Comparative Analysis of Suprapatellar and Infrapatellar Nailing in Tibial Fracture: A Randomized Clinical Study.

Introduction: Tibial fractures are among the most frequently encountered long-bone injuries requiring surgical management. The conventional infrapatellar (IP) approach for intramedullary nailing (IMN) is associated with challenges, such as difficulty in position holding the reduction and post-operative knee pain. The suprapatellar (SP) approach has emerged as an alternative, potentially offering ease in the intraoperative position of the limb, holding the reduction and better functional outcomes with less knee pain. This study aims to compare the functional and radiological outcomes, as well as complication rates, between SP and IP approaches for tibial shaft IMN. Materials and Methods: This randomized controlled trial included 85 patients with tibial shaft fractures, allocated to either SP (n = 40) or IP (n = 45) groups. All underwent closed reduction and internal fixation using IMN. Functional outcomes were assessed using the Visual Analog Scale (VAS) and Lysholm scores, while radiological outcomes were measured using the Radiographic Union Scale for Tibia (RUST) and alignment parameters. Evaluations were performed at post-operative day 2, 2 weeks, 6 weeks, 12 weeks, and 6 months. Results: There was no statistically significant difference in age, gender, fracture type, or AO classification between the groups. RUST scores and fracture alignment were comparable across all time points. The SP group demonstrated significantly lower VAS scores at 6 weeks, 12 weeks, and 6 months (P < 0.001) and higher Lysholm scores at corresponding intervals (P < 0.001). The mean time to union was marginally shorter in the SP group (19.27 weeks) than the IP group (20.13 weeks), though not statistically significant (P = 0.342). Post-operative complications, including anterior knee pain, were lower in the SP group (5%) compared to the IP group (26.7%). Conclusion: The SP approach for tibial IMN yields superior early functional outcomes and reduced anterior knee pain without compromising radiological healing or alignment. These findings support its broader use, especially where early mobilization and patient comfort are priorities. Long-term studies are warranted for further validation.