Effects Of Intramedullary Nailing For The Treatment Of Extra-articular Proximal Tibial Fracture:Compared With Minimally Invasive Percutaneous Plate Fixation

Objective: To analyze the effects of intramedullary nailing on the supra-patellar approach or sub-patellar approach and minimally invasive percutaneous plate fixation for the treatment of extra-articular proximal tibial fracture,which could be helpful to choose the best surgical procedure for this disease.Methods: The clinical data of 37 patients with extra-articular proximal tibial fracture treated in Department of Orthopaedics,Affiliated Hospital of North Sichuan Medical College from February 2015 to March 2017 were analyzed retrospectively.According to the different surgical procedures,the patients included were divided into three groups: group A with 10 patients who underwent intramedullary nailing on the suprapatellar approach,group B with 12 patients who underwent intramedullary nailing on the sub-patellar approach,and group C with 15 patients who were treated with minimally invasive percutaneous plate fixation for this fracture.In group A,there were 6 males and 4 females with the average age of 38.9±11.7 years.According to AO/OTA fracture classification,group A was composed of 8 cases of type 41A2 and 2 of type 41A3.In group B,8 males and 4 females with the average age of 37.4±10.9 years were analyzed,which was composed of 10 cases of type 41A2 and 2 of type 41A3 according to AO/OTA fracture classification.In group C,10 males and 5 females(average age,37.9±11.4 years)with 13 cases of type 41A2 and 2 of type 41A3 were analyzed.Follow-up examinations were performed regularly after operation.The fracture healing,Johner-Wruhs scores,Lysholm scores,and Visual Analogue scores for prepatellar area were observed.The operative time,blood loss during the operation,the frequency of C-arm fluoroscopy during the operation,the load time of the involved leg,the rate of malreduction,the rate of infection after opertion,the good rates of Johner-Wruhs scores and Lysholm scores,and the rate of prepatellar area pain were analyzed statistically.Results: No significant differences of the blood loss during the operation,Johner-Wruhs scores,Lysholm scores,the fracture healing,the frequency of C-arm fluoroscopy during the operation,and the rate of infection after opertion could be found among the three groups above-mentioned(all P > 0.05).The hospital stays and the load time of the involved leg after operation in the group A and B were shorter than those in the group C(all P<0.05).The operative time in the group A and C were superior to those in the group B(all P<0.05).Patients in group A underwent less pain in prepatellar area after operation than group B(P < 0.05).Conclusion: Intramedullary nailing on the supra-patellar approach or sub-patellar approach and minimally invasive percutaneous plate fixation could achieve satisfactory effect for the treatment of extra-articular proximal tibial fracture.Compared to minimally invasive percutaneous plate fixation,the supra-patellar approach for the nailing treatment has an obvious advantage in shorten of the hospital stays and the load time of the involved leg after operation.Furthermore,the supra-patellar approach has less pain in prepatellar area after operation than the sub-patellar approach.Hence,intramedullary nailing on the supra-patellar approach is worthy to be applied widely in clinic for the treatment of closed extra-articular proximal tibial fracture due to its central fixation,quick recovery,short load time of the involved leg,and few complications.