Fri., 10/15/10 Knee, Tibia & Pediatrics, Paper #58, 4:04 pm OTA-2010
Semi-Extended Nailing: Is the Patellofemoral Joint Safe?
David P. Zamorano, MD; Grant W. Robicheaux, MD; Janessa Law, BS; Jeff Mercer, MD;
University of California Irvine Medical Center, Orange, California, USA
Background: Intramedullary (IM) nailing of proximal-third tibial shaft fractures is fraught with difficulty and associated with an increase risk of malunion. To help reduce the chances of poor implant placement, the surgical technique of placing the IM nail with knee in a semi-extended position relaxes the extensor mechanism and may help to prevent an apexanterior deformity. This technique, however, requires intra-articular passage of instruments and implants that may cause damage to the patellofemoral joint.
Hypothesis: IM nailing of tibial shaft fractures with the knee in the semi-extended position can be performed without causing iatrogenic damage to the articular surfaces of the patella or intercondylar groove of the femur.
Methods: From March 2008 to June 2009, 17 patients with 18 tibial shaft fractures at a single institution amenable to IM nailing were included. All of the fractures were stabilized using a semi-extended IM nailing technique. Knee arthroscopy was performed before and after instrumentation through a suprapatellar incision using the same quadriceps-splitting approach used for IM nail insertion. Inspection of the femoral intercondylar groove and the patellar facets were performed and noted for any gross damage.
Results: 14 of the 18 knees (78%) did not demonstrate any iatrogenic articular surface damage; 4 of the 18 knees (22%) had articular cartilage damage seen in the postnailing arthroscopy that was not visualized prior to instrumentation and nailing. The 4 knees with postnailing articular damage occurred early in the study and were due to errors in technique. The articular damage was consistently located in the intercondylar notch.
Conclusions: IM nailing of tibial fractures in the semi-extended position can be done with minimal risk of iatrogenic damage to the articular surfaces of the patella and intercondylar notch of the femur. Proper technique is imperative to minimize damage to the patellofemoral joint while nailing through a semi-extended technique.
Alphabetical Disclosure Listing (292K PDF)
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.