Suprapatellar Versus Infrapatellar Approach for Intramedullary Nailing of Tibial Shaft Fractures: A Comparative Analysis of Clinical and Functional Outcomes

Background With the increasing adoption of the suprapatellar approach for intramedullary tibial nailing in diaphyseal tibial fractures, this study compared intraoperative and postoperative outcomes between infrapatellar nailing (IPN) and suprapatellar nailing (SPN). Methods A retrospective analysis was conducted on 51 SPN and 58 IPN procedures performed at a single trauma center between October 2018 and June 2023. Operative time, postoperative blood loss, functional outcomes using the Lysholm score, and the incidence of anterior knee pain (AKP) at follow-up were compared. Results There were no significant differences in age or sex between the groups. Mean follow-up was 36.74 ± 18.11 months for SPN and 35.98 ± 15.11 months for IPN. Mean operative time was significantly shorter in the SPN group (79.7 ± 34.0 min) compared to the IPN group (91.9 ± 36.0 min, p < 0.05). The SPN group showed significantly higher Lysholm scores (89.45 ± 9.2 vs. 85.1 ± 10.5, p = 0.017) and a lower incidence of AKP. No significant difference was observed in postoperative blood loss. Conclusion Compared to the IPN approach, SPN for diaphyseal tibial fractures may reduce operative time, decrease the incidence of AKP, and improve postoperative functional outcomes.