ASSESSMENT OF FUNCTIONAL AND RADIOLOGICAL OUTCOMES OF SUPRAPATELLAR AND INFRAPATELLAR APPROACHES OF TIBIAL NAILING IN PATIENTS WITH TIBIA SHAFT FRACTURE: A RANDOMIZED CONTROLLED TRIAL

Tibia shaft fractures are due to the high-end energytrauma and more common long bone to get fractured, approximately 2% of allfractures in adult. Presently reamed Intramedullary nailing of the tibia withadditional interlocking screws for the axial and rotational stability is preferredfor unstable tibia shaft fracture.

Traditionally,an infrapatellar port between the articular surface of the knee and tibialtubercle, lateral to tibial tubercle is practiced. Thisapproach requires cutting or splitting of the patellar tendon and sometimesthere is transection of theinfrapatellar nerve, a branch of the saphenous nerve during the procedure. Thisiatrogenic damage leads to anterior knee pain in few patients (10 to 80%). Also,due to the quadriceps extensor complex pull, the conical shape of tibialmetaphysis, and hyperflexion positioning intraoperatively, any angulated entry to the tibia during nailing leads tomalalignment and difficulty to maintain reduction for imaging.To overcomethese challenges, a novel entry port in a semi-extended kneeat a flexion of 15-20 degrees was proposed. This new Suprapatellar approach of tibial IntramedullaryInterlocking Nailing (IMILN) allows easy reduction, lesser fluoroscopy time,decreased malalignment, and reduces the anterior knee pain with equivalentfunctional outcome.

There are a few studies thatshow the superiority of Suprapatellar Approach (SPA) vs Infrapatellar Approach (IPA).These are majorly western literature and extensive research on the Indianpopulation is lacking. Hence a study to further declutter in the Indian setupis required.