A Comparative Prospective Study Evaluating Functional and Radiological Outcomes of Suprapatellar Versus Infrapatellar Approaches for Intramedullary Nailing in Patients with Distal Tibial Shaft Fractures

Abstract

Background: Distal tibial shaft fractures are common injuries associated with high-energy trauma and functional disability. Intramedullary
nailing is the standard treatment; however, the optimal surgical approach, suprapatellar or infrapatellar, remains debated, particularly in resourcelimited
settings like Bihar, where early mobilization and functional recovery are essential.
Aim: To compare the functional and radiological outcomes of suprapatellar versus infrapatellar approaches for intramedullary nailing in patients
with distal tibial shaft fractures.
Methodology: This prospective comparative study was conducted at a tertiary care center in Patna over one year, including 40 patients with
distal tibial shaft fractures. Patients were equally divided into suprapatellar (n=20) and infrapatellar (n=20) groups. Outcomes assessed included
fracture union time, malalignment, anterior knee pain (VAS), functional outcome using Lysholm knee score, and postoperative complications.
Statistical analysis was performed using SPSS version 20.0, with p < 0.05 considered significant.
Results: The suprapatellar group demonstrated significantly shorter mean time to union (17.2 vs 19.6 weeks, p = 0.02), lower malalignment
rates (10% vs 30%, p = 0.04), and better functional outcomes with higher Lysholm scores (91.6 vs 85.3, p = 0.01). Anterior knee pain was
significantly lower in the suprapatellar group (VAS 1.8 vs 3.6, p = 0.003). Complication rates were lower in the suprapatellar group, with no
significant increase in infection or implant failure.
Conclusion: Suprapatellar intramedullary nailing offers superior radiological alignment, faster fracture union, improved functional recovery,
and reduced anterior knee pain compared to the infrapatellar approach, making it a preferable technique for distal tibial shaft fractures in the
Bihar population.