TY - JOUR
T1 - Retropatellar technique for intramedullary nailing of proximal tibia fractures
T2 - A cadaveric assessment
AU - Eastman, Jonathan
AU - Tseng, Susan
AU - Lo, Eddie
AU - Li, Chin Shang
AU - Yoo, Brad
AU - Lee, Mark
PY - 2010/11
Y1 - 2010/11
N2 - 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.
AB - 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.
KW - intramedullary nailing
KW - proximal tibia fractures
KW - retropatellar
KW - suprapatellar
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U2 - 10.1097/BOT.0b013e3181c1d675
DO - 10.1097/BOT.0b013e3181c1d675
M3 - Article
C2 - 20926965
AN - SCOPUS:78049285765
SN - 0890-5339
VL - 24
SP - 672
EP - 676
JO - Journal of orthopaedic trauma
JF - Journal of orthopaedic trauma
IS - 11
ER -