Reduced knee pain seen with novel medial incision for nailing tibial shaft fractures
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Data presented showed return-to-sport time and anterior knee pain were improved when surgeons used a novel transverse medial parapatellar incision for intramedullary nailing of tibial shaft fractures.
At the Virtual EFORT Congress, Joseph Brennan, a fifth-year medical student at Royal Infirmary of Edinburgh, presented the findings for the novel incision compared with a traditional longitudinal parapatellar incision. He said the impetus for developing this technique was the complications patients, particularly athletes, report with the traditional treatment.
“Tibial diaphyseal fractures represent 4% of acute sports fractures and have the longest return-to-sport time. The gold standard treatment for these fractures is intramedullary nail fixation, however the main complication is anterior knee pain, which affects 47.4%,” Brennan said.
“Our study showed good clinical potential for our novel transverse medial parapatellar incision, as it was associated with a non-statistically significant improvement in anterior knee pain and return-to-sport time,” he said.
Among 558 patients who underwent intramedullary nailing of tibial shaft fractures at Royal Edinburgh Infirmary from 2009 to 2016, 93 patients who completed postoperative questionnaires by mail or telephone were included in the retrospective study. Forty-two patients underwent surgery with the novel transverse incision and 51 patients underwent surgery with the traditional longitudinal incision.
Brennan and colleagues assessed knee pain with the Oxford Knee Score (OKS) pain subscale and a VAS scale, and they assessed postoperative activity with the University of California Los Angeles scale.
“Our results showed no difference in postoperative activity level but did show an improved return-to-sport time when using the novel medial incision, although this did not reach statistical significance either,” Brennan said.
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Brennan J, et al. Anterior knee pain and return to sport time following tibial intramedullary nail fixation using a novel transverse medial parapatellar incision. Presented at: Virtual EFORT Congress; Oct. 28-30, 2020.
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