TY - JOUR
T1 - Prevalence of Rotational Malalignment after Infrapatellar Versus Suprapatellar Intramedullary Nailing of Tibial Shaft Fractures
AU - Alderlieste, Dagmar S.
AU - Cain, Megan E.
AU - Van Der Gaast, Nynke
AU - Verbakel, Joy
AU - Edwards, Britt
AU - Jaarsma, Emily H.
AU - Hendrickx, Laurent A.M.
AU - Ijpma, F. F.A.
AU - Hermans, Erik
AU - Edwards, Michael J.R.
AU - Doornberg, Job N.
AU - Jaarsma, Ruurd L.
PY - 2024/4
Y1 - 2024/4
N2 - Background:Up to 30% of patients with a tibial shaft fracture sustain iatrogenic rotational malalignment (RM) after infrapatellar (IP) nailing. Although IP nailing remains the management of choice for most patients, suprapatellar (SP) nailing has been gaining popularity. It is currently unknown whether SP nailing can provide superior outcomes with regard to tibial RM. The aim of this study was to compare the differences in the prevalence of RM following IP versus SP nailing.Methods:This retrospective study included 253 patients with a unilateral, closed tibial shaft fracture treated with either an IP or SP approach between January 2009 and April 2023 in a Level-I trauma center. All patients underwent a postoperative, protocolized, bilateral computed tomography (CT) scan for RM assessment.Results:RM was observed in 30% and 33% of patients treated with IP and SP nailing, respectively. These results indicate no significant difference (p = 0.639) in the prevalence of RM between approaches. Furthermore, there were no significant differences in the distribution (p = 0.553) and direction of RM (p = 0.771) between the 2 approaches. With the IP and SP approaches, nailing of left-sided tibial shaft fractures resulted in predominantly internal RM (85% and 73%, respectively), while nailing of right-sided tibial shaft fractures resulted in predominantly external RM (90% and 80%, respectively). The intraobserver reliability for the CT measurements was 0.95.Conclusions:The prevalence of RM was not influenced by the entry point of tibial nailing (i.e., IP versus SP). Hence, the choice of surgical approach should rely on factors other than the risk of RM.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
AB - Background:Up to 30% of patients with a tibial shaft fracture sustain iatrogenic rotational malalignment (RM) after infrapatellar (IP) nailing. Although IP nailing remains the management of choice for most patients, suprapatellar (SP) nailing has been gaining popularity. It is currently unknown whether SP nailing can provide superior outcomes with regard to tibial RM. The aim of this study was to compare the differences in the prevalence of RM following IP versus SP nailing.Methods:This retrospective study included 253 patients with a unilateral, closed tibial shaft fracture treated with either an IP or SP approach between January 2009 and April 2023 in a Level-I trauma center. All patients underwent a postoperative, protocolized, bilateral computed tomography (CT) scan for RM assessment.Results:RM was observed in 30% and 33% of patients treated with IP and SP nailing, respectively. These results indicate no significant difference (p = 0.639) in the prevalence of RM between approaches. Furthermore, there were no significant differences in the distribution (p = 0.553) and direction of RM (p = 0.771) between the 2 approaches. With the IP and SP approaches, nailing of left-sided tibial shaft fractures resulted in predominantly internal RM (85% and 73%, respectively), while nailing of right-sided tibial shaft fractures resulted in predominantly external RM (90% and 80%, respectively). The intraobserver reliability for the CT measurements was 0.95.Conclusions:The prevalence of RM was not influenced by the entry point of tibial nailing (i.e., IP versus SP). Hence, the choice of surgical approach should rely on factors other than the risk of RM.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
KW - Tibial shaft fracture
KW - rotational malalignment
KW - infrapatellar nailing
UR - http://www.scopus.com/inward/record.url?scp=85191403181&partnerID=8YFLogxK
U2 - 10.2106/JBJS.OA.23.00134
DO - 10.2106/JBJS.OA.23.00134
M3 - Article
AN - SCOPUS:85191403181
SN - 2472-7245
VL - 9
JO - JBJS Open Access
JF - JBJS Open Access
IS - 2
M1 - e23.00134
ER -