A Retrospective Study With 2-Year Follow-up Comparing Semi-Extended Tibia Nailing Techniques: The Suprapatellar Versus the Extra-Articular Lateral Parapatellar Approach

Background: The quest for optimal approaches to treating tibial shaft fractures in orthopedic surgery remains a topic of debate. Purpose: We sought to compare the patellofemoral and radiological outcomes of 2 surgical techniques for treating tibial shaft fractures: the suprapatellar and extra-articular lateral parapatellar (ELP) approaches, both used in intramedullary tibial nailing in a semi-extended position. Methodology: This retrospective analysis examined 73 adult patients treated for tibial shaft fracture from January 2018 to December 2023, divided into 2 groups: 42 in the suprapatellar group and 31 in the ELP group. Evaluation metrics included radiographic outcomes, clinical results, and complication rates, focusing on anterior knee pain (measured by visual analog scale) and knee function (Kujala and Lysholm scores). Results: No significant differences were found in union rate, nail apex distance, reoperation rate, or malalignment between the 2 approaches. However, the ELP approach was associated with significantly better clinical outcomes, with higher Lysholm scores and reduced anterior knee pain. Additionally, the suprapatellar approach (SP) was associated with a higher incidence of painful hemarthrosis during hospitalization. Conclusion: While this retrospective comparison found both techniques to be effective in treating tibial shaft fractures, the ELP approach was associated with superior functional outcomes as assessed by higher Lysholm scores and Kujala scores, less anterior knee pain, and a lower risk of painful hemarthrosis compared to the SP approach. Further study is warranted.