Suprapatellar Tibial Nailing - PowerPoint Presentation

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Suprapatellar Tibial Nailing

Michael J. Gardner, MD

Professor & Vice Chairman

Chief, Orthopaedic Trauma

Stanford University School of Medicine

Palo Alto, CA

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Tibial Nailing: Entrance Portals

Infrapatellar:

Medial

parapatellarLateral parapatellarSplit tendonSemi-extendedSuprapatellar”Extra-articular”, parapatellar

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What are the problems with the “OLD”?

1. Position affects reduction

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What are the problems with the “OLD”?

2.

Fluoro

is a pain in the A**

C-arm Beam

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Surgical Technique

Incision superior to proximal patella

Instrumentation through patellofemoral joint

Some flexion0-50⁰

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Supra-Patellar

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What about the

PF Joint?

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What we think we know

Gelbke

et al JOT ‘10

PF contact pressures 3.8 MPa (SP) vs 1.3 MPa (IP)Loening et al Arch Biochem Biphys ‘00 Chondrocyte apoptosis occurs at 4.5 Mpa

May be able to reduce further with retinacular releases

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RCT – SP vs IP

Scope pre and post nailing

6/11 had chondromalacia pre nailing

1 had worsening post nailing scope2 had new injuries (one trochlea one patella)No difference in knee pain at one yearUnderpowered

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26% greater than 5 degrees malalignment infra patellar

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Metaanalysis of 4 RCT’sNo difference in complications

Suprapatellar appears to be superior approach

Mehta 2015, AJO

Medicine 2018

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What does SP approach offer

Mitigates Deforming Forces

Especially proximal fractures

Potential Ease in Reduction (even if not proximal)AssessmentEase in Fluoro utilizationEase in Start Site Placement ?Identification, trajectory

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Indications

Proximal 1/3

rd

Tibia Fractures

Quad

Pes

Gastroc

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Supra-Patellar

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Thank You