It appears that intramedullary nailing is now the treatment of choice for diaphyseal tibial fractures. Nail placement provides excellent fracture stability, prevents misalignment, and allows rapid mobilization. The best way to get to the tibia to nail is to split the patellar tendon and infrapatellar tendon with the knee bent at a 90-degree angle. Surgeons face an issue when determining whether proximal and distal tibial fractures require nailing.
Nailing may intensify the patellar tendon tension that causes anterior misalignment of the proximal fragment in proximal fractures.
Overview
Surgical intervention is frequently necessary for the best possible healing and restoration of function after tibial fractures, particularly those involving the shaft, which are common injuries. Supra patella tibial nailing is an innovative technique for these types of fractures. This all-inclusive guide will go into the basics of tibial nailing, including the meaning, indications, surgical process, benefits, risks case studies, comparisons to other procedures, and what the future holds for this technique.
What is a Supra Patella Tibial Nail?
One intramedullary nail used to fix tibia fractures is the supra patella tibial nail, which is put into the kneecap, directly above the patella. When treating tibial shaft fractures, this method is preferable to the more extensive infrapatellar methods, as it is simpler and more effective.
Indications for Using a Supra Patella Tibial Nail
An effective treatment option for a wide spectrum of tibial fractures, the Supra Patella Tibial Nail provides solid fixation while minimizing damage to soft tissues. This results in improved outcomes and faster recovery for patients.
Its primary applications are as follows:
Acute Tibial Shaft Fractures
These are uncommon fractures that have recently happened in the middle and length of the tibia.
Reasoning: SPTN offers stable internal fixation, which is necessary for acute tibial shaft fractures to heal properly and stay in place.
Tibia Pathological Fractures
Diseases like osteoporosis and metastatic cancer weaken bones, which can lead to these types of fractures.
Reasoning: Bones affected by underlying diseases require the powerful support and stabilization the nail provides.
Complex Fractures Extending into the Knee Joint
These fractures impact the region where the tibia connects to the knee joint.
Reasoning: SPTN enables exact alignment and stabilization, which aids in the preservation of knee function and appropriate recovery.
Tibia’s Non-Unions and Malunions
Fractures that have not healed properly are called non-unions, and fractures that have healed incorrectly are called malunions.
Reasoning: When other treatment methods have failed, the nail can serve as a strong framework to straighten and stabilize the bone, speeding up the healing process.
Fractures with Severe Soft Tissue Damage
These types of fractures are defined by significant damage to the skin, ligaments, and muscles around the affected area.
Reasoning: Patients suffering from serious soft tissue injuries can benefit from the supra patellar approach, since it is less annoying and reduces the risk of further injury to sensitive tissues.
Complex Multi-Fragmentary Fractures
It might be challenging to align and stabilize these fractures since they contain multiple fragments of bone.
Reasoning: The SPTN is able to handle complex fracture patterns with ease, making sure that all the bone pieces are correctly positioned and stabilized.
Pediatric Tibial Fractures Description
Fractures in children and adolescents.
Reasoning: Modifying the nail to fit the developing bones of children allows for efficient treatment with less chance of growth disruptions.
Obesity-Related Bone Breaks
Patients with a higher body mass index (BMI) have it tougher when they break a bone, since their bones are under more stress.
Reasoning: Since the conventional infrapatellar approach to the tibia can be challenging in obese patients, the supra-patellar approach is frequently the preferable method for accessing the tibia.
The Method of Surgery
Inserting a supra patella tibial nail requires a multi-stage surgical process:
Step: 1
To get ready for surgery, lay the patient lying down on the operating table with their knee bent at a 15-20-degree angle. The tibial nail might be better aligned in this position.
Step: 2
The procedure begins with a little incision made just above the patella. By using fluoroscopic guidance, the surgeon carefully determines the quadriceps tendon as the starting place for the nail.
Step: 3
Preparing the medullary canal for the nail’s insertion involves reading it to fit the diameter of the nail. The next step is to insert the nail into the tibia so it can span the fracture.
Step: 4
Placing proximal and distal locking screws ensures rotational stability and secures the nail.
Step: 5
To help with the early healing process, the incision is closed, and the knee is simply immobilized.
Benefits of Supra Patella Tibial Nail (SPN)
- The supra patellar technique reduces spreading by minimizing damage to soft tissues.
- Patients typically report less postoperative pain as a result of the starting point being above the knee.
- With this method, the fracture can be properly aligned and controlled.
- Benefits include a shorter recovery time and the ability to move around more quickly than alternative approaches.
Potential Risks and Complications
- The risks and hazards of supra patella tibial nailing are similar to those of any surgical procedure:
- The possibility of surgical infection slows the healing process.
- The incision above the patella might cause anterior knee pain for some people.
- As a result of improper placement, the fracture may become out of place.
- Breakage of screws or nails is possible.
Case Studies and Success Stories
Supra patella tibial nailing has been shown in multiple case studies to be an effective treatment for complicated tibial fractures. When it comes to mending the fracture and functional recovery, for example, a study with 50 patients who had tibial shaft fractures demonstrated a 95% success rate. Compared to conventional treatments, patients experienced less pain and were able to resume their normal activities more quickly.
Comparing Supra Patella Tibial Nail to Others
There are a number of interesting differences between Supra Patella Tibial Nailing and other techniques, like infrapatellar nailing and external fixation:
Infrapatellar Nailing:
The infrapatellar nailing technique is efficient, although it usually necessitates more extensive dissection of soft tissues and more postoperative discomfort.
External Fixation:
Although external fixation is the treatment of choice for serious open fractures, it comes with the drawbacks of increased infection risk and longer immobilization periods.
What’s Next for Tibial Nailing
Continuous improvements in surgical methods and implant technology show well for the future of tibial nailing. In the future, tibial fracture treatments will have better success rates because of innovations such biodegradable nails, robotic-assisted surgery, and better imaging techniques.
Wrapping It Up
When it comes to fixing tibial fractures, the Supra Patella Tibial Nail is a huge step forward. The combination of its less invasive method and good stabilization allows for faster recovery times and better patient outcomes. Those who suffer from tibial fractures will have even more hope for the future of tibial nailing as procedures and technology keep improving.
