Functional and Radiological Outcomes in Adults with Proximal Tibia Fractures Treated with Intramedullary Interlocking Nail by Suprapatellar Technique: A Prospective Observational Study.

Abstract

Background: To evaluate the functional and radiological outcomes of adults with selected proximal tibial fractures treated with intramedullary interlocking nailing using the suprapatellar technique. Methods: A prospective observational study was conducted in the Department of Orthopaedics at R.N.T. Medical College and Maharana Bhupal Government Hospital, Udaipur, from April 2024 to March 2025. Twenty-four adults aged 18–50 years with closed proximal tibial fractures classified as AO/OTA 41A2, 41A3, or 41B1 were included. All patients underwent intramedullary interlocking nailing through a suprapatellar approach with the knee maintained in a semi-extended position. Functional and radiological outcomes were assessed using the Knee Society Score, clinical examination, and serial radiographs.   Results: The study included 14 males (58.3%) and 10 females (41.7%), with a mean age of 33.87 years. Road traffic accidents accounted for 20 cases (83.3%), and AO/OTA 41A2 was the most common fracture pattern, affecting 14 patients (58.3%). The mean operative time was 45.3 minutes, the mean hospital stay was 8.2 days, and the mean fracture union time was 14.5 weeks. At 3 months, 7 patients (29.1%) had excellent, 9 (37.5%) good, 5 (20.8%) fair, and 3 (12.5%) poor functional outcomes. At 6 months, 20 patients (83.3%) had excellent, 2 (8.3%) good, 1 (4.2%) fair, and 1 (4.2%) poor outcomes. Two patients developed postoperative knee stiffness, and one developed proximal screw loosening. No loss of reduction or progressive displacement was reported.   Conclusion: Suprapatellar intramedullary interlocking nailing in the semi-extended position was associated with satisfactory functional and radiological outcomes in this small series of selected proximal tibial fractures.   Recommendation: Larger multicentre comparative studies with standardized radiological measurements and longer follow-up are recommended to further evaluate the effectiveness and safety of the suprapatellar technique.