study is needed, the suprapatellar entry portal appears to be a safe alternative for tibial nailing with use of appropriate instrumentation.