Comparison of Suprapatellar and Infrapatellar Approaches for Tibia Intramedullary Nailing: Meta-Analysis

Introduction: Tibia fractures, comprising approximately 2% of all fractures, are common diaphyseal fractures. IMN is the standard surgical treatment. Suprapatellar (SP) nailing is advised for proximal fractures to minimize mal-reduction risk and potentially alleviate post-IMN anterior knee pain. This study seeks a comprehensive assessment of the Suprapatellar and Infrapatellar approaches in tibia fracture treatment, evaluating clinical and functional outcomes. Method: Systematic review and meta-analysis were conducted using PRISMA guidelines. Literature was searched through PubMed, Google Scholar, Science Direct and Cochrane Library using Boolean operators. The outcomes assessed included clinical and functional outcome, namely pain after operation, knee functional score and operation time. Result: From 108 studies obtained, after full-text review, 9 studies included in the systematic review. Total sample range was 50-190 patients with mean age 30-45 years old. The number of male patients were higher than female. Discussion: The results of the meta-analysis revealed that suprapatellar IMN reduces the incidence of knee pain and the average malalignment of fracture compared to infrapatellar IMN. There was also compared postoperative function between supra and infrapatellar approaches for antegrade nailing of tibial fractur and found no significant difference and no difference compared to IP IMN with operation time Conclusion: There is significant difference between the two groups in terms of their knee pain after the surgery and the functional outcome. The decision to perform which surgery relies on the surgeon’s preference and the availability of the instruments. Keywords: Tibia Fracture, Intramedullary Nailing, Suprapatellar Approach, Infrapatellar Approach