The semi-extended lateral parapatellar approach vastly simplifies many technical aspects of nailing compared to knee hyperflexion approaches, and does not violate the knee joint The intraarticular suprapatellar approach has been described as a soft tissue approach to maintain the leg in a position that would not complicate management of these fractures, especially those in the proximal third of the tibia
Parapatellar nailing of the tibia is becoming an increasingly popular approach. One of the indications for the approach to nail insertion is the association of tibial shaft fracture with distal intraarticular extension. This video demonstrates the parapatellar approach with stabilization of distal articular extension The parapatellar approach for tibia nailing has similar rate of soft tissue damage compared to the suprapatellar approach. The suprapatellar approach damaged the cartilage in one-third of the cases and if cartilage injury occurs with the parapatellar approach, this is located in a low risk area Introduction: Medial parapatellar or transpatellar ligament approaches are commonly used for nail osteosynthesis in tibia shaft fractures. The lower leg is normally in a hanging position to allow guide wire insertion and reaming of the tibia
flex knee over radiolucent triangle and mark out inferior pole of patella, borders of patellar tendon, joint line, tibial tubercle make incision from inferior pole of patella distally 2.5cm towards tibial tubercle along medial 1/3 of patellar tendon spread down to dissect paratenon, identify medial edge of patellar tendon and incis Nailing ensures good fracture stability, safeguards against malalignments, and allows quick mobilization. An infrapatellar and patellar tendon splitting entry to the tibia with the knee joint flexed 90 degrees seems to be the preferred entry for tibial nailing
1.. IntroductionAlthough the medial parapatellar approach to the tibia for intramedullary nailing of fractures has been described as preferable , the patellar tendon splitting approach is still recommended in the surgical manuals .Recently it has been shown that the patellar tendon splitting approach is associated with a higher incidence of post-operative knee pain Semiextended medial or lateral parapatellar. This approach is used to nail proximal tibial fractures. Advantages include ease of positioning, imaging, and aid to fracture reduction. Suprapatellar (transquadriceps tendon). This is an alternative approach for proximal tibial nailing but requires special instruments. Inadvertent trochlear damage. Various studies suggest that, medial parapatellar approach has less anterior knee pain but both the approaches are considered safe. As compared to transpatellar approach for intramedullary interlocking nail insertion, medial parapatellar incision is more preferred in the management of tibial shaft fracture [3,11,12]
The aim of this study was to compare anterior knee pain and functional outcomes in patients who underwent intramedullary tibial nailing using transpatellar, medial parapatellar or suprapatellar nail entry methods. We retrospectively reviewed patients who underwent tibial fracture repair in our clinic between January 2010 and March 2017. After applying the exclusion criteria, 58 patients were. McAndrew - This video demonstrates treatment of a distal tibial fracture with an Intramedullary nail, utilizing an extraarticular, lateral parapatellar approach Distal Tibial Intramedullary Nailing Utilizing an Extraarticular, Lateral Parapatellar Approach in a Semiextended Position - McA on Vime Transpatellar tendon approach is commonly used for tibial intramedullary interlocking nailing but it can also be done through medial parapatellar tendon approach. The objective of the study was to compare post-operative anterior knee pain after intramedullary nailing technique by transpatellar approach compared to medial parapatellar approach A specialized SP insertion cannula within a protective sleeve was placed through the skin incision, through the trochlear groove under the surface of the patella, and at the desired start point for tibial nailing, which is in the intersection of tibial midline and tibial plateau articular surface (Fig. 2) ted from March 2012 to July 2015 with intramedullary nailing (IMN) using an extraarticular lateral parapatellar approach in the semiextended position were reviewed. Patients were clinically and radiographically checked at a minimum follow-up of 24 months, and the following data were recorded: fracture healing, any residual deformity, nail-apex distance, range of motion of the treated knee.
