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Intramedullary nailing of open tibia and femur fractures through the supra & infrapatellar approach. Is septic arthritis a real concern?

Background: A theoretical risk exists concerning the development of septic arthritis in the knee following the utilisation of intramedullary nailing techniques. These techniques encompass the supra/infrapatellar approach during tibial nailing and the retrograde approach during femoral nailing. This...

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Main Author: Armas, Selma
Other Authors: Maqungo, Sithombo
Format: Thesis
Language:English
English
Published: Division of General Surgery 2025
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access_status_str Open Access
author Armas, Selma
author2 Maqungo, Sithombo
author_browse Armas, Selma
Maqungo, Sithombo
author_facet Maqungo, Sithombo
Armas, Selma
author_sort Armas, Selma
collection Thesis
description Background: A theoretical risk exists concerning the development of septic arthritis in the knee following the utilisation of intramedullary nailing techniques. These techniques encompass the supra/infrapatellar approach during tibial nailing and the retrograde approach during femoral nailing. This potential risk stems from the mechanical bridging of the knee joint in both methodologies. The susceptibility to this risk increases notably in cases involving open fractures, as all associated wounds are deemed contaminated. Consequently, the potential introduction of infection into the knee joint consistently remains a concern for the surgeon performing these procedures. Methods: All instances of open fractures involving the tibia and femur, categorised according to the Gustillo Anderson classification as grades 1 through 3C, within the timeframe spanning from January 2017 to December 2018, were identified. Inclusion criteria encompassed cases where fracture fixation was accomplished utilising the retrograde femur intramedullary nail (IMN) approach and the suprapatellar approach for tibial fractures. Recorded cases underwent a comprehensive 12-month follow-up period, during which clinical evaluation for evidence of union and any indications of infection at both the surgical and fracture wound sites (FRI) was conducted. Findings: The study included a total of 116 open fracture cases that met the inclusion criteria, comprising 34 cases of femur fractures and 82 cases of tibia fractures. No instances of septic knee arthritis were detected within this cohort. Conclusion: Within both the femur and tibia open fracture groups subjected to treatment involving the use of intramedullary nails via a through-the-knee surgical approach, the study found no reported septic knee arthritis cases. Revealing that septic arthritis of the knee post retrograde femur nailing and/or suprapatellar tibia nail fixation may not be a real concern.
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language English
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last_indexed 2026-06-10T12:40:07.564Z
license_str Not specified — see source repository
provenance_str_mv Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository
publishDate 2025
publishDateRange 2025
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spelling oai:open.uct.ac.za:11427/42063 Intramedullary nailing of open tibia and femur fractures through the supra & infrapatellar approach. Is septic arthritis a real concern? Armas, Selma Maqungo, Sithombo Laubscher, Maritz septic knee arthritis open fractures retrograde femur IMN suprapatellar IMN infections FRI Background: A theoretical risk exists concerning the development of septic arthritis in the knee following the utilisation of intramedullary nailing techniques. These techniques encompass the supra/infrapatellar approach during tibial nailing and the retrograde approach during femoral nailing. This potential risk stems from the mechanical bridging of the knee joint in both methodologies. The susceptibility to this risk increases notably in cases involving open fractures, as all associated wounds are deemed contaminated. Consequently, the potential introduction of infection into the knee joint consistently remains a concern for the surgeon performing these procedures. Methods: All instances of open fractures involving the tibia and femur, categorised according to the Gustillo Anderson classification as grades 1 through 3C, within the timeframe spanning from January 2017 to December 2018, were identified. Inclusion criteria encompassed cases where fracture fixation was accomplished utilising the retrograde femur intramedullary nail (IMN) approach and the suprapatellar approach for tibial fractures. Recorded cases underwent a comprehensive 12-month follow-up period, during which clinical evaluation for evidence of union and any indications of infection at both the surgical and fracture wound sites (FRI) was conducted. Findings: The study included a total of 116 open fracture cases that met the inclusion criteria, comprising 34 cases of femur fractures and 82 cases of tibia fractures. No instances of septic knee arthritis were detected within this cohort. Conclusion: Within both the femur and tibia open fracture groups subjected to treatment involving the use of intramedullary nails via a through-the-knee surgical approach, the study found no reported septic knee arthritis cases. Revealing that septic arthritis of the knee post retrograde femur nailing and/or suprapatellar tibia nail fixation may not be a real concern. 2025-10-30T11:25:12Z 2025-10-30T11:25:12Z 2025 2025-10-30T11:22:00Z Thesis / Dissertation Masters MMed http://hdl.handle.net/11427/42063 en eng application/pdf Division of General Surgery Faculty of Health Sciences University of Cape Town
spellingShingle septic knee arthritis
open fractures
retrograde femur IMN
suprapatellar IMN
infections
FRI
Armas, Selma
Intramedullary nailing of open tibia and femur fractures through the supra & infrapatellar approach. Is septic arthritis a real concern?
thesis_degree_str Master's
title Intramedullary nailing of open tibia and femur fractures through the supra & infrapatellar approach. Is septic arthritis a real concern?
title_full Intramedullary nailing of open tibia and femur fractures through the supra & infrapatellar approach. Is septic arthritis a real concern?
title_fullStr Intramedullary nailing of open tibia and femur fractures through the supra & infrapatellar approach. Is septic arthritis a real concern?
title_full_unstemmed Intramedullary nailing of open tibia and femur fractures through the supra & infrapatellar approach. Is septic arthritis a real concern?
title_short Intramedullary nailing of open tibia and femur fractures through the supra & infrapatellar approach. Is septic arthritis a real concern?
title_sort intramedullary nailing of open tibia and femur fractures through the supra amp infrapatellar approach is septic arthritis a real concern
topic septic knee arthritis
open fractures
retrograde femur IMN
suprapatellar IMN
infections
FRI
url http://hdl.handle.net/11427/42063
work_keys_str_mv AT armasselma intramedullarynailingofopentibiaandfemurfracturesthroughthesupraampinfrapatellarapproachissepticarthritisarealconcern