title: Suprapatellar Intramedullary Nail Technique Lowers Rate of Malalignment of Distal Tibia Fractures.
abstract: OBJECTIVE
  To report on the immediate postoperative alignment of distal tibia fractures (within 5 cm of the tibial plafond) treated with suprapatellar intramedullary nail (IMN) insertion compared with the infrapatellar technique. Primary outcomes include alignment on both the anteroposterior and lateral radiographic views.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Two urban level I trauma centers.
  
  
  METHODS
  A total of 266 skeletally mature patients with a distal tibia fracture were treated with an IMN. One hundred thirty-two patients underwent this procedure through a suprapatellar technique.
  
  
  METHODS
  Intramedullary nail placement.
  
  
  METHODS
  Alignment.
  
  
  RESULTS
  The 2 treatment groups were evenly matched with respect to age, gender, fracture grade, and the presence of open fracture. Within the suprapatellar group, the fibula was intact, fixed, and remained fractured in 6 (4.5%), 22 (16.7%), and 104 (78.8%) cases, respectively. The fibula was intact, repaired, and remained fractured in 9 (6.7%), 32 (23.9%), and 93 (69.4%) cases, respectively, in the infrapatellar group. There was no difference in the rate of fibular fixation between the groups (P = 0.2). Primary angular malalignment of ≥5 degrees occurred in 35 (26.1%) patients with infrapatellar IMN insertion and in 5 (3.8%) patients who underwent suprapatellar IMN insertion (P < 0.0001).
  
  
  CONCLUSIONS
  This is the largest patient series directly comparing the suprapatellar with infrapatellar IMN insertion technique in the treatment of distal tibia fractures. In the treatment of distal tibia fractures, suprapatellar IMN technique results in a significantly lower rate of malalignment compared with the infrapatellar IMN technique.
  
  
  METHODS
  Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: *Department of Orthopaedic Surgery, Division of Orthopaedic Trauma, University of Cincinnati, Cincinnati, OH; †University Orthopaedic Surgeons, University of Tennessee Medical Center, Knoxville, TN; ‡Department of Orthopaedics and Rehabilitation, University of Wisconsin Hospital and Clinics, Madison, WI; §University of Tennessee, Campbell Clinic, Memphis, TN; and ‖University of South Florida, Tampa, FL.
authors.forename: Frank R
authors.initials: FR
authors.lastname: Avilucea
authors.forename: Kostas
authors.initials: K
authors.lastname: Triantafillou
authors.forename: Paul S
authors.initials: PS
authors.lastname: Whiting
authors.forename: Edward A
authors.initials: EA
authors.lastname: Perez
authors.forename: Hassan R
authors.initials: HR
authors.lastname: Mir
mesh_terms: D000328:Adult; D017760:Bone Malalignment / Q000209:etiology / Q000517:prevention & control*; D001858:Bone Nails; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D010329:Patella / Q000601:surgery; D012189:Retrospective Studies; D013978:Tibial Fractures / Q000601:surgery*; D014193:Trauma Centers; D014505:Urban Population