To systematically review the existing literature to determine whether knee pain and function following intramedullary nailing of tibial shaft fractures differs significantly by surgical technique—specifically with semi-extended nailing versus traditional infrapatellar approaches.
A comprehensive search of PubMed/MEDLINE, EMBASE, and the Cochrane Database was conducted on August 15, 2018.
We included level I–level III studies that examined outcomes of tibial intramedullary nailing utilizing a semi-extended technique. All included studies reported Lysholm Knee Scores with minimum clinical follow-up of 1 year. Non-English language literature and studies older than 20 years were not included.
Data from each study were independently recorded by 2 reviewers.
Two prospective, randomized trials and 4 retrospective cohort studies were included in this review. A meta-analysis was not performed.
Evidence comparing postoperative knee pain and functional outcomes between semi-extended and traditional infrapatellar nailing is limited. Available literature suggests satisfactory outcomes with semi-extended nailing. The highest level of evidence available does indicate improved pain and function with semi-extended nailing as compared to infrapatellar nailing. Additional research may be required to reach consensus conclusions.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
*Harvard Combined Orthopaedic Residency Program, Massachusetts General Hospital, Boston, MA; and
†Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA.
Reprints: Ishaq Ibrahim, MD, Harvard University Combined Orthopaedic Residency Program, 55 Fruit St, Boston, MA 02114 (e-mail: firstname.lastname@example.org).
The authors report no conflict of interest.
Accepted November 06, 2018