Improved Outcomes With Semi-extended Nailing of Tibial Fractures? A Systematic Review.

OBJECTIVE: To systematically review the existing literature to determine whether knee pain and function following intramedullary nailing of tibial shaft fractures differs significantly by surgical technique-specifically with semi-extended nailing versus traditional infrapatellar approaches.

DATA SOURCE: A comprehensive search of PubMed/MEDLINE, EMBASE, and the Cochrane Database was conducted on August 15, 2018.

STUDY SELECTION: We included level I-level III studies that examined outcomes of tibial intramedullary nailing utilizing a semi-extended technique. All included studies reported Lysholm Knee Scores with minimum clinical follow-up of 1 year. Non-English language literature and studies older than 20 years were not included.

DATA EXTRACTION: Data from each study were independently recorded by 2 reviewers.

DATA SYNTHESIS: Two prospective, randomized trials and 4 retrospective cohort studies were included in this review. A meta-analysis was not performed.

CONCLUSIONS: Evidence comparing postoperative knee pain and functional outcomes between semi-extended and traditional infrapatellar nailing is limited. Available literature suggests satisfactory outcomes with semi-extended nailing. The highest level of evidence available does indicate improved pain and function with semi-extended nailing as compared to infrapatellar nailing. Additional research may be required to reach consensus conclusions.

LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.