Comparison of Functional Recovery Following Medial Parapatellar and Transpatellar Approaches for Intramedullary Nailing of Tibial Shaft Fractures

Tibial shaft fractures are common long-bone injuries that frequently require operative fixation, particularly when the fracture is displaced or associated with significant soft-tissue injury. Intramedullary interlocking nailing is widely used because it provides stable fixation while allowing early mobilization and weight-bearing.

The surgical approach used to access the proximal tibia for intramedullary nail insertion may influence postoperative knee symptoms and functional recovery. The medial parapatellar and transpatellar approaches are commonly used techniques; however, previous comparative studies have reported inconsistent findings regarding postoperative pain, knee function, and range of motion.

This randomized controlled trial will compare functional recovery following intramedullary nailing of tibial shaft fractures using the medial parapatellar approach versus the transpatellar approach. Eligible participants will be randomly allocated in a 1:1 ratio to one of the two surgical approach groups.

Participants will undergo static interlocked intramedullary nailing performed by experienced orthopedic surgeons according to standardized operative and postoperative protocols. The surgical approach will be the primary difference between the two intervention groups.

The primary outcome will be functional recovery assessed using the Lower Extremity Functional Scale (LEFS). Secondary outcomes will include postoperative pain assessed using the Numeric Pain Rating Scale (NPRS) and knee range of motion assessed using a universal goniometer. Outcome assessments will be performed at 4 and 8 weeks after surgery.

Baseline demographic and clinical characteristics, including age, sex, body mass index, time from injury to surgery, and Gustilo-Anderson fracture classification, will also be recorded.

The study will include 56 participants, with 28 participants allocated to each treatment group. Participants will be adults aged 18 to 60 years with acute tibial shaft fractures meeting the predefined eligibility criteria.

The study will evaluate whether the choice of surgical approach is associated with differences in early postoperative functional recovery, pain, and knee mobility. The findings may provide comparative evidence to support surgical decision-making and postoperative rehabilitation following intramedullary nailing of tibial shaft fractures.

Inclusion criteria

• Adults aged 18 to 60 years, irrespective of sex.
• Patients with an acute tibial shaft fracture confirmed by radiographic examination.
• Gustilo-Anderson type I, II, or IIIA open fractures.
• Patients who are eligible for intramedullary interlocking nailing according to the treating orthopedic surgeon.
• Patients willing and able to provide written informed consent.

Exclusion criteria

• Previous fracture or surgery involving the affected tibia.
• Osteoporosis or other conditions significantly affecting bone healing.
• Diabetes mellitus, peripheral vascular disease, autoimmune disorders, or other systemic conditions that may adversely affect bone healing or postoperative recovery.
• Neurovascular injury involving the affected limb.