Radiologic outcome and patient-reported function after intramedullary nailing: a comparison of the retropatellar and infrapatellar approach.
OBJECTIVE
The purpose of this study was to compare the patient-reported functional outcomes after intramedullary nailing of the tibia through a retropatellar or infrapatellar approach. Radiographic assessment of nail entry point and accuracy of fracture reduction were included to aid in the identification of variables that may explain any difference in patient-reported outcomes.


METHODS
A retrospective radiographic and questionnaire-based assessment of patient-reported outcomes and complications after tibial nailing for trauma or limb reconstruction through a retropatellar or infrapatellar approach.


METHODS
Regional limb reconstruction unit within a university teaching hospital.


METHODS
Two consecutive series of 38 patients with intramedullary tibial nails inserted through a retropatellar approach, and 36 patients with a tibial nail inserted through an infrapatellar approach.


METHODS
Tibial nail insertion through either a retropatellar or infrapatellar approach.


METHODS
Patient-reported outcomes and complication rates and radiographic assessment of fracture reduction and nail insertion entry point.


RESULTS
No significant difference was seen in Kujala score as a measure of anterior knee pain (P = 0.217), either in the physical (P = 0.372) or mental (0.504) components of the SF-12 between the groups, although there was a trend toward symptomatic intrusive knee pain in the infrapatellar group. A more accurate fracture reduction, both in terms of angulation (P = 0.003) and translation (P = 0.010) in the coronal plane, was seen in the retropatellar group. The entry point for nail insertion was more accurate in both the sagittal (P = 0.011) and coronal (P = 0.014) planes.


CONCLUSIONS
Retropatellar tibial nail insertion is not associated with more anterior knee pain when compared with infrapatellar nail insertion but is associated with more accurate nail insertion and fracture reduction.


METHODS
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
*Bristol Limb Reconstruction Unit, Bristol Royal Infirmary, University Hospitals NHS Foundation Trust, Bristol, United Kingdom; and †Musculoskeletal Research Unit, University Department of Orthopaedic Surgery, Avon Orthopaedic Centre, Southmead Hospital, Bristol, United Kingdom.
Mark
M
Jones
Michael
M
Parry
Michael
M
Whitehouse
Steven
S
Mitchell
D000328:Adult; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010329:Patella / Q000601:surgery; D011859:Radiography; D020127:Recovery of Function; D012189:Retrospective Studies; D057566:Self Report; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult