Skip to main content

Intramedullary nailing of tibial shaft fractures in the semi-extended position using a suprapatellar portal technique

International Orthopaedics volume 41, pages 1909–1914 (2017)Cite this article

Abstract

Intramedullary nail fixation remains the standard treatment for displaced tibial shaft fractures. Establishing an appropriate starting point remains a crucial step in the surgical procedure. Tibial nailing using an infrapatellar starting point with the knee flexed over a radiolucent triangle has been established as a widely-used standard technique. Tibial nail insertion with the knee in the semi-extended position was introduced with the goal to counteract post-operative procurvatum deformities that frequently have been reported as a common problem in proximal third tibial shaft fractures. Early reports on tibial nailing in the semi-extended position used a knee arthrotomy in order to establish the proximal tibial starting point. Recent technological advances have provided the surgical community with instrumentation systems that allow for tibial nailing in the semi-extended position using a suprapatellar portal with nail insertion through the patellofemoral joint. Preliminary clinical studies have suggested favorable outcomes that can be achieved with this technique. This article provides a description of the surgical technique and a review of the currently available evidence.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

References

  1. Buehler KC, Green J, Woll TS, Duwelius PJ (1997) A technique for intramedullary nailing of proximal third tibia fractures. J Orthop Trauma 11(3):218–223

    CAS  Article  PubMed  Google Scholar 

  2. McConnell T, Tornetta P III, Tilzey J, Casey D (2001) Tibial portal placement: the radiographic correlate of the anatomic safe zone. J Orthop Trauma 15(3):207–209

    CAS  Article  PubMed  Google Scholar 

  3. Tornetta P III, Riina J, Geller J, Purban W (1999) Intraarticular anatomic risks of tibial nailing. J Orthop Trauma 13(4):247–251

    Article  PubMed  Google Scholar 

  4. Hiesterman TG, Shafiq BX, Cole PA (2011) Intramedullary nailing of extra-articular proximal tibia fractures. J Am Acad Orthop Surg 19(11):690–700

    Article  PubMed  Google Scholar 

  5. Tornetta P III, Collins E (1996) Semiextended position of intramedullary nailing of the proximal tibia. Clin Orthop Relat Res 328:185–189

    Article  Google Scholar 

  6. Chan DS, Serrano-Riera R, Griffing R, Steverson B, Infante A, Watson D, Sagi HC, Sanders RW (2016) Suprapatellar versus infrapatellar tibial nail insertion: a prospective randomized control pilot study. J Orthop Trauma 30(3):130–134. doi:10.1097/BOT.0000000000000499

    Article  PubMed  Google Scholar 

  7. Gelbke MK, Coombs D, Powell S, DiPasquale TG (2010) Suprapatellar versus infra-patellar intramedullary nail insertion of the tibia: a cadaveric model for comparison of patellofemoral contact pressures and forces. J Orthop Trauma 24(11):665–671. doi:10.1097/BOT.0b013e3181f6c001

    Article  PubMed  Google Scholar 

  8. Jones M, Parry M, Whitehouse M, Mitchell S (2014) Radiologic outcome and patient-reported function after intramedullary nailing: a comparison of the retropatellar and infrapatellar approach. J Orthop Trauma 28(5):256–262. doi:10.1097/BOT.0000000000000070

    Article  PubMed  Google Scholar 

  9. Sanders RW, DiPasquale TG, Jordan CJ, Arrington JA, Sagi HC (2014) Semiextended intramedullary nailing of the tibia using a suprapatellar approach: radiographic results and clinical outcomes at a minimum of 12 months follow-up. J Orthop Trauma 28(5):245–255. doi:10.1097/BOT.0000000000000082

    Article  PubMed  Google Scholar 

  10. Court-Brown CM, Gustilo T, Shaw AD (1997) Knee pain after intramedullary tibial nailing: its incidence, etiology, and outcome. J Orthop Trauma 11(2):103–105

    CAS  Article  PubMed  Google Scholar 

  11. Hernigou P, Cohen D (2000) Proximal entry for intramedullary nailing of the tibia: the risk of unrecognised articular damage. J Bone Joint Surg (Br) 82(1):33–41

    CAS  Article  Google Scholar 

  12. Katsoulis E, Court-Brown C, Giannoudis PV (2006) Incidence and aetiology of anterior knee pain after intramedullary nailing of the femur and tibia. J Bone Joint Surg (Br) 88(5):576–580

    CAS  Article  Google Scholar 

  13. Keating JF, Orfaly R, O’Brien PJ (1997) Knee pain after tibial nailing. J Orthop Trauma 11(1):10–13

    CAS  Article  PubMed  Google Scholar 

  14. Koval KJ, Clapper MF, Brumback RJ, Ellison PS Jr, Poka A, Bathon GH, Burgess AR (1991) Complications of reamed intramedullary nailing of the tibia. J Orthop Trauma 5(2):184–189

    CAS  Article  PubMed  Google Scholar 

  15. Lefaivre KA, Guy P, Chan H, Blachut PA (2008) Long-term follow-up of tibial shaft fractures treated with intramedullary nailing. J Orthop Trauma 22(8):525–529. doi:10.1097/BOT.0b013e318180e646

    Article  PubMed  Google Scholar 

  16. Devitt AT, Coughlan KA, Ward T et al (1998) Patellofemoral contact forces and pressures during intramedullary tibial nailing. Int Orthop 22(2):92–96

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  17. Mochida H, Kikuchi S (1995) Injury to infrapatellar branch of saphenous nerve in arthroscopic knee surgery. Clin Orthop Relat Res 320:88–94

    Google Scholar 

  18. Nyland J, Bealle DP, Kaufer H, Johnson DL (2001) Long-term quadriceps femoris functional deficits following intramedullary nailing of isolated tibial fractures. Int Orthop 24(6):342–346

    CAS  Article  PubMed  Google Scholar 

  19. Zelle BA, Boni G, Hak DJ, Stahel PF (2015) Advances in intramedullary nailing: suprapatellar nailing of tibial shaft fractures in the semiextended position. Orthopedics 38(12):751–755. doi:10.3928/01477447-20151119-06

    Article  PubMed  Google Scholar 

Download references

Author information

Affiliations

  1. Department of Orthopaedic Surgery, Division of Orthopaedic Traumatology, UT Health Science Center at San Antonio, 7703 Floyd Curl Dr, MC-7774, San Antonio, TX, 78229, USA

    Boris A. Zelle

Authors
  1. Boris A. Zelle
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Boris A. Zelle.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Funding

There is no funding source.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Zelle, B.A. Intramedullary nailing of tibial shaft fractures in the semi-extended position using a suprapatellar portal technique. International Orthopaedics (SICOT) 41, 1909–1914 (2017). https://doi.org/10.1007/s00264-017-3457-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-017-3457-7

Keywords

  • Tibia
  • Diaphysis
  • Fracture
  • Nail