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

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dc.contributor.advisorMaqungo, Sithombo
dc.contributor.advisorLaubscher, Maritz
dc.contributor.authorArmas, Selma
dc.date.accessioned2025-10-30T11:25:12Z
dc.date.available2025-10-30T11:25:12Z
dc.date.issued2025
dc.date.updated2025-10-30T11:22:00Z
dc.description.abstractBackground: 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.
dc.identifier.apacitationArmas, S. (2025). <i>Intramedullary nailing of open tibia and femur fractures through the supra &amp; infrapatellar approach. Is septic arthritis a real concern?</i>. (). University of Cape Town ,Faculty of Health Sciences ,Division of General Surgery. Retrieved from http://hdl.handle.net/11427/42063en_ZA
dc.identifier.chicagocitationArmas, Selma. <i>"Intramedullary nailing of open tibia and femur fractures through the supra &amp; infrapatellar approach. Is septic arthritis a real concern?."</i> ., University of Cape Town ,Faculty of Health Sciences ,Division of General Surgery, 2025. http://hdl.handle.net/11427/42063en_ZA
dc.identifier.citationArmas, S. 2025. Intramedullary nailing of open tibia and femur fractures through the supra &amp; infrapatellar approach. Is septic arthritis a real concern?. . University of Cape Town ,Faculty of Health Sciences ,Division of General Surgery. http://hdl.handle.net/11427/42063en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - Armas, Selma AB - 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. DA - 2025 DB - OpenUCT DP - University of Cape Town KW - septic knee arthritis KW - open fractures KW - retrograde femur IMN KW - suprapatellar IMN KW - infections KW - FRI LK - https://open.uct.ac.za PB - University of Cape Town PY - 2025 T1 - Intramedullary nailing of open tibia and femur fractures through the supra &amp; infrapatellar approach. Is septic arthritis a real concern? TI - Intramedullary nailing of open tibia and femur fractures through the supra &amp; infrapatellar approach. Is septic arthritis a real concern? UR - http://hdl.handle.net/11427/42063 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/42063
dc.identifier.vancouvercitationArmas S. Intramedullary nailing of open tibia and femur fractures through the supra &amp; infrapatellar approach. Is septic arthritis a real concern?. []. University of Cape Town ,Faculty of Health Sciences ,Division of General Surgery, 2025 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/42063en_ZA
dc.language.isoen
dc.language.rfc3066eng
dc.publisher.departmentDivision of General Surgery
dc.publisher.facultyFaculty of Health Sciences
dc.publisher.institutionUniversity of Cape Town
dc.subjectseptic knee arthritis
dc.subjectopen fractures
dc.subjectretrograde femur IMN
dc.subjectsuprapatellar IMN
dc.subjectinfections
dc.subjectFRI
dc.titleIntramedullary nailing of open tibia and femur fractures through the supra &amp; infrapatellar approach. Is septic arthritis a real concern?
dc.typeThesis / Dissertation
dc.type.qualificationlevelMasters
dc.type.qualificationlevelMMed
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