Abstract

Intramedullary pinpoint of the tibia with suprapatellar entrance and semi-extended placement makes it technically easier to nail the proximal and distal fractures. The determination of this article was to describe a childlike method acting for suprapatellar collar ( SPN ). A bit-by-bit run through of the surgical proficiency is described, including placement of the affected role. There are as so far only a few clinical studies that illustrate the complications with this method acting, and there has been no increased frequency of intraarticular wrong. Within the soundbox of the manuscript, data is included about intraarticular damage and comments with references about anterior knee pain. Key Words:

tibia fracture, suprapatellar nail, surgical technique

INTRODUCTION

today, intramedullary smash seems to be the gold standard for the treatment of diaphyseal tibial fractures. Nailing ensures full fracture constancy, safeguards against malalignments, and allows quick mobilization. An infrapatellar and patellar tendon splitting entrance to the tibia with the knee articulation flexed 90 degrees seems to be the prefer entrance for tibial pinpoint. If the indications for pinpoint of proximal and distal tibial fractures are extended, this is a challenge for surgical techniques. With proximal fractures, there is a leaning for front tooth malalignment of the proximal shard from perpetrate of the patellar tendon, and this attract is increased far when the stifle is flexed during nailing. 1 With nail in a conventional manner, there is a risk of poor reposition, suboptimal ream, and a hapless placement of the nail. Tornetta and Collins 1 ( 1996 ) reported 25 patients in whom a partial median parapatellar arthrotomy was performed with the stifle in a semi-extended position ( 15-degree bend of the knee joint ), with two-thirds of the the retinaculum split. When the patella was subluxed laterally, the trochlear groove was used as a bed for the instruments and nail. The argumentation for this introduction was that when the knee joint is maximally bent to 15 degrees, the pull of the patellar tendon on the proximal fragment is eliminated, and frankincense the fracture can be easily repositioned and fixed. Morandi et aluminum. 2 described a transdermal lateral suprapatellar approach through a 1.5-cm cross peel incision at the superolateral corner of the patella. Jakma et aluminum. 3 used a 1-2 curium incision equitable above the patella and in telephone line with the tibial cock. They used unreamed nails, and arthroscopy before and after the breeze through revealed damage to the patellofemoral cartilage. A cadaver study has shown injuries to median meniscus and intermeniscal ligament with a suprapatellar entrance. 4 Despite the challenges with different accesses and the risk of intraarticular damage, tibial nail with the knee semi-extended through a suprapatellar submission appears to have become more far-flung, and new instruments developed by different manufacturers have made the proficiency dim-witted and more secure. At our institution, we have used the proficiency for 4 year with unlike systems. In the begin, we used it for selected proximal fractures and later for distal tibial fractures and immediately besides beam fractures. The technique besides has been found to be useful in patients with multiple fractures, such as ipsilateral femoral fault and tibial-femoral fault on the opposite leg, because all fractures can be operated without the necessitate for manual grip or rearrangement. Although the suprapatellar entry has become more far-flung during the by years, and the manufacturers have refined the equipment, many orthopaedists do not have personal experience with this access. The purpose of this article is to present a simple proficiency for suprapatellar breeze through ( SPN ) of tibial fractures providing bit-by-bit education supplemented with relevant illustrations .

DISCUSSION

With SPN, it has become simpler to perform complete of proximal tibial fractures. The indications for this technique are far more extensive, and it can besides be used well for cock fractures and distal metaphyseal fractures. The method acting has significant advantages but besides has electric potential risks that should be assessed.

