title: ANATOMICAL STUDY ON THE LATERAL SUPRAPATELLAR ACCESS ROUTE FOR LOCKED INTRAMEDULLARY NAILS IN TIBIAL FRACTURES.
abstract: OBJECTIVE
  Intramedullary nails are the gold standard for treating tibial shaft fractures. Knee pain is a frequent complication after the procedure. Alternative routes such as the suprapatellar approach for nail insertion are seen as an option for avoiding late postoperative knee pain. The question is whether this approach might give rise to any injury to intra-articular structures of the knee.
  
  
  METHODS
  This study analyzed the suprapatellar approach and the risk to adjacent structures by reproducing it in 10 knees of five cadavers.
  
  
  RESULTS
  This approach was seen to make it easy to locate the entry point, with lesions only occurring in the Hoffa fat. In three of our cases, there were lesions of the chondral surface, which is an obstacle that is difficult to overcome.
  
  
  CONCLUSIONS
  There is a need to develop specific material to minimize injury to intra-articular structures when using this route.
authors.affiliation: Resident in Orthopedics and Traumatology, Institute of Orthopedics and Traumatology, HC-FMUSP, São Paulo, SP, Brazil.
authors.forename: Italo Scanavini
authors.initials: IS
authors.lastname: Cerqueira
authors.affiliation: Resident in Orthopedics and Traumatology, Institute of Orthopedics and Traumatology, HC-FMUSP, São Paulo, SP, Brazil.
authors.forename: Pedro Araujo
authors.initials: PA
authors.lastname: Petersen
authors.affiliation: Associate Professor in the School of Medicine, University of São Paulo, and Head of the Hand and Microsurgery Group, Institute of Orthopedics and Traumatology, HC-FMUSP, São Paulo, SP, Brazil.
authors.forename: Rames Mattar
authors.initials: RM
authors.lastname: Júnior
authors.affiliation: Attending Physician and Head of the Traumatology Group, Institute of Orthopedics and Traumatology, HC-FMUSP, São Paulo, SP, Brazil.
authors.forename: Jorge Dos Santos
authors.initials: Jdos S
authors.lastname: Silva
authors.affiliation: Attending Physician in the Traumatology and Reconstruction Group, Institute of Orthopedics and Traumatology, HC-FMUSP, São Paulo, SP, Brazil.
authors.forename: Paulo
authors.initials: P
authors.lastname: Reis
authors.affiliation: Attending Physician in the Traumatology and Reconstruction Group, Institute of Orthopedics and Traumatology, HC-FMUSP, São Paulo, SP, Brazil.
authors.forename: Guilherme Pelosini
authors.initials: GP
authors.lastname: Gaiarsa
authors.affiliation: Head of the Trauma Service, Henry Ford Hospital, Detroit, USA.
authors.forename: Massimo
authors.initials: M
authors.lastname: Morandi
keywords: Fracture Fixation, Intramedullary; Orthopedic Procedures; Tibial Fractures