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 Table of Contents  
LETTER TO EDITOR
Year : 2022  |  Volume : 5  |  Issue : 3  |  Page : 195-196

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


1 Department of Trauma and Emergency, IGIMS, Patna, Bihar, India
2 Department of Orthopaedics, IGIMS, Patna, Bihar, India

Date of Submission25-Feb-2022
Date of Decision01-Apr-2022
Date of Acceptance02-Apr-2022
Date of Web Publication1-Sep-2022

Correspondence Address:
Wasim Ahmed
Department of Orthopaedics, Indira Gandhi Institute of Medical Sciences, Patna, Bihar
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jodp.jodp_19_22

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How to cite this article:
Kumar A, Kumar R, Shankar A, Kumar R, Ahmed W. Tips and tricks of suprapatellar nailing of tibial fractures and its indications. J Orthop Dis Traumatol 2022;5:195-6

How to cite this URL:
Kumar A, Kumar R, Shankar A, Kumar R, Ahmed W. Tips and tricks of suprapatellar nailing of tibial fractures and its indications. J Orthop Dis Traumatol [serial online] 2022 [cited 2022 Dec 3];5:195-6. Available from: https://jodt.org/text.asp?2022/5/3/195/355240



Letter to the editor regarding “Clinical and radiological evaluation of proximal tibia fracture fixed with variable angle proximal tibial interlocking plate” in the prestigious journal of Orthopaedics Disease and Traumatology of Year: 2022 | Volume: 5 | Issue: 1 | Page: 8-13.

Dear Editor,

We enjoyed reading a recently published article by Shekhar and Pranjal[1] on Clinical and radiological evaluation of proximal tibia fracture fixed with variable angle proximal tibial interlocking plate: A prospective observational study. Along with plating for proximal tibia, suprapatellar nailing is also a good option in case of extra-articular proximal tibia fracture. We would like to raise some points and put forward more insights into this subject, as follows:

  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]


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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.  Back to cited text no. 1
  [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.  Back to cited text no. 2
    
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.  Back to cited text no. 3
    
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.  Back to cited text no. 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.  Back to cited text no. 5
    




 

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