The Parapatellar Approach to Intramedullary Tibial Nailing
|Knee Pain Intermittent|
|Study Design:||Observational Model: Cohort
Time Perspective: Prospective
|Official Title:||The Parapatellar Approach to Intramedullary Tibial Nailing: Is There a Difference in Anterior Knee Pain When Compared to a Traditional Flexed Approach?|
- incidence of anterior knee pain in the approaches used for tibial nailing [ Time Frame: 6 months after surgery ]This project will address the incidence of anterior knee pain in the approaches used for tibial nailing. A parapatellar approach, with nail insertion in relative extension, will be compared to the approaches in which nail insertion requires the knee to be placed in flexion
- compare knee pain levels in patients whose tibial fractures required intramedullary nailing and were treated using a parapatellar approach [ Time Frame: 1 year after surgery ]The purpose of this prospective study is to compare knee pain levels in patients whose tibial fractures required intramedullary nailing and were treated using a parapatellar approach (knee flexed ~30 degrees) or a traditional approach requiring full flexion of the knee (transtendinous and peritendinous approaches utilize flexion of ~90 degrees).
|Study Start Date:||June 2010|
|Estimated Study Completion Date:||December 2018|
|Estimated Primary Completion Date:||December 2018 (Final data collection date for primary outcome measure)|
In the population affected by orthopaedic injury, fractures of the tibial shaft are the most common of all long bone fractures. This fracture pattern occurs approximately 26 times per 100,000 people and accounts for 77,000 hospitalizations per annum.(1, 2) Intramedullary nailing is the most common operative treatment choice for fractures of the diaphyseal tibia (tibial shaft). Intramedullary nailing is also commonly used for shaft fractures that extend into the metaphyses (excluding fractures that extend into the knee and/or exhibit comminution at the ankle joint).
Tibial nails are inserted at or about the knee. Three different insertion approaches are used as standard of care at this institution, including the transtendinous, peritendinous, and parapatellar approach. In all three techniques, the nail is placed in the tibia in the same manner: after fracture reduction, the proper entry point in the proximal tibia is found and the tibia is sequentially reamed until a suitable nail can be passed and locked in place with interlocking screws. The three named approaches vary the (1) angulation of the knee at the time of insertion and the (2) location of the incision and soft tissue dissection, relative to the patellar tendon, necessary to locate the proper entry point for the nail. Tibial nails are inserted with the knee in flexion (bent to ~90°) for the transtendinous and peritendinous approaches, and in relative extension (less than 30°) for the parapatellar approach. For insertion, the transtendinous and peritendinous approaches require dissections that allow the nail to be passed through or around the patellar tendon. In the parapatellar technique, dissection is carried out juxtaposed to the patella.
Anterior knee pain is the most common complication of intramedullary tibial nailing. It has been reported in a range of 10% to 86% with average follow up of two years.(3) Review of current literature regarding the subject of anterior knee pain and tibial nailing reveals four commonly attributable causes: skin incision location,(4,5) approach in reference to the patellar tendon,(6-9) nail insertion site,(10) and nail prominence.(11-13) No study has specifically examined whether knee angulation at the time of insertion impacts anterior knee pain.
Please refer to this study by its ClinicalTrials.gov identifier: NCT01407718
|United States, Utah|
|University of Utah Orthopedics Center|
|Salt Lake City, Utah, United States, 84121|
|Principal Investigator:||Erik Kubiak, MD||University of Utah Orthapedics|