• Cong Wang, Erman Chen, Chenyi Ye, and Zhijun Pan.
• Department of Orthopedics, Second Affiliated Hospital, School of Medicine, Zhejiang University, 310000, Hangzhou, People's Republic of China.
• Int J Surg. 2018 Mar 1; 51: 133-139.

ObjectiveThis meta-analysis was performed to determine the efficacy of suprapatellar versus infrapatellar approach for tibia intramedullary nailing (IMN).MethodsA systematic search was performed in PubMed, Embase, Cochrane library, CNKI and Wanfang. Cochrane collaboration's tool and the Newcastle-Ottawa scale were used to evaluate literature qualities. Meta-analysis was performed using RevMan 5.3 software.ResultsEight studies were eligible, including two randomized controlled trials (RCTs) and six retrospective cohort trials. There were no significant differences between suprapatellar and infrapatellar approaches in operation time, coronal plane alignment, and incidence of postoperative deep infection, nonunion and secondary operation. However, suprapatellar nailing achieved a significant shorter fluoroscopy time, less VAS pain score, better sagittal plane alignment and lower incidence of angular malalignment. Though pooled results indicated no significant difference in terms of final follow-up knee functional score, the RCT subgroup analysis showed that a higher knee functional score existed in suprapatellar group.ConclusionsFor tibia IMN, suprapatellar approach might be superior to infrapatellar approach with shorter fluoroscopy time, less knee pain, better knee function recovery, and more accurate fracture reduction. Meanwhile, no increased risk of postoperative complications was identified. More RCTs are required for further research.Copyright © 2018 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

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