Abstract
This ongoing prospective RCT compares two surgical approaches with respect to accuracy of guidewire and tibial nail position.
29 patients with tibial fractures were randomised to semi-extended (SE) or standard (S) approaches of tibial nail insertion. Fluoroscopy obtained guidewire and final nail position. The SE approach is more proximal with the guidewire inserted posterior to the patella, theoretically allowing more accurate wire and nail placement.
Measurements were taken in both planes of the nail and guidewire to determine deviation from optimum angle of insertion (relative to the long axes of the tibial shaft).
14 and 15 patients were treated with semi-extended and standard approaches respectively.
The semi-extended approach results in better guidewire and nail placement in both planes with mean deviation from the optimal angle of insertion as below:
Guidewire AP 4.5° (SE) versus 4.04° (S) Lateral 24.59° (SE) versus 33.36° (S)
Nail AP 3.21° (SE) versus 3.68° (S) Lateral 17.73° (SE) versus 24.04° (S)
Anterior knee pain may be due to excessive anterior placement of the nail. We assessed anterior placement of the guidewire and nail in the lateral plane. This was expressed as a percentage from the anterior cortex of the tibia. Mean results are below:
Guidewire 9.7% (SE) versus 9.3% (S)
Nail 19.5% (SE) versus 16.3% (S)
Semi-extended nailing may allow for better guidewire position and as such nail placement. This may reduce anterior knee pain.
