Suprapatellar Nailing of the Tibia: Indications, Advantages, Disadvantages, Surgical tips and tricks

Vol 02 | January 2021 | page: 08-11 | Saurav N. Nanda, Saswat Samant, Govind VJ, Ashok Gachhayat, Sumanyu Kumar Tripathy, Debashish Mishra


Authors: Saurav N. Nanda [1], Saswat Samant [1], Govind VJ [1], Ashok Gachhayat [1], Sumanyu Kumar Tripathy [1], Debashish Mishra [1]

[1] Department of Orthopaedics, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India.

Address of Correspondence

Dr. Saurav N. Nanda,
Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India.


Extra-articular proximal tibial fractures account for approximately 10% of all tibial fractures. In proximal tibial shaft fractures, surgeons have struggled with inadequate maintenance of reduction, suboptimal reaming, and poor placement of the nail resulting in malalignment and further complications.The primary indication for suprapatellar nailing is probably an extra-articular proximal tibia fracture. Suprapatellar intramedullary nailing is a safe and easy method for treating extra-articular proximal tibia fractures without causing malalignment and without resorting to additional fixation methods.

Keywords: Suprapatellar nailing; Proximal tibia fracture; Nailing techniques.


1. Court-Brown CM, McBirnie J. The epidemiology of tibial fractures. J Bone Joint Surg Br 1995;77:417–21.
2. Attal R, Hansen M, Kirjavainen M, Bail H, Hammer O, Rosenberger R, et al. A multicenter case series of tibia fractures treated with the Expert Tibia Nail (ETN). Arch Orthop Trauma Surg 2012;132:975–84.
3. Tornetta P, Collins E. Semiextended position of intramedullary nailing of the proximal tibia. Clin Orthop Relat Res 1996;328:185–9.
4. Franke J, Hohendorff B, Alt V, Thormann U, Schnettler R. Suprapatellar nailing of tibial fractures–Indications and technique. Injury. 2016;47(2):495-501.
5. Tornetta P, 3rd, Riina J, Geller J, et al. Intra Articular anatomic risks of tibial nailing. J Orthop Trauma 1999;13:247–51
6. Cole JD. Distal tibia fracture: Opinion: intramedullary nailing. J Orthop Trauma 2006;20:73–4
7. Chen X, Xu HT, Zhang HJ, Chen J. Suprapatellar versus infrapatellar intramedullary nailing for treatment of tibial shaft fractures in adults. Medicine (Baltimore). 2018;97(32):e11799.
8. Morandi M, Banka T, Gaiarsa GP, Guthrie ST, Khalil J, Hoegler J, Lindeque BG. Intramedullary nailing of tibial fractures: review of surgical techniques and description of a percutaneous lateral suprapatellar approach. Orthopedics. 2010;33(3):172–9.
9. Song SY, Chang HG, Byun JC, Kim TY. Anterior knee pain after tibial intramedullary nailing using a medial paratendinous approach. J Orthop Trauma. 2012;26(3):172–7.
10. Jang Y, Kempton LB, TO MK, Sorkin AT. Insertion-related pain with intramedullary nailing. Injury. 2017;48(Suppl 1):S18–21.
11. Leliveld MS, Verhofstad MH. Injury to the infrapatellar branch of the saphenous nerve, a possible cause for anterior knee pain after tibial nailing? Injury. 2012;43(6):779–83.
12. Courtney PM, Boniello A, Donegan D, Ahn J, Mehta S. Functional knee outcomes in infrapatellar and suprapatellar tibial nailing: does approach matter? Am J Orthop. 2015;44(12):E513–6.
13. Gaines RJ, Rockwood J, Garland J, Ellingson C, Demaio M. Comparison of insertional trauma between suprapatellar and infrapatellar portals for tibial nailing. Orthopedics. 2013;36(9):e1155–8.
14. Chan DS, Serrano-Riera R, Griffing R, Steverson B, Infante A, Watson D, Sagi HC, Sanders RW. Suprapatellar versus infrapatellar tibial nail insertion: a prospective randomized control pilot study. J Orthop Trauma. 2016;30(3):130–4.
15. Lysholm J, Gillquist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med. 1982;10(3):150–4.
16. Yang, L., Sun, Y. & Li, G. Comparison of suprapatellar and infrapatellar intramedullary nailing for tibial shaft fractures: a systematic review and meta-analysis. J Orthop Surg Res 13, 146 (2018).
17. Brink O. Suprapatellar nailing of tibial fractures: surgical hints. Current orthopaedic practice. 2016;27(1):107–12.
18. Wang Z, Li SL, Wang XY, et al. Supra-patellar versus infra-patellar intramedullary nailing in treatment of tibial shaft fractures. China J Orthop Trauma 2016;18:283–9.
19. Hessmann, M.H., Buhl, M., Finkemeier, C. et al. Suprapatellar nailing of fractures of the tibia. Oper Orthop Traumatol (2020).

How to Cite this Article: Nanda SN, Samant S, Govind VJ, Gachhayat A, Tripathy SK, Mishra D | Suprapatellar Nailing of the Tibia: Indications, Advantages, Disadvantages, Surgical tips and tricks | Odisha Journal of Orthopaedics and Trauma | January 2021; 02: 08-11.

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