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German Congress of Orthopaedics and Traumatology (DKOU 2022)

25. - 28.10.2022, Berlin

Comparative Analysis of Knee Pain in Transpatellar and Medial Parapatellar Tendon Approaches for Tibial Interlocking Nailing

Meeting Abstract

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  • presenting/speaker Rajiv Maharjan - BP Koirala Institute of Health Sciences, Dharan, Nepal
  • Rabindra Adhikari - BP Koirala Institute of Health Sciences, Dharan, Nepal

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2022). Berlin, 25.-28.10.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocAB31-1095

doi: 10.3205/22dkou190, urn:nbn:de:0183-22dkou1906

Published: October 25, 2022

© 2022 Maharjan et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objectives: The tibia is the most commonly fractured long bone and most likely bone to sustain an open fracture. Intramedullary interlocking nailing is the gold standard and most established treatment for tibial shaft fracture. Transpatellar tendon or medial parapatellar tendon approaches are commonly used where anterior knee pain, though multifactorial, is the peculiar complication associated with nail entry portal. We studied prospectively to determine the overall incidence as well as any significance difference (if any) in the anterior knee pain between these two approaches provided other factors remained same.

Methods: Adults of 16 years or over with traumatic, closed and Gustilo grade I extra-articular tibial shaft fractures (42A, 2B and 2C) were included. After clinico-radiological evaluation, they were randomized into transpatellar (n=20) and medial parapatellar tendon approach (n=20) for intramedullary nailing. Similar prophylactic antibiotics and same physiotherapy regime was prescribed for all patients. They were followed at 2, 6, 12, 24 and 52 weeks for clinico-radiological assessment of union and functional outcome assessment.

Results and conclusion: The age distribution (p=0.25), gender distribution (p=0.41), mode of injury (p=0.75), fracture type (p=0.45), level of fracture (p=0.73) and associated fibula fracture (p=0.99) was not significantly different between the groups showing no selection bias. Mean age (years) and mean hospital stay (days) were 39.20±17.59 and 4.60±2.16 respectively for transpatellar group and 32.0±14.5 and 4.45±1.98 for parapatellar group respectively with corresponding p values 0.17 and 0.99 respectively. Duration of surgery (min.), blood loss (ml.) and tourniquet time (min.) were 83.5±10.89, 100.0±17.17 and 56.67±11.55 respectively in transpatellar approach while they were 88.50±13.49, 101.50±20.59 and 65.0±5.77 for parapatellar approach respectively with corresponding p values as 0.23, 0.93 and 0.26 respectively. The Lysholm Knee score, knee range of motion (degrees), knee pain (VAS) at final follow up were 73.05±2.33, 116.5±4.7 and 1.85±0.67 respectively in transpatellar approach while they were 73.50±2.73, 117.0±4.89 and 1.60±0.60 for parapatellar approach respectively with corresponding p values as 0.70, 0.80 and 0.29 respectively. The overall incidence of anterior knee pain in our study was 63% (65% in transpatellar approach and 60% in medial parapatellar approach). The fracture level, associated fibula fracture and tourniquet use were not significantly associated with anterior knee pain (VAS score) at any follow up irrespective of the approach used.

We found no significant difference in anterior knee pain for transpatellar tendon approach and medial parapatellar tendon approach for nail entry during intramedullary interlocking nailing of tibial shaft fracture at one year follow up.