Operative Outcome of Proximal Tibial Fractures Treated with Intramedullary Tibial Nailing Using the Suprapatellar Approachin Adults: A Prospective Study

Background: Proximal-third tibial fractures are challenging to stabilize because of metaphyseal flare and deforming forces around the knee. The suprapatellar approach permits intramedullary nail insertion with the knee in a semi-extended position and may facilitate alignment. This study evaluated clinical, radiological, and functional outcomes after suprapatellar intramedullary nailing in adults with proximal tibial fractures.Materials and Methods: This prospective study included 30 adults with proximal tibial metaphyseal or diaphyseal fractures treated at G K General Hospital, Bhuj, from April 2024 to September 2025. Patients aged >18 years who were medically fit for surgery were included; open, intra-condylar, pathological, peri-implant fractures and fractures with neurovascular deficits were excluded. All patients underwent suprapatellar intramedullary tibial nailing. Patients were followed for a minimum of 6 months and assessed clinically, radiologically, and functionally using the Lysholm Knee Scoring System.Results: The largest age group was 31–40 years (33.3%); 24 patients (80%) were male. Right-sided fractures accounted for 60%. Road traffic accidents were the most common mechanism (63.3%). AO/OTA type 42C was the most frequent (11/30, 36.7%). The mean final Lysholm score was 89.6. Excellent, good, fair, and poor outcomes were observed in 33.3%, 46.7%, 13.3%, and 6.7% of patients, respectively. The mean radiological union time was 14.8 weeks. Reported complications included anterior knee pain (6.7%), malalignment (3.3%), superficial infection (3.3%), delayed union (6.7%), and knee stiffness (6.7%).Conclusion: In this 30-patient prospective series, suprapatellar intramedullary nailing of proximal tibial fractures was associated with satisfactory fracture union and predominantly good to excellent functional outcomes at a minimum 6-month follow-up.