The main advantages are the simpleton put of the affected role and the hurt leg, which simplifies reduction of the fracture and the retentiveness of this during nailing. When the leg is positioned stretched on the table, it besides is easier to install blocking screws and stead the C-arm when the distal screws are to be inserted, with no need for rearrangement. From experience in this method acting of complete, the indulgent weave is exposed to far less intraoperative injury compared with traditional position, and it is possible that the risk of compartment syndrome is thereby reduced. far advantages of the method are reduced need for an assistant and a short engage clock time. Concerns over the use of SPN include entry through a healthy knee roast and the gamble of inflicting damage to the knee joint and, at worst, causing an infection in the joint. Despite this, today many retrograde femoral nailings and arthroscopies of the knee joint are performed without the lapp concerns. Jakma et aluminum. 3 operated on seven patients with SPN, four of whom had arthroscopy performed before or after nailing. In cattiness of the fact that unreamed nails were inserted and only the thinnest reamers were used to open proximally all showed signs of cartilage price. 3 In Tornetta and Collins ’ 1 original series of 25 patients, one patient developed postoperative hemarthrosis, and two patients had minor cartilage abrasion. 1 Later Ryan and Tornetta 6 modified the method by nailing with the stifle joint in 20-30 degrees flexion, changing the surgical entry to a smaller incision of 3-5 curium from the middle to the upper part of the patella, and performing the median arthrotomy covering entirely the upper berth function of the retinaculum and 1-2 curium into the quadriceps tendon. 6 respective manufacturers have now developed equipment for SPN in which security sleeves protect against intraarticular price. Sanders et aluminum. 7 operated on 55 patients with T2 ( Stryker, Kalamazoo, MI ) and Trigen ( Smith and Nephew, Memphis, TN ) nails with the suprapatellar overture. In 13 of 15 patients, arthroscopy was performed before and after nailing, and no cartilage changes were seen. One class after surgery, 33 patients had MRI performed with deference to cartilage price, one had grade II patellofemoral changes and one had grade III changes, but there was no correlation coefficient between the arthroscopic changes, MRI scans, or the clinical examination. In cadaver studies that examined the risk of intraarticular wrong by the traditional infrapatellar entry, injury to the medial meniscus and the intermeniscal ligament has chiefly been reported, but with less wrong to the lateral pass meniscus and the footprint of the anterior cruciate ligament ( ACL ). 5 Cadaver studies examining the injuries after nailing through a suprapatellar approach path have shown alike injuries to the intermeniscal ligament and medial meniscus, but no violations were observed to the articular come on, lateral meniscus, or ACL, although Beltran et alabama. 4 reported that the nail insertion in six out of 15 patients were in conclusion proximity to the ACL interpolation. Gaines et al., 8 in a cadaver study, compared the suprapatellar approach with the standard median parapatellar entry and demonstrated a smaller rate of intraarticular injuries when using the suprapatellar set about. The hazard of injury to anterior knee structures seems to be reduced by using an entry target within the safe zone, where the center is located 9 mm±5 millimeter lateral to midline of the tibial tableland and 3 millimeter lateral to the kernel of the tibial tubercle, as described by Tornetta et alabama. 5 A major side effect of tibial breeze through is front tooth knee pain, with a mean incidence of 47 % after 2 year. 9 The reasons for knee trouble remain unknown, but it is fair to assume that surgical introduction by nailing may be of importance. A retrospective study comparing SPN with standard nailing found no differences in the flush pain. 6 In a report of 37 patients operated with SPN there were no patients with anterior stifle pain at 1-year follow-up. 7 Rothberg et alabama. 10 compared 18 patients with semi-extended tibial complete with a master group of uninjured patients, and at 1 year there was no increase incidence of anterior stifle pain in the fracture group. Suprapatellar nail down of tibial fractures is a simple method acting with many advantages over traditional tibial breeze through. The method is even new and not yet widely used. There is room for development of the method and improvement of instruments, frankincense increasing condom and indications.

CONCLUSION

This article describes an operation method acting, and in addition to the benefits, potential risks with the method are shown. The method appears to be condom with no greater rate of complications compared with the traditional method, but clearly promote studies with longer follow-up are necessary and in detail randomized studies comparing it with the previous aureate standard discussion .

Footnotes

fiscal Disclosures : The writer reports no disclosures and no conflicts of interest .

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