Abstract
Background and Objectives: Knee pain is a common complaint after intramedullary nailing of tibia. Several entry sites have been described, but the optimal site remains a topic of debate. The aim of this study was to compare two surgical approaches, transpatellar and medial parapatellar tendon in tibial intramedullary nailing for treatment of tibial fractures.
Materials and Methods: In a randomized clinical trial, 50 patients with fracture of tibial shaft were recruited during a 16-month period in Tabriz Shohada Hospital. Intramedullary nailing was employed as the surgical technique in all patients through two different approaches; transpatellar (group T) and medial parapatellar tendon (group M). Patients were randomly assigned to each group (25 patients in each group). Pain was assessed by visual analogue scale (VAS), as well as range of motion (ROM) 2 weeks and 1, 3 and 6 months after operation.
Results: There were 23 males and 2 females with a mean age of 28.68±5.76 years in group T and 21 males and 4 females with a mean age of 28.80±5.82 years in group M (P=0.667 and 0.942, respectively). The mean score of pain (VAS) was significantly higher in group T three and 6 months after operation comparing with that in group M (P=0.013 and 0.009, respectively). Range of motion as well as length of skin incision and nail out of anterior tibial cortex was not significantly different between the two groups.
Conclusion: Based on our results, both approaches are safe; however, the transpatellar approach might be along with more pain for the patients. Therefore, the medial parapatellar tendon approach is recommended in this regard.