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CLOSED INTRAMEDULLARY NAILING TREATED TIBIAL SHAFT FRACTURE USING LATERAL PARAPATELLAR TENDON APPROACH
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Abstract
Objective: To describe technique of closed intramedullary nailing via lateral parapatellar tendon approach in treating tibial shaft fractures at Viet Tiep Hospital and compare its efficacy versus infrapatellar approach. Subjects and methods: A retrospective analysis was conducted on the clinical data of 45 patients with tibial shaft fractures treated with closed intramedullary interlocking nailing via lateral parapatellar tendon approach (n = 23) or infrapatellar approach (n = 22) between January 2023 and January 2024. We recorded and compared the operative time, intraoperative fluoroscopies, success rate of closed reduction, anteroposterior and lateral entry point accuracy, postoperative infection, fracture healing time, as well as NRS (Numeric Rating Scale) pain scores, Lysholm knee function scores, and knee range of motion. Results: Both groups completed the surgery without any complications. The lateral parapatellar tendon approach group had significantly better results regarding shorter operative time and fewer intraoperative fluoroscopies compared to the infrapatellar approach group (P < 0.05). All cases in the lateral parapatellar tendon approach group achieved closed reduction, while 5 cases in the infrapatellar approach group required open reduction. Fractures in both groups healed successfully, without statistically difference in healing time (P > 0.05). The accuracy of anteroposterior and lateral entry points was better with lateral parapatellar tendon approach (P < 0.05). At 3 and 12 months postoperatively, lateral parapatellar tendon approach showed better Lysholm and NRS scores compared to infrapatellar approach (P < 0.05). Two groups had no significant difference in range of motion (P > 0.05). Conclusion: Using lateral parapatellar tendon approach in closed intramedullary nailing of tibial shaft fractures provides favorable results, and semi-extended position is especially suitable for proximal shaft fractures or complex multisegment fractures.
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Keywords
tibial shaft fracture, closed intramedullary interlocking nailing, lateral parapatellar tendon approach, semi-extended position
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