The outcome comparison of the suprapatellar approach and infrapatellar approach for tibia intramedullary nailing

Objectives This paper aimed to compare the outcome of suprapatellar and infrapatellar approaches for the tibia intramedullary nailing. Methods From February 2010 to August 2013, a total of 162 skeletally mature participants with tibia shaft fractures were identified and divided into suprapatellar approach group (SPAG) and infrapatellar approach group (IPAG) randomly. Fluoroscopy time, length of hospital stay, operative time, blood loss and complications were recorded. Visual analog score (VAS), Lysholm knee score and range of motion (ROM) were reviewed at one, three, six, 12 and 24 months post-operatively. All patients were required to complete short form 36 questionnaire (SF-36) at six, 12 and 24 months postoperatively. Results The follow–ups lasted two years at least. No significant differences were in major complication rate, operation time, blood loss, the ROM of injured extremity and length of hospital stay between SPAG and IPAG. Nevertheless, the fluoroscopy time was significantly lower in SPAG. VAS pain scores were lower in SPAG at six, 12 and 24 months post-operatively. A higher Lysholm knee score was observed in SPAG at six and 24 months post-operatively. Besides, a better overall physical components score was observed in SPAG except at six months post-operatively. Conclusions The suprapatellar approach was superior to infrapatrellar approach for the treatment of tibia shaft fracture. Therefore, we recommend the suprapatellar approach as a preferable approach in tibia intramedullary nailing.