Most traditional surgical approaches used for tibial IM nailing use a patellar-tendon splitting or medial paratendinous interval. The lateral parapatellar approach has been used less frequently [ 1 ] Semi-extended Parapatellar Approach Surgical Technique DePuy Synthes 3 Indications The Tibial Nail Advanced implants are intended for treat-ment of fractures in adults and adolescents (12-21) in which the growth plates have fused. Speciﬁcally, the im-plants are indicated for: • Open and closed proximal and distal tibia fracture
Tibial shaft fractures are most commonly treated via reamed intramedullary nail (IMN). Surgical approaches for tibial IMN insertion include the parapatellar (medial or lateral), transpatellar (ie, tendon splitting), or suprapatellar approach. Irrespective of the approach, the ideal start point is generally medial to the lateral tibial spine Conclusions will be drawn regarding the efficacy of the semi-extended parapatellar approach for tibial nailing in regards to anterior knee pain. Inclusion Criteria All patients, 18 years of age or older, who present to the University of Utah Medical Center for treatment of a tibia fracture that requires use of an intramedullary nail for. Semi-Extended Parapatellar Approach Surgical Technique DePuy Synthes 3 Indications The Tibial Nail Advanced implants are intended for treatment of fractures in adults and adolescents (12-21) in which the growth plates have fused. Specifically, the implants are indi-cated for: • Open and closed proximal and distal tibial fracture Tibial Shaft Fx Intramedullary Nailing Tibial Plafond Fracture External Fixation Tibial Plafond Fracture ORIF with Anterolateral Approach and Plate Fixation Parapatellar Knee Approach. 1. Plan out anterior approach to knee . options include medial parapatellar (most common, described below) lateral parapatellar. Suprapatellar nailing of tibial fractures is a simple method with many advantages over traditional tibial nailing. The method is still new and not yet widely used. There is room for development of the method and improvement of instruments, thus increasing safety and indications
Although the medial parapatellar approach is a popular approach for tibia nailing, in the lateral parapatellar approach, the knee may be maintained in the semi-extended position, which aids in reducing the surgical time, and reduction may be performed easily with minimal assistance [6,7,8] (Fig. 6). A lateral parapatellar incision should be. Medial parapatellar approach. 1. Principles. This approach is used for medial femoral condylar fractures. In addition, it may be used in retrograde nailing of intra articular fractures. 2. Neurovascular structures. The saphenous nerve runs along the medial aspect of the distal femur. The infrapatellar branches of the saphenous nerve lie on the.
The Tibial Nail-EX is intended to stabilize fractures of the Approach Make an incision in line with the central axis of the patient, this incision can be transpatellar, medial or even lateral parapatellar. The incision starts proximally at the distal third of the patella along the patellar ligament down to the tibial tuberosity 8.5mm diameter META-NAIL Tibial Nail follows the same technique as the 10mm, 11.5mm and 13mm diameter nails. Attach the Anterior Drop (7165-4501) to the Drill Guide and verify targeting accuracy by inserting a gold 9.0mm Drill Sleeve (7163-1152) and silver 4.0mm Drill Sleeve (7167-4083) into the Drop and passing a 4.0mm Long Pilot Drill (7163. Alternatively, semi-extended nailing, which was originally used to reduce the occurrence of apex anterior deformity in proximal tibial fractures, could be used with an extra-articular, parapatellar, or suprapatellar approach [12,13,14,15,16,17]. Recent studies have suggested that the semi-extended leg position is favored as it facilitates the. ing the semi-extended approach for tibial nailing. The authors' null hypothesis was that the semi-extended, extra-articular, parapatellar approach does not increase the incidence of anterior knee pain after tibial nailing. Materials and Methods After institutional review board ap-proval, 26 patients who presented to th
The traditional infrapatellar approach for tibia IMN involves placing the knee in either flexion or hyperflexion and inserting the nail through either a patellar tendon-splitting or patellar tendon-sparing technique(Fig. 1A).However, quadriceps muscle force often causes proximal fracture fragments displacement with the knee in flexion, resulting in valgus and procurvatum [4,5] allowing easier reduction and nail placement. In the literature, a few different approaches have been described.25-27,30 Tor-netta et al25 nailed 25 proximal tibia fractures with the knee in 15 degrees of ﬂexion. Using a medial parapatellar approach and laterally subluxating the patella, the trochlear groove wa Introduction. For tibial-shaft fractures, operative treatment via fixation with intramedullary nails is common, and it offers a more favourable functional prognosis than conservative treatments , .The parapatellar, patellar-tendon-split, and suprapatellar approaches are primarily used for nail insertion .Intramedullary tibial nail insertion can also be performed with the knee of the affected. techniques: Medial Parapatellar tendon (MP) approach and Transpatellar tendon (TP) approach in the insertion of IMIL tibial nail for shaft of tibia fractures in terms of range of motion, anterior knee pain, impairment caused by that pain in different activities, functional ability evaluation with kneeling and squatting
