Retropatellar technique for intramedullary nailing of proximal tibia fractures

A cadaveric assessment

Jonathan Eastman, Susan Tseng, Eddie Lo, Chin Shang Li, Brad Yoo, Mark Lee

Research output: Contribution to journalArticle

43 Citations (Scopus)

Abstract

Objective: To investigate if the radiographically correct and anatomically safe starting point and the appropriate sagittal plane vector could be obtained using a retropatellar technique for proximal tibia fractures treated with an intramedullary device. Methods: We performed a cadaveric and radiographic study utilizing 16 limbs. We performed a retropatellar approach via longitudinal quadriceps split, passed a specialized trocar through the patellofemoral joint and onto the superior aspect of the tibia, and inserted Kirschner wires into the anatomic safe zone of the tibial plateau at 0, 10, 20, 30, 40, and 50 degrees of knee flexion utilizing biplanar fluoroscopy. We recorded knee flexion with a goniometer and the entrance vector of the Kirschner wire in relation to the anterior tibial cortex. Setting: University-affiliated cadaver and anatomy laboratory. Results: There was a progressive increase in the ability to obtain the correct anatomical start site from 1 of 16 (6.25%) at full extension to 12 of 16 (75%) at 50 degrees of knee flexion (P = 0.00098). A statistically significant decrease in the average sagittal plane entrance vector in relation to the anterior tibial cortex was found from 23.1 degrees at full extension to -0.41 degrees at 50 degrees of knee flexion (P <0.0001). Conclusions: The retropatellar technique allows the radiographically defined correct start site to be localized, particularly at higher degrees of knee flexion. More favorable intramedullary nail insertion angles were possible with the retropatellar technique, particularly with knee flexion angles greater than 20 degrees. The retropatellar technique demands further investigations to further delineate its advantages, limitations, and possible risks to local anatomy.

Original languageEnglish (US)
Pages (from-to)672-676
Number of pages5
JournalJournal of Orthopaedic Trauma
Volume24
Issue number11
DOIs
StatePublished - Nov 2010
Externally publishedYes

Fingerprint

Intramedullary Fracture Fixation
Tibia
Knee
Bone Wires
Anatomy
Patellofemoral Joint
Fluoroscopy
Nails
Cadaver
Surgical Instruments
Extremities
Equipment and Supplies

Keywords

  • intramedullary nailing
  • proximal tibia fractures
  • retropatellar
  • suprapatellar

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Retropatellar technique for intramedullary nailing of proximal tibia fractures : A cadaveric assessment. / Eastman, Jonathan; Tseng, Susan; Lo, Eddie; Li, Chin Shang; Yoo, Brad; Lee, Mark.

In: Journal of Orthopaedic Trauma, Vol. 24, No. 11, 11.2010, p. 672-676.

Research output: Contribution to journalArticle

Eastman, Jonathan ; Tseng, Susan ; Lo, Eddie ; Li, Chin Shang ; Yoo, Brad ; Lee, Mark. / Retropatellar technique for intramedullary nailing of proximal tibia fractures : A cadaveric assessment. In: Journal of Orthopaedic Trauma. 2010 ; Vol. 24, No. 11. pp. 672-676.
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