DEPARTMENT SCIENTIFIC

COMMITTEE
IOT, MADRAS MEDICAL COLLEGE,
RGGGH
Investigator: S.Kiran Kumar
MS Orthopaedics 1st year PG,
MMC,RGGGH,Chennai -3

Guide: Prof.M.Antony Vimal Raj

Professor of orthopaedics,
Institute of Orthopaedics and Traumatology,
MMC, RGGGH, Chennai- 3

Co guide: Dr.Aravind,
Assistant Professor of Orthopaedics,
Institute of Orthopaedics and Traumatology,
MMC, RGGGH, Chennai- 3
To assess the clinical and
radiological outcome of
semiextended intramedullary nailing
of the tibial fracture using a
suprapatellar approach on stiff knee.
Design of study
• Duration:2 years(2023-2025)
• Prospective study
• Study population:All type of tibial shaft fracture
with knee stiffness.
• Sample size:
• Study centre: Institute of orthopaedics and
Traumatology,MMC , RGGGH
Inclusion criteria
• Age above 18 years
• Closed/open tibial shaft fracture with knee
stiffness- flexion less than 90°
• After longterm cast immobilisation for tibia fracture
with knee stiffness.
• After long term knee spanning external fixator with
tibial fracture with knee stiffness.
• Patient willing for surgery and follow up.
Exclusion criteria
• Patient not willing to participate in study.
• Fracture extending into the joint.
• No evidence of knee stiffness.
• Infection in the knee joint.
Steps
• Patient in supine position.
• Injured limb is positioned with roll under the knee
joint.
• A 1.5 to 2cm longitudinal skin incision made 1cm
above the base of patella.
• Quadriceps tendon exposed and splitted.
• Sleeve and trochar placed.
• Entry made and serial reaming done.
• Nail fixed.
Position – Semiextended
Skin incision
Splitting quadriceps tendon
Insertion of protective sleeve
Lateral view
Variable for analysis -
Intraoperatively
A.Ease of technique(Suprapatellar than infrapatellar)
• Duration of surgery in minutes.
• Number of C-arm short required.
• Blood loss during surgery(with number of gauze
pad soaked)
• Ease of fracture reduction.
• If there is need for conversion of closed to open
reduction.
B.Followup outcome variable.

Subjective:
• Functional score – SF-36 and Lysholm score.
• Visual analog score for knee pain.
Objective:
• Full weight bearing without support
• Radiological score- RUST Score(3months,6months,1
year)
Lysholm score
SF- 36 score
RUST score
VAS score
Post op protocol
• Early weight bearing as tolerated by patient.
• Early passive knee mobilisation.
• Quadricepes strengthening exercises.
• Knee should be kept in flexed position with pillow.
Reference article
THANK YOU SIR