Lateral Parapatellar Approach. This approach is useful for proximal third fractures, to facilitate nail placement along the lateral tibial cortex. A 3- to 4-cm incision is made along the lateral border of the patellar tendon. The paratenon is reflected, and the patellar fat pad is separated from the posterior aspect of the patella . This lateral parapatellar approach can be performed without specialized instrumentation, results in precise establishment of the start point and completion of the fixation without injury to the knee OBJECTIVES: For intramedullary nailing of tibial shaft fractures, a recent study has determined that the entry site should be just medial to the lateral tibial spine at the anterior margin of the articular surface. Gaining access to this site is often through a medial parapatellar or transpatellar approach
95 patients with tibial fractures undergoing intramedullary nailing randomized to one of two approaches: the conventional medial parapatellar surgical approach (CMPP), or a suprapatellar semi-extended approach (SPSE). The study was conducted in order to determine if the use of the suprapatellar semi-extended approach significantly reduced anterior knee discomfort, through a newly developed. - the authors noted that a paratendinous approach for nail insertion does not reduce the prevalence of chronic anterior knee pain or functional impairment by a clinically relevant amount after IM nailing of a tibial shaft fracture; - references: - Knee pain after tibial nailing Intramedullary (IM) tibial nailing is an accepted fixation method for tibial shaft fractures. 12 However, postoperative knee pain is a clinically important complication that can result in substantial patient morbidity. 3,4,7 Knee pain reportedly affects from 56% to 67% of patients after tibial nailing. 4,7,13 The pain after tibial nailing. different in postoperative limping, with medial parapatellar having the lowest LKS score. The semi-extended lateral parapatellar approach vastly simplifies many technical aspects of tibial nailing compared to those that involve hyperflexion of the knee, and does not involve violation of or instrumentation through the knee joint
Lateral parapatellar approach to the distal femur. 1. Introduction. The lateral parapatellar approach provides a good view of the articular surface of the distal femur. With a longitudinal division of the quadriceps tendon and extensor mechanism, the patella can be dislocated medially Purpose: Knee pain is a common complication of intramedullary tibial nailing with a reported incidence of 10-86% at 2-year follow-up. Four reasons are commonly offered for knee pain after tibial nailing: skin incision location, approach in reference to the patellar tendon, nail insertion site, and nail prominence Objectives: To evaluate the post-operative complications of intramedullary nailing technique by transpatellar approach compared to medial parapatellar approach. Methods: Fifty patients with tibial fractures treated by intramedullary nailing through two transpatellar (t-group) and medial parapatellar (p-group) approaches were studied. Knee pain was assessed with visual analogue scale (VAS) for.
Methods. Between July 2018 and September 2019, 22 patients with tibial shaft fracture treated with intramedullary nailing fixation in semi-extended position via extraarticular parapatellar approach. There were 15 males and 7 females, with an average age of 46.4 years (range, 25-68 years) tained.6 Opponents to this tibial nail entry portal cite the potential for intra-articular injury as a reason to avoid this technique.2 This study investigated the potential injury to intra-articular structures near the preferred start point for tibial nailing, comparing a medial parapatellar tendon approach to a suprapatellar approach. Th
Suprapatellar surgical approach will be used for intramedullary nailing of tibial fractures. Arthroscopic photos will be obtained before and after nail insertion. Postoperative radiographs, outcome questionnaires and an MRI will be performed over ther course of one-year follow-up intramedullary stabilization of tibial fractures; however, the approach to nailing a diaphyseal fracture has remained largely unchanged: either a patellar tendon-splitting or medial or lateral parapatellar approach. Tornetta16and Cole17have described the use of medial patellar arthrotomies for nailing proximal tibial fractures
The purpose of this study was to determine whether patients with a tibia fracture who were treated with an intramedullary nail using a semi-extended, extra-articular, parapatellar approach had anterior knee pain at a higher than acceptable incidence compared with control patients time was documented when a lateral parapatellar approach was chosen (211 ± 189 s) compared to the transpatellar (347 ± 204 s) or the medial parapatellar approach (241 ± 222 s). CONCLUSION The extra-articular semi-extended tibial nailing technique using a lateral parapatellar approach was associated with a significant decrease in time o The tibial nail is universal and available in outer diameters of 7.5mm, 9mm, 10.5mm, 12mm and 13.5mm for applications Either a lateral or medial parapatellar approach is performed, but the knee joint should not be entered. The patella fat pad should only be cleared anteriorly to permit entry for prope Weil YA, Gardner MJ, Boraiah S, Helfet DL, Lorich DG. Anterior knee pain following the lateral parapatellar approach for tibial nailing. Arch Orthop Trauma Surg. 2009; 129 (6):773-777. doi: 10.1007/s00402-008-0678-7. [Google Scholar Purpose The aim of this study was to compare anterior knee pain and functional outcomes in patients who underwent intramedullary tibial nailing using transpatellar, medial parapatellar or suprapatellar nail entry methods. Methods We retrospectively reviewed patients who underwent tibial fracture repair in our clinic between January 2010 and March 2017. After applying the exclusion criteria, 58.
