Intra-articular Debris and Damage to the Trochlea Following Supra-Patellar IMN Approach

Rationale: IMN tibial fracture repair via suprapatellar approach is an acceptable modality and highly popular surgicaltechnique in case of proximal diaphyseal tibia fractures.

Patient concern and Diagnoses: A 25 year old male who sustained a proximal tibial shaft due to motor vehicle accident underwent an IntraMedullaryNailing via suprapatellar approach. Postoperatively, the patient suffered from anterior knee pain at the site of the procedure. On X-ray imaging intraarticular bone debris were found. The patient was sent to a CT scan for further evaluation. Based on the images from the CT scan an explorating arthroscopy was performed and the debris were lavages and aspirated.

Interventions and Outcomes: The patient underwent intramedullary nailing via suprapatellar approach according the AO surgical technique. Yet, debris was found at the end of the procedure. A secondary procedure was needed to prevent infection and further damage to patient’s knee.

Lessons: In this case report we emphasize the potential damage to the articular surface of the knee and present to you a complication which should be kept in mind for the operating staff, with a notion for future prevention.