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Improved Outcomes With Semi-extended Nailing of Tibial Fractures? A Systematic Review

Ibrahim, Ishaq, MD*; Johnson, Andrew, BS; Rodriguez, Edward K., MD, PhD

Journal of Orthopaedic Trauma: March 2019 - Volume 33 - Issue 3 - p 155–160
doi: 10.1097/BOT.0000000000001395
Review Article

Objective: 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.

Data Source: A comprehensive search of PubMed/MEDLINE, EMBASE, and the Cochrane Database was conducted on August 15, 2018.

Study Selection: 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 Extraction: Data from each study were independently recorded by 2 reviewers.

Data Synthesis: Two prospective, randomized trials and 4 retrospective cohort studies were included in this review. A meta-analysis was not performed.

Conclusions: 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.

Level of Evidence: 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:

The authors report no conflict of interest.

Accepted November 06, 2018

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