Abstract: Background: Distal tibial metaphyseal fractures are common lower limb injuries and results in extensive musculoskeletal damage due to paucity of soft tissue coverage. Fixation methods include open reduction and internal fixation (ORIF) with plates, minimally invasive percutaneous plate osteosynthesis (MIPPO) and intrameduallary nailing. Extensive exposure for ORIF leads to wound complications,nonunion and infection. Intramedullary nailing is the preferred for diaphyseal tibial fracture however conventional nailing is less suited for distal tibial metaphysis due to diameter mismatch between the nail and the bone leading to very little nail effect and impaired stability. Expert tibial nail with multiplanar locking options at the proximal and distal end allows for secure stabilization of the metaphyseal fragments. Infrapatellar approach is traditionally used for tibial nailing however suprapatellar approach is emerging as an alternative as semi-extended positioning makes it technically easier to nail the proximal and distal fractures.
Materials and Methods: This is a prospective study conducted from February 2019 to February 2020. 14 patients fulfilling the inclusion criteria underwent intramedullary nailing using the suprapatellar approach. The functional outcomes were measured at 6 months using the Lysholm knee score and the SF-36 physical and mental score. The obtained data was analyzed using SPSSv16.
Result: The average time of fracture union was 17.8 weeks. The mean SF-36 physical and mental score were 42.4 and 44.5 respectively. The average Lysholm score was 84. The mean arc of motion in the involved knee was 110áµ’. Secondary procedure in the form of dynamization was done in 2 cases. Anterior knee pain was observed in 3 patients.
Conclusion: Expert tibial nailing using suprapatellar approach appears to be a suitable fixation method for distal tibial metaphyseal injuries as it provides good functional and clinical outcome at the same time minimizing the violation of delicate soft tissue structures.
