Bleeker, N.J. (2020) Difference in Pain, Complication Rates and Clinical Outcomes after Suprapatellar vs. Infrapatellar Nailing for Tibia Fractures? A Systematic Review. thesis, Medicine.
Full text available on request.Abstract
Tibia fractures are the most common long bone fractures in Orthopaedic Trauma. The preferred treatment is intramedullary nailing which can be performed with the traditional infrapatellar (IP) approach or relatively new suprapatellar (SP) approach. The aim was to assess the effectiveness of the IP-approach versus the SP-approach in terms of anterior knee pain, complications (including retropatellar chondropathy, infection, malalignment) and physical functioning as well as quality of life. A clinical question-driven and thorough systematic review of current literature was provided. PubMed and Embase databases were searched for studies published between 2010 and 2020 relating to SP-nailing and IP-nailing. Studies eligible for inclusion were randomized controlled trials (RCTs) and observational studies reporting on outcomes of interest. Data extraction was performed independently by two assessors and methodological quality and risk of bias was assessed according to the guidelines of the McMaster Critical Appraisal. Continuous variables were presented as means with standard deviation (SD) and dichotomous variables as frequency and percentages. The weighted mean, standardized weighted mean differences (SMD) and 95%CI were calculated. A pooled analysis could not be performed due to differences in outcome measures, time-points and heterogeneity. A total of 14 studies with 1447 patients were analyzed. The weighted incidence of anterior knee pain was 29% after SP-nailing and 39% after IP-nailing, without reported statistically significance. Furthermore, there was a significant lower rate of malalignment after the SP-approach (5% vs. 27%). Although, the absolute differences were small and clinically irrelevant. No substantial differences were observed in retropatellar chondropathy, infection, physical functioning and quality of life. This systematic review does not reveal superiority of either technique in any of the respective outcomes of interest. Definitive choice should depend on the surgeon’s experience, available resources and patient’s preference.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | IJpma, MD PhD, F.F.A. and Reininga, MSc PhD, I.H.F. |
| Faculty: | Medical Sciences |
| Date Deposited: | 18 Aug 2023 11:34 |
| Last Modified: | 18 Aug 2023 11:34 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/3635 |
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