Does the suprapatellar nailing technique address the issue of malunion in segmental tibial fractures?

Abstract

: Segmental tibia fractures are caused by high-velocity trauma. They are often associated with soft tissue and other systemic injuries leading to higher complications rates. In this study, we aimed to analyse the clinical, functional and radiological outcome including the incidence of malunion in these fracture following suprapatellar nailing. We retrospectively analysed 55 patients from January 2016 to January 2020 who underwent suprapatellar nailing using two different nailing systems at a single tertiary care trauma centre. Periodic follow-ups were done to evaluate the union rates, the functionality of the limb and associated complications like malunion. Average time of union overall was 26 weeks with closed fractures healing at an average of 22 weeks and open fractures healing at an average of 33 weeks. The average functional score using LEFS at the end of one year was 86% with 89% of the patients having good to excellent functional outcome. We had 22 cases of the delayed union out of which only 5 cases required secondary procedures to aid in the union. Malalignment was noted in 1 case. All fractures included in this study eventually healed at the final follow up. Anterior knee pain was reported in 3.6% of the cases.: We recommend suprapatellar nailing in all segmental tibial fractures irrespective of the type of injury as it reduced the rate of malunion and anterior knee pain, without compromising on union rates and functional outcome.