Transpatellar Approach: Intramedullary Nailing of the Tibia Through an Open Patella Fracture

Tibial shaft fractures are most commonly treated via reamed intramedullary nail (IMN). Surgical approaches for tibial IMN insertion include the parapatellar (medial or lateral), transpatellar (ie, tendon splitting), or suprapatellar approach. Irrespective of the approach, the ideal start point is generally medial to the lateral tibial spine. Because of the traumatic nature of high energy tibial shaft fractures, they occasionally present with ipsilateral open knee and patellar injuries. These ipsilateral injuries are usually associated with extensive soft tissue damage and nonviable skin flaps. When an additional incision is created for tibial IMN placement this can be particularly problematic with small skin bridges. Accordingly, the authors introduce a method that minimizes further insult to the soft tissue while concomitantly providing easy access for the tibial IMN starting point through an injured patella.