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Update in Tibia Intramedullary Nailing: Percutaneous Suprapatellar Access Route With the Knee in Semiextended Position for Intramedullary Stabilization of Tibia Fractures

Morandi, Massimo “Max MD, FACS*”; Rose, Kyle M. MS*; Mangano, Sebastiano “Seby MD†”

doi: 10.1097/BTO.0000000000000075
Invited Review Articles

Since the first description of modern intramedullary tibia nails by Kuntscher and through the subsequent introduction of the locked nails by Gross and colleagues, infrapatellar access routes have been utilized. The discussion on the correlation between different entry points and the incidence of anterior knee pain has been extensive. Furthermore, nailing of proximal tibia fracture can be complicated by malalignment, typically an apex anterior with valgus angulation, coupled with posterior displacement of the distal fragment. The insertion of an intramedullary nail in the tibia utilizing a lateral suprapatellar percutaneous entry point, with the knee in semiextension, appears to mitigate the establishment of malreduction. Because the suprapatellar route does not directly injure the tendon, it consequently appears to lead to reduced incidence of knee pain. Originally indicated for proximal tibia fractures, this modification of the classical tibial nailing has been proven effective in all tibial locations. It allows for fast setup of the operating room, without the need for cumbersome traction tables; it simplifies the treatment in polytrauma patients with injuries to the soft tissue surrounding the patellar tendon area and it reduces the manipulation of concomitant fractures, such as femur and pelvis.

*Louisiana State University Health Sciences Center, Shreveport, LA

A.O.U. “Policlinico Vittorio Emanuele,” Catania, Italy

The authors declare that they have nothing to disclose.

Address correspondence and reprint requests to Massimo “Max” Morandi, MD, FACS, Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA, 71130. E-mail:

© 2014 by Lippincott Williams & Wilkins