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Outcomes and their predictors in suprapatellar nailing for tibia fractures. Multivariable analysis of 293 consecutive cases

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Abstract

Purpose

Intramedullary nailing of tibial fractures is one of the most common procedures in orthopedic surgery. It can be technically demanding in proximal or distal fractures, which may be facilitated using semi-extended approaches. The aim of this study is to identify outcomes and their predictors using a semi-extended suprapatellar approach for tibial fracture nailing.

Methods

This is a retrospective cohort of 293 patients who underwent intramedullary nail fixation of a tibial fracture through a suprapatellar approach, considering a postoperative follow-up of 1 year. Data on patient’s baseline characteristics, injuries, treatments, and outcomes regarding alignment, fracture union, and complications were recorded. For multivariable analysis, hierarchical binary (logistic) regression analysis was performed.

Results

The mean patient age was 47.7 years (SD 18.9), with 42A1 the most frequent fracture pattern (n = 98, 33.5%). Correct or anatomical alignment (≤ 5º in both planes) was achieved in 272 (92.8%) of the patients. On multivariate analysis, surgical delay ≥ 7 days (OR = 1.3, 95% CI = 1.3–8.1) and age over 50 years (OR = 3.2, 95% CI = 1.2–8.3) were found as predictors of fracture malalignment. Fracture healing was achieved in 97.6%, and reoperation rate was 6.14%. Overall complication’s predictors were proximal fracture (OR = 2.8, 95% CI = 1.1–7.2), temporary external fixation (OR = 2.4, 95% CI = 1.2–4.9), and fracture malalignment (OR = 2.9, 95% CI = 1.1–7.9).

Conclusion

The suprapatellar approach is a safe and useful technique for treating tibial fractures, leading to no less than correct reduction in almost all patients and achieving a high fracture healing rate, at very low rates of complications. Pre- and postoperative predictors identified must be taken into account to improve outcomes while treating these fractures.

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Data Availability

The data that support the findings of this study are available from the corresponding author, JVAP, upon reasonable request.

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Funding

This study was funded by Smith & Nephew.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d’Hebron, Barcelona, Spain

    Jordi Teixidor-Serra, José Vicente Andrés-Peiró, Jordi Selga-Marsa, Carla Carbonell-Rosell, Enrique García-Albó & Jordi Tomás-Hernández

  2. Department of Orthopaedic Surgery and Traumatology, Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain

    Jordi Teixidor-Serra, José Vicente Andrés-Peiró, Yaiza García-Sanchez, Jordi Selga-Marsa, Carla Carbonell-Rosell & Jordi Tomás-Hernández

  3. Department of Orthopaedic Surgery and Traumatology, Hospital Municipal de Badalona, Badalona, Spain

    María Cristina Garcia-Martínez

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Contributions

Material preparation, data collection, and analysis were performed by JVAP, YGS, MCGM, CCR, and EGA. The first draft of the manuscript was written by JTS, JVAP, and YGS, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to José Vicente Andrés-Peiró.

Ethics declarations

Ethical approval

This study was approved by our institutional review board (reference number (PR(ATR)100/2019).

Consent to participate and for publication

This is a retrospective study. Its realization did not imply any risk for the participants, and all the collected data were de-identified. Therefore, IRB approved a full waiver of informed consent.

Competing interests

The authors have financial conflicts of interest to declare with Smith & Nephew, Zimmer-Biomet, Link Orthopaedics, Stryker, and MBA Surgical Empowerment.

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Teixidor-Serra, J., Andrés-Peiró, J.V., García-Sanchez, Y. et al. Outcomes and their predictors in suprapatellar nailing for tibia fractures. Multivariable analysis of 293 consecutive cases. Eur J Trauma Emerg Surg (2024). https://doi.org/10.1007/s00068-024-02476-0

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