OBJECTIVE:
To analyze the outcomes of tibial shaft fractures treated with a lateral parapatellar approach in the semi-extended position for IMN insertion.

DESIGN:
Prospective cohort study.

SETTING:
Level I trauma center.

PATIENTS AND METHODS:
Seventy patients treated from March 2012 to July 2015 with IMN using an extra-articular lateral parapatellar approach in the semi-extended position were reviewed. Patients were clinically and radiographically checked at a minimum follow-up of 24 months, and the following data were recorded: fracture healing, any residual deformity, nail-apex distance, range of motion of the treated knee together with the contralateral side, knee functional outcome and residual knee pain.

RESULTS:
24 months after surgery, all patients were clinically and radiographically healed, with 2 cases of malalignment (angular deformity < 10°). The average ROM of the treated knee was 0-130.6° (± 8.6°) compared to 0-131.1° (± 7.9°) of the contralateral. Lysholm knee score was excellent for 57 patients, good for eleven and fair for two. The mean residual pain was 0.6 (± 1.1) according to the VAS scale.

CONCLUSIONS:
The described technique represents an effective option for IMN of tibial fractures. It is suitable for all tibial fractures, including proximal and distal. The results of our series demonstrate the effectiveness of this technique with nearly complete recovery of knee function and negligible incidence of anterior knee pain at a minimum follow-up of 24 months.

LEVEL OF EVIDENCE:
Therapeutic Level II.