Comparison of Therapeutic Effects of Intramedullary Nail Fixation of Tibial Fractures Through Different Approaches and Analysis of the Causes of Postoperative Knee Pain

Liao Yunjian; Huang Jia; You Jiarui; Li Xiaoxin; Huang Ping; Yuan Huabing; Hu Rui

Abstract：Objective To compare the therapeutic effects of intramedullary nail fixation using suprapatellar and infrapatellar approaches in the treatment of tibial shaft fractures and explore the differences in the effectiveness of different approaches in the treatment of tibial fractures,and analyze the causes of postoperative anterior knee pain.Methods A retrospective analysis was conducted on 143 cases of tibial shaft fractures treated with intramedullary nails at Jingmen People's Hospital from January 2019 to December 2022.74 cases underwent suprapatellar approach were included in Group A.There were 39 males and 35 females in group A.The patients aged 34～55 years,with an average age of(41.56±3.24)years.In group B,69 cases were treated through the infrapatellar approach.There were 35 males and 34 females and the patients aged 30 to 56 years,with an average age of(40.56±5.54)years.After surgery,all patients were followed up for 6 months to compare the surgical time,intraoperative blood loss,occult blood loss at 48 hours after surgery,length of hospital stay,intraoperative X-ray fluoroscopy frequency,visual analog scale(VAS)for pain at different postoperative stages,hospital for special surgery(HSS)knee joint score,Lysholm score,and range of motion(ROM)between the two groups.Results All patients were followed up for 7 to 10 months,with an average of(8.31±1.21)months.All patients successfully completed the surgery without any vascular or nerve damage during the operation.Except for 3 cases of intramuscular venous thrombosis in the calf after surgery,all other patients did not experience serious complications such as deep tissue infection,internal fixation failure,skin necrosis,and osteomyelitis.There was no statistically significant difference in intraoperative bleeding,hospital stay,and bone healing time between the two groups of patients(P＞0.05).There was no statistically significant difference(P＞0.05)in HSS scores between postoperative follow-up at 1 and 3 months.After 6 months of follow-up,the HSS score of Group A was better than that of Group B,and the difference was statistically significant(P＜0.05).The surgical time and intraoperative X-ray fluoroscopy frequency in Group A were significantly less than those in Group B,and the difference was statistically significant(P＜0.05).There was no statistically significant difference in ROM between the two groups at 1,3,and 6 months after surgery(P＞0.05).The Lysholm score of Group A was better than that of Group B at 3 and 6 months after surgery,and the difference was statistically significant(P＜0.05).There was no statistically significant difference(P＞0.05)in the VAS scores of preoperative and postoperative 1 and 3 months.On the 6th month after surgery,the VAS score of Group A was lower than that of Group B,and the difference was statistically significant(P＜0.05).Conclusion Both approaches for intramedullary nail treatment of tibial fractures are safe and reliable,and can achieve good surgical results.But the suprapatellar approach has more advantages.Reducing iatrogenic injuries during surgery,moderate tailcap protrusion,and continuous postoperative functional exercise can reduce the incidence of knee joint pain.