Rotational alignment in tibial diaphyseal fractures with the suprapatellar semi –extended versus standard infrapatellar entry tibial nailing techniques – a randomized controlled trial

Abstract

INTRODUCTION: Fractures of tibia diaphysis are the most common fractures of long bone. As most of the surgeons noted and many studies showing that the reamed intramedullary interlocking nail fixation done for displaced and unstable fractures provided better functional results and lesser complications than compared with conservative management with cast immobilization, open reduction and internal fixation with plating, unreamed intramedullary nailing or use of external fixators. A potentially debilitating and serious but usually under-appreciated complication of intramedullary nailing for tibia fractures is rotational malalignment. As of now there is very less known about what is the true incidence of malrotation after IMIL nail fixation, what degree of rotation that is actually significant or what are the indications of correcting the malalignment. The anatomical twist of tibial Proximal versus Distal articulate axis in transverse plane around longitudinal axis is known as tibial torsion. Following the closed intramedullary nailing of tibial shaft fractures, any alteration in the tibial torsion, whether internal or external, is referred to as a malrotation. To evaluate tibial malrotation, one compares the torsion of the affected and unaffected tibia. Concerns have recently been expressed over the high frequency of malrotation that has been documented after tibial intramedullary nailing. The traditional infrapatellar intramedullary nailing technique is done by placing the knee in hyperflexion over a radiolucent bump and passing the nail through a longitudinal incision made over and parallel patellar tendon fibres. Segmental fractures and proximal one third tibial fractures frequently fall into valgus and procu rvatum due to deforming muscle stresses. The novel semi-extended suprapatellar tibial nailing technique will make it easier to access the beginning site location, xvii counter the deforming muscle forces, and also allows easier intraoperative imaging. The results of suprapatellar nailing are scarcely reported in the literature, despite the well-established results of typical infrapatellar nailing. OBJECTIVE : to determine the incidence and degree of tibial rotational malalignment with the suprapatellar semi-extended versus standard infrapatellar entry tibial nailing techniques.