To report upon the immediate post-operative alignment of distal tibia fractures (within 5 cm of the tibial plafond) treated with suprapatellar intramedullary nail (IMN) insertion compared to the infrapatellar technique. Primary outcomes include alignment on both the anteroposterior and lateral radiographic views.

Retrospective cohort study.

Two urban level I trauma centers PATIENTS:: A total of 266 skeletally mature patients with a distal tibia fracture were treated with an IMN. 132 patients underwent this procedure through a suprapatellar technique.

Intramedullary nail placement MAIN OUTCOME MEASUREMENT:: Alignment RESULTS:: The two treatment groups were evenly matched with respect to age, gender, fracture grade, and presence of open fracture. Within the suprapatellar group, the fibula was intact, fixed, and remained fractured in 6 (4.5%), 22 (16.7%), and 104 (78.8%) cases, respectively. The fibula was intact, repaired, and remained fractured in 9 (6.7%), 32 (23.9%), and 93 (69.4%) cases, respectively, in the infrapatellar group. There was no difference in the rate of fibular fixation between groups (p = 0.2). Primary angular malalignment > 5 degrees occurred in 35 patients (26.1%) with infrapatellar IMN insertion, and in five patients (3.8%) who underwent suprapatellar IMN insertion (p < 0.0001).

This is the largest patient series directly comparing the suprapatellar to infrapatellar IMN insertion technique in the treatment of distal tibia fractures. In the treatment of distal tibia fractures, suprapatellar IMN technique results in a significantly lower rate of malalignment compared to the infrapatellar IMN technique.

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.