Clinical Faceoff: Suprapatellar Tibial Nailing for Tibia Fractures

摘要

Tibial shaft fractures are common, often arise from high-energy trauma, and may be accompanied by soft-tissue injuries. Static, locked intramedullary nailing is one common approach that works well for many patients with these injuries. The conventional approach to tibial nailing involves an infrapatellar starting point, obtained with the knee in a flexed position, but it can result in anterior knee pain [1, 23, 28]. There have been multiple suggestions as to the etiology, including the position of the nail tip and angle of insertion [12, 15]. In addition, with certain fracture patterns such as proximal tibia fractures, a flexed position of the knee to obtain the starting point was felt to contribute to apex anterior deformity. Although approaches to minimize apex anterior and possible valgus deformities in proximal tibia fractures have been described, including mini-fragment plating, nailing in a semi-extended position, and the judicious use of blocking screws [10, 17, 19, 30, 35], some surgeons felt these techniques alone were not sufficient for easy insertion of intramedullary nails in proximal tibia fractures.