Purpose . Anterior knee pain (AKP) is a common complication after tibia intramedullary nailing surgery, but yet the etiology is not fully revealed. Our study had two hypotheses. The first one is after tibia intramedullary nailing with transtendinous approach, thigh muscles strength decreases and this loss of muscle strength causes AKP. Secondly, lower extremity rotational. One technique used to correct proximal tibial malalign-ment at the time of IMN is the semiextended technique described by Tornetta et al.9 This approach employs a partial medial parapatellar arthrotomy to subluxate the patella later-ally. This allows IMN insertion with the knee in approxi-mately 15 degrees of ﬂexion. Satisfactory results have. Approach. Incision. landmark. palpate midline of patella in line to tibial tubercle. make midline longitudinal incision. begin 5 cm above superior pole of the patella. extending to the level of the tibial tubercle. curved or straight incision can be used. and can be done with knee flexed INTRODUCTION Post-operative knee pain is common following intramedullary nailing of the tibia, regardless of surgical approach, though the exact source is controversial. Historically, the most common surgical approaches position the knee in hyperflexion, including patellar tendon splitting (PTS) and medial parapatellar (MPP). A novel technique, the semi-extended lateral parapatellar approach. were achieved with suprapatellar tibial nailing than with infrapatellar tibial nailing. Suprapatellar tibial intramedul-lary nailing is a safe procedure for patellofemoral joints and does not increase anterior knee pain. The type of ap-proach did not influence clinical outcomes in this study. Keywords: Suprapatellar approach, tibia fracture.
The suprapatellar nailing technique can also be used for periarticular fractures. In cases where there are ipsilateral tibial plateau and tibial shaft fractures, the plateau is reduced and fixed. femoral nailing (TFN for an intertrochanteric fracture), or tibial nailing using the parapatellar approach Stoll Retractor/Wire Guide Designed by Jordan Stoll, MD PRODUCT NO: 8012 Overall Length: 12 30,5 cm) Blade Width: .71 (1,8 cm) Prong Length: 6 mm Guide Hole Diameter: 4,5 mm FR TRL ON OST NSTRMENTS tu rie Saaa G 1.800.548.2362 wwwioedet. medial parapatellar approach may lead to valgus deformity. suprapatellar. facilitates nailing in semiextended position. technique. Use of a lateral tibial nail starting point. 8% (208/2603) 4. Use of supplementary plate and screw fixation. 2% (54/2603) 5. Use of a suprapatellar nailing portal. 32
Intramedullary Nailing of the Tibia Mark A. Lee Jonathan G. Eastman Brett Crist DEFINITION Intramedullary nailing techniques are typically used for closed and open displaced diaphyseal tibial fractures. The indications for intramedullary nailing can be extended to proximal and distal metaphyseal tibia fractures, including those associated with simple articular involvement Tornetta utilized a lateral parapatellar approach with subluxation of the patella and intra-articular nail insertion to achieve satisfactory post-operative alignment in a series of proximal 1/3 tibia fractures. 8 An extra-articular modification of this technique using either a medial or lateral parapatellar approach without violation of the. parapatellar incision,the SP approach is truly percutaneous. The main concern in its useis the potential for damage to thepatella-femoral (PF) articulation. This study was a prospective, ran-domized clinical trial designed to (1) determine whether the SP approach was equivalent to the IP approach with respect to kne Lateral parapatellar approach with tibial tubercle osteotomy for the treatment of non-correctable valgus knee osteoarthritis: a retrospective clinical study. Chalidis BE(1), Ye K(2), Sachinis NP(2), Hawdon G(2), McMahon S(2). Author information: (1)Malabar Orthopaedic Clinic, 43 The Avenue, Windsor 3181, Melbourne, Australia
