Tibial nailing using a suprapatellar rather than an infrapatellar approach significantly reduces anterior knee pain postoperatively: a multicentre clinical trial

AIMS

The aim of this study was to compare the incidence of anterior knee pain after antegrade tibial nailing using suprapatellar and infrapatellar surgical approaches.

PATIENTS AND METHODS

A total of 95 patients with a tibial fracture requiring an intramedullary nail were randomized to treatment using a supra- or infrapatellar approach. Anterior knee pain was assessed at four and six months, and one year postoperatively, using the Aberdeen Weightbearing Test - Knee (AWT-K) score and a visual analogue scale (VAS) score for pain. The AWT-K is an objective patient-reported outcome measure that uses weight transmitted through the knee when kneeling as a surrogate for anterior knee pain.

RESULTS

A total of 53 patients were randomized to a suprapatellar approach and 42 to an infrapatellar approach. AWT-K results showed a greater mean proportion of weight transmitted through the injured leg compared with the uninjured leg when kneeling in the suprapatellar group compared with the infrapatellar group at all timepoints at all follow-up visits. This reached significance at four months for all timepoints except 30 seconds. It also reached significance at six months at 0 seconds, and for one year at 60 seconds.

CONCLUSION

The suprapatellar surgical approach for antegrade tibial nailing is associated with less anterior knee pain postoperatively compared with the infrapatellar approach Cite this article: Bone Joint J 2019;101-B:1138-1143.

Synthesis and characterization of Zinc/Chitosan-Folic acid complex

Therapeutic drug delivery systems using polymeric materials is an emerging field of research. However, the use of certain polymers has gained much-needed attention by the researchers due to their low toxic nature. In recent years, chitosan has gained popularity as a potential biodegradable polymer that can be used as a component in drug delivery systems. In this study, we synthesized a chitosan derivative that is composed of both folic acid and zinc and may serve as a viable component of a drug delivery system. The results of Fourier Transform Infrared Spectroscopy (FTIR), solid-state 13C Nuclear Magnetic Resonance Spectroscopy (NMR) and UV-visible Spectroscopy demonstrated a substantial difference between chitosan and ZnS/Chitosan-Folic acid derivative. The results were also confirmed using Thermogravimetric Analysis (TGA) and Scanning Electron Microscopy/Energy Dispersive X-ray Spectroscopy (SEM-EDS) techniques. The average particle size of the ZnS/Chitosan-Folic acid system was measured to be 463.67 ± 5.76 nm, showing that the product is within the nano-size range.