Comparison of the efficacy of intramedullary nailing via the lateral parapatellar approach versus the infrapatellar approach in the treatment of tibial metaphyseal-diaphyseal junction fractures.

Background: To compare the efficacy of intramedullary nailing via the lateral parapatellar approach versus the infrapatellar approach in treating fractures at the tibial metaphyseal-diaphyseal junction.

Methods: A retrospective analysis was conducted on the clinical data of 45 patients with proximal or distal tibial fractures treated with intramedullary nailing via lateral parapatellar approach (n = 23) or infrapatellar approach (n = 22) between January 2019 and March 2023. We recorded and compared the operative time, intraoperative blood loss/fluoroscopies, success rate of closed reduction, anteroposterior and lateral entry point accuracy, postoperative infection, fracture healing time, as well as NRS pain scores, Lysholm knee function scores, and knee range of motion.

Results: Both groups completed the surgery without any complications. The lateral parapatellar approach group had significantly better results regarding shorter operative time, less intraoperative blood loss, and fewer intraoperative fluoroscopies compared to the infrapatellar approach group (P < 0.05). All cases in the lateral parapatellar approach group achieved closed reduction, while 10 cases in the infrapatellar approach group required open reduction. Fractures in both groups healed successfully, without statistically difference in healing time (P > 0.05). The accuracy of anteroposterior and lateral entry points was better with lateral parapatellar approach (P < 0.05). At 3 and 12 months postoperatively, lateral parapatellar approach showed better Lysholm and NRS scores compared to infrapatellar approach (P < 0.05). Two groups had no significant difference in range of motion (P > 0.05).

Conclusions: Lateral parapatellar approach combined with the blocking screw technique provides superior clinical outcomes compared to infrapatellar approach in the treatment of proximal or distal tibial fractures, making it suitable for further investigation.