Suprapatellar Nailing Versus Infrapatellar Nailing for Tibial Shaft Fractures – Alignment and Clincial Outcome Study

Background: Intramedullary interlocking nailing is the preferred treatment for displaced tibial shaft fractures. The conventional infrapatellar approach may be associated with malalignment and anterior knee pain, whereas suprapatellar nailing in the semiextended position may improve fracture reduction and functional recovery. The objective is to compare functional outcomes and fracture alignment following suprapatellar and infrapatellar intramedullary nailing of tibial shaft fractures. Material and Methods: This randomized controlled study included 50 adults with tibial shaft fractures treated at Basaveshwara Medical College Hospital and Research Centre from August 2022 to May 2024. Patients were randomized into suprapatellar and infrapatellar groups, with 25 patients in each. Functional outcomes were assessed using Lysholm, SF-36, and VAS scores at 3, 6, and 12 months. Knee range of motion, time to union, coronal and sagittal alignment, anterior knee pain, and postoperative complications were also evaluated. Results: Both groups were comparable at baseline. Lysholm and SF-36 scores were significantly higher in the suprapatellar group at all follow-up visits, while VAS pain scores were significantly lower (p<0.001). Mean knee range of motion was 129.0° in the suprapatellar group and 115.0° in the infrapatellar group (p<0.001). Malalignment greater than 5° occurred in 8% and 36% of patients, respectively (p=0.017). Coronal and sagittal deviations were significantly lower in the suprapatellar group. Anterior knee pain was present in 4% of suprapatellar cases compared with 36% of infrapatellar cases. Mean time to union and complication rates were comparable. Conclusion: Suprapatellar nailing resulted in better functional recovery, lower pain, improved knee movement, and superior fracture alignment compared with infrapatellar nailing, without affecting union time or increasing complications.

Keywords: Tibial shaft fracture, suprapatellar nailing, infrapatellar nailing, intramedullary nail, anterior knee pain, fracture alignment.