Intramedullary nailing for distal tibial fracture through Suprapatellar Approach: A Prospective Study.

Abstract

Background: Management of distal tibial is always a challenging task for orthopedic traumatologists with a conflicting study on treatment of choice. The suprapatellar approach for intramedullary nailing is one of the effective methods for the treatment of distal tibia fracture.

Aim: Treatment of both extra-articular and intraarticular fracture of the distal tibia with intramedullary nailing is discussed. The efficacy of the suprapatellar approach is analyzed and shared. Method: A prospective study about the functional outcome of intramedullary nailing through the supra patellar approach was carried out at Jawaharlal Institute of Medical Sciences (JNIMS) from March 2021 to March 2023 among 26 patients who satisfied the inclusion criteria. The Declaration of Helsinki was strictly followed. Result: Age range of the patients was 20-55 years. The most common cause of the fracture is road traffic accidents. Fibular plating was done for 4 patients with associated fibular fractures with associated syndesmotic injury. Partial Proximal fibulectomy was done for the remaining patients with no associated fibular fracture. The average time of healing was 25.8 weeks (Range 24-29 weeks). Partial weight bearing started around 6 weeks. Functional outcome was assessed using Johner and Ruh criteria with 22 patients (84.6 %) showing excellent results, 3 patients (7.7 %) being good and 1 patient (3.85%) showing poor results. Conclusion: Osteosynthesis with an intramedullary interlocking nail through a suprapatellar approach with combined fistulectomy for intact fibula and fibular plating for associated distal fibular fracture for syndesmotic injury is effective for distal tibia fracture with satisfactory results.