Functional and Radiological Outcome of Proximal Tibia Fracture Treated with Suprapatellar Nailing

Abstract

Background:
Proximal third tibial fractures, often resulting from high-energy trauma, present a challenge due to the difficulty in achieving optimal alignment and maintaining fixation. Traditional intramedullary nailing via the infrapatellar route is associated with complications such as anterior knee pain and malalignment. The suprapatellar (SP) approach, performed with the knee in a semi-extended position, has gained popularity due to improved reduction and ease of instrumentation.
Objective:
To evaluate the functional and radiological outcomes of proximal third tibia fractures treated with suprapatellar intramedullary interlocking (IMIL) nailing.
Materials and Methods:
A prospective interventional study was conducted on 15 skeletally mature patients (aged 18–65 years) with extra-articular proximal third tibia fractures. Patients underwent suprapatellar IMIL nailing and were followed up at 2 weeks, 6 weeks, and 24 weeks. Functional outcome was assessed using the Lower Extremity Functional Scale (LEFS), and radiological union was monitored through serial radiographs.
Results:
The mean age was 34.6 years, with 60% being male. Left-sided fractures were more common (60%). The average time to union was 14 weeks. Functional outcomes were excellent in 54%, good in 33%, and fair in 13% of patients. Only 2 patients (13%) experienced delayed union; no cases of infection or significant malalignment were reported. The suprapatellar approach was associated with minimal anterior knee pain and satisfactory alignment.
Conclusion:
Suprapatellar IMIL nailing for proximal third tibial fractures provides a favorable alternative to conventional approaches. It offers improved alignment, fewer complications, and excellent early functional outcomes. This approach is particularly beneficial in proximal fractures where anatomical reduction is difficult with traditional infrapatellar techniques.