Vol. 11, Issue 4 (2025)

Aim: To compare the clinical and functional outcomes of tibial shaft fractures treated with intramedullary nailing using the suprapatellar (SP) and infrapatellar (IP) approaches.

Materials and Methods: A prospective comparative study was conducted on 40 patients with closed or Gustilo-Anderson type I open tibial shaft fractures at Government Medical College, Patiala. Patients were randomly assigned to two groups: Group A (SP, n = 20) and Group B (IP, n = 20). Inclusion criteria were acute tibial diaphyseal fractures in patients aged 18-60 years. Exclusion criteria included pathological fractures, intra-articular extension, polytrauma, prior knee surgery, or unfit for anesthesia. Operative parameters assessed included surgical duration, fluoroscopy time, and blood loss. Postoperative evaluation included anterior knee pain (VAS), knee range of motion, fracture union, and functional outcomes using Johner and Wruhs criteria. Follow-up was performed at 6 weeks, 3 months, and 6 months. Statistical analysis was performed using SPSS, with p<0.05 considered significant.

Results: Demographics were comparable between groups. The SP approach showed significantly shorter operative time (72.4±8.6 vs 83.7±9.4 min), reduced fluoroscopy time (42.3±6.5 vs 55.2±8.2 s), lower blood loss (115±22 vs 130±27 mL), decreased anterior knee pain (VAS 2.6±0.8 vs 3.8±1.1), and greater knee flexion (128.4°±6.2 vs 120.3°±8.7°) compared to the IP group. Fracture union times and complication rates were similar. Functional outcomes were superior in the SP group, with excellent results in 60% versus 40% in the IP group.

Conclusion: The suprapatellar approach for intramedullary nailing of tibial shaft fractures provides better functional outcomes, less pain, improved alignment, and reduced operative and fluoroscopy time without compromising fracture healing, making it superior to the infrapatellar technique.