Semiextended position for IM Nailing of Tibia Fractures: - Discussion: - extended medial parapatellar incision: (from Tornetta and Collins (1996)). - utilize extended medial parapatellar incision, which allow lateral subluxation of patella, and which allows more. proximal and lateral starting hole; - w/ a extended incision, hyperflexion of knee. Learn the Tibial intramedullary nailing (suprapatella approach): Synthes Expert Tibial Nail surgical technique with step by step instructions on OrthOracle. Our e-learning platform contains high resolution images and a certified CME of the Tibial intramedullary nailing (suprapatella approach): Synthes Expert Tibial Nail surgical procedure (4) The classic parapatellar and transtendon approaches are associated with postoperative anterior knee pain, which is one of the most common complaints after tibial intramedullary nailing. Court-Brown 11 found the incidence of anterior knee pain to be 56% when using the classic approach
Read the full article: http://tiny.cc/itp3kzA video to accompany the article Tibial nailing using a suprapatellar rather than an infrapatellar approach sign.. Distal Tibial Intramedullary Nailing Utilizing an Extraarticular, Lateral Parapatellar Approach in a Semiextended Position - McA 3 years ago McAndrew - This video demonstrates treatment of a distal tibial fracture with an Intramedullary nail, utilizing an extraarticular, lateral parapatellar approach with the patient in the semiextended position A medial parapatellar approach was found most likely to injure the medial meniscus, while a lateral parapatellar approach was most likely to involve the lateral articular surface. The safe zone for tibial nail insertion is located 9.1 mm (+/- 5 mm) lateral to the midline of the tibial plateau and 3 mm lateral to the center of the tibial plateau To remove a tibial IM nail, a transpatellar or parapatellar approach is used . However, it is possible to damage the soft tissue around the patella while approaching, and more damage may be caused while manipulating the knee joint to remove the nail. These injuries may increase the possibility of patella dislocation in the future
Intramedullary nailing is the procedure of choice for fractures of the tibial shaft. Proximal tibial fractures are noted to produce deformities when an IM nail is used. There are deforming forces in the proximal tibia (patellar tendon), also the wide intramedullary canal of the proximal tibia contributes to the deformity The conventional infrapatellar approach to intramedullary nailing of tibial fractures adopts the supine high-flexion knee position. However, this has disadvantages including difficulty in obtaining the proximal tibial anteroposterior view during intraoperative fluoroscopy, prolonged duration of fluoroscopy. Accordingly, the present study investigated the utility of the lateral position in the. The Expert Tibial Nail is indicated for fractures in the tibial shaft 10 Synthes Expert Tibial Nail Surgical technique 4 Approach Make an incision in line with the central axis of the intra- this incision can be transpatellar, medial or even lateral parapatellar. The incision starts proximally at the distal third of the patella along. Infrapatellar Approach Intramedullary Nailing. Surgeons will be allowed to use any size intramedullary tibial nail through an infrapatellar incision using either a medial parapatellar approach or a transpatellar approach. The knee will then be scanned using T1Rho MRI at 2 weeks postoperatively and 6 months postoperatively Suprapatellar Approach. Phoenix Suprapatellar Approach. Step 9. Nail Assembly Attach the Suprapatellar Driver Handle (Catalog #SSI000229) to the proximal aspect of the tibial nail, ensure the slope is . anterior and the three tangs on the underside of the Driver Handle engage with the three slots of the nail. Place th
The medial parapatellar approach for TKA is indicated for both primary and revision TKA cases. Variations in pathologic morphology may include varus or valgus deformity, patella alta or patellar infera, and previous tibial or femoral osteotomy. It can be used regardless of preoperative range of motion If the address matches an existing account you will receive an email with instructions to retrieve your usernam Infrapatellar Approach Surgical Technique DePuy Synthes 16 2C Monitor the nail passage across the fracture; control in two planes to avoid malalignment. Insert the nail until it is at or below the tibial opening. Check fi nal nail position in AP and lateral views. Precaution:To use the hammer, attach the drivin