Malasani Surya, Jha Gaurav, Ganesh Sai
Orthopedics and Traumatology, University Hospitals of Leicester, Leicester, GBR.
Trauma and Orthopedics, Leicester Royal Infirmary, Leicester, GBR.
Cureus. 2024 Nov 30;16(11):e74862. doi: 10.7759/cureus.74862. eCollection 2024 Nov.
Tibial shaft fractures are among the most common long bone injuries and often can be challenging to manage surgically. While infrapatellar (IP) intramedullary nailing (IMN) has been a widely accepted treatment, its limitations have led to the emergence of alternative approaches, such as suprapatellar nailing (SPN) in a semi-extended knee position.
To evaluate the clinical, radiological, and functional outcomes of tibial shaft fractures treated with an SPN approach in a semi-extended knee position.
A prospective study was conducted at Saveetha Medical College, including 20 patients diagnosed with tibial shaft fractures between August 2021 and December 2022. All patients underwent IMN using a suprapatellar approach after being assessed for surgical fitness and providing informed consent. Clinical and radiological follow-ups were performed over a 12-month period to evaluate knee range of motion, fracture healing, implant positioning, and knee pain, using the Lower Extremity Functional Scale (LEFS) and Visual Analog Scale (VAS).
The study cohort consisted of 20 patients, with a male-to-female ratio of 3:1. The majority (70%) were aged between 20 and 40 years. Fractures affected the left tibia in 11 cases and the right in nine cases. Among the fractures, 12 were closed and eight were open, classified according to the Gustilo-Anderson classification as ranging from Grade 1 to Grade 3. The mean surgery duration was 83.5 minutes, with an average blood loss of less than 100 mL. The mean time to fracture union was 12 weeks, and the mean LEFS score recorded was 75.75. Three patients experienced complications, which were managed successfully. Overall, patients demonstrated favorable clinical, radiological, and functional outcomes with minimal knee pain post-surgery.
Suprapatellar IMN in the semi-extended position is a viable and effective surgical approach for managing tibial shaft fractures, providing good clinical, radiological, and functional outcomes with minimal complications.
胫骨干骨折是最常见的长骨损伤之一，手术治疗往往具有挑战性。虽然髌下（IP）髓内钉固定术（IMN）一直是一种广泛接受的治疗方法，但其局限性导致了替代方法的出现，如在半伸直膝关节位置进行髌上髓内钉固定术（SPN）。
评估在半伸直膝关节位置采用SPN方法治疗胫骨干骨折的临床、放射学和功能结果。
在Saveetha医学院进行了一项前瞻性研究，纳入了2021年8月至2022年12月期间诊断为胫骨干骨折的20例患者。所有患者在评估手术适应性并获得知情同意后，采用髌上入路进行IMN。在12个月期间进行临床和放射学随访，使用下肢功能量表（LEFS）和视觉模拟量表（VAS）评估膝关节活动范围、骨折愈合情况、植入物位置和膝关节疼痛。
研究队列包括20例患者，男女比例为3∶1。大多数（70%）年龄在20至40岁之间。骨折累及左侧胫骨11例，右侧9例。在骨折中，12例为闭合性骨折，8例为开放性骨折，根据Gustilo-Anderson分类法分为1级至3级。平均手术时间为83.5分钟，平均失血量少于100 mL。骨折愈合的平均时间为12周，记录的平均LEFS评分为75.75。3例患者出现并发症，均成功处理。总体而言，患者术后膝关节疼痛轻微，临床、放射学和功能结果良好。
半伸直位髌上髓内钉固定术是治疗胫骨干骨折的一种可行且有效的手术方法，可提供良好的临床、放射学和功能结果，并发症最少。
