Journal of Orthopaedic Diseases and Traumatology

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

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


Ashutosh Kumar1, Rishabh Kumar1, Anand Shankar1, Rakesh Kumar1, Wasim Ahmed2,  
1 Department of Trauma and Emergency, IGIMS, Patna, Bihar, India
2 Department of Orthopaedics, IGIMS, Patna, Bihar, India

Correspondence Address:
Wasim Ahmed
Department of Orthopaedics, Indira Gandhi Institute of Medical Sciences, Patna, Bihar
India




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;5:195-196


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 2023 Jan 30 ];5:195-196
Available from: https://jodt.org/text.asp?2022/5/3/195/355240


Full Text



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:

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]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]Indications for suprapatellar nailing of the tibia

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 tibiaInfrapatellar soft-tissue damage in a tibia fracture. Perfect fracture reduction can be achieved in nearly every case by positioning the extremity in slight flexionThe traumatized soft-tissue envelope is intact in suprapatellar nailing, hence the chances of infections are very less.[3]

There are a few, less common indications for treating tibia fractures by the suprapatellar nailing technique:[4]

Flexion deficit of the knee jointPatella bajaOssification in the patellar tendonAdditional nerve and/or blood vessel damageA two-stage surgical procedure after flap reconstruction.

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

1Shekhar 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.
2Oh 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.
3Orfaly 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.
4Pommer 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.
5Ricci 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.