INfrapatellar Versus SUprapatellar Reamed Intramedullary Nailing for Fractures of the Tibia (INSURT)
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|ClinicalTrials.gov Identifier: NCT02750072|
Recruitment Status : Recruiting
First Posted : April 25, 2016
Last Update Posted : March 11, 2020
|Condition or disease||Intervention/treatment||Phase|
|Tibial Fractures Anterior Knee Pain Syndrome||Procedure: Infrapatellar Approach Procedure: Suprapatellar Approach||Not Applicable|
There are a number of ways to approach the tibial canal when using an intramedullary nail for fracture fixation.
The gold standard is the infrapatellar approach (below the knee cap). This approach has the patient positioned with the knee flexed at 90 degrees or greater on the operating table. However, there are challenges with this approach, including imaging, placement of supplemental fixation, conversion to open reduction when necessary and malunion with apex anterior angulation for proximal tibial fractures. The positioning of the patient causes tension on the structures and soft tissues around the knee which can hinder the placement of the nail and can cause damage to the soft tissues that can result in significant long-term anterior knee pain for many patients.
The semi-extended suprapatellar approach has the patient positioned in approximately 15-20 degrees of flexion, putting less tension on the structures and soft tissues about the knee and enables the surgeon to insert the nail in an optimal position with relative ease.
|Study Type :||Interventional (Clinical Trial)|
|Estimated Enrollment :||232 participants|
|Intervention Model:||Parallel Assignment|
|Masking:||Single (Outcomes Assessor)|
|Official Title:||INfrapatellar Versus SUprapatellar Reamed Intramedullary Nailing for Fractures of the Tibia|
|Study Start Date :||July 2016|
|Estimated Primary Completion Date :||June 2021|
|Estimated Study Completion Date :||June 2022|
Active Comparator: Infrapatellar approach
Infrapatellar approach using the surgeon's incision of choice (i.e., patellar tendon split, tendon retraction medial, tendon retraction lateral).
Procedure: Infrapatellar Approach
Infrapatellar approach using the surgeon's incision of choice (i.e. patellar tendon split, tendon retraction medial, tendon retraction lateral)
Experimental: Semi-extended suprapatellar approach
Semi-extended suprapatellar approach using quadriceps split combined with purpose designed suprapatellar percutaneous instrumentation (patellofemoral protection sleeve).
Procedure: Suprapatellar Approach
Semi-extended suprapatellar approach using quadriceps split combined with purpose designed percutaneous instrumentation
- VAS (visual analog scale) for pain on kneeling/ability to knee [ Time Frame: 12 months post treatment ]Participants assessment of their degree/level of pain on kneeling after performing the AKT (Aberdeen Kneeling Weight-Distribution Test) on a 10 cm visual analog scale
- AKT (Aberdeen Kneeling Weight-Distribution Test) [ Time Frame: 4, 6, 12 and 24 months post treatment ]The AKT involves kneeling on two separate calibrated scales for up to 60 seconds with the patient blinded to the readings. At 15-second intervals the weight distribution, measured in kg, between the two knees is documented.
- AST (Aberdeen Standing Weight-Distribution Test) [ Time Frame: 4, 6, 12 and 24 months post treatment ]The AST involves the patient standing on two separate calibrated scales (one foot on each scale) and the weight in kg recorded with the patient blinded to the readings.
- VAS (Visual Analog Scale) at rest, with walking and descending stairs [ Time Frame: 4, 6, 12 and 24 months post treatment ]Participants overall assessment of their pain at rest, with walking and descending stairs over the past week on a 10 cm visual analog scale
- Lysholm Knee Scoring Scale [ Time Frame: 4, 6, 12 and 24 months post treatment ]Used to evaluate outcomes of knee ligament surgery using 8-items commonly affecting patients with anterior knee pain: Limp, support, locking, instability, pain, swelling, stair climbing and squatting.
- PKPM (Photographic knee pain map) [ Time Frame: 4, 6,12 and 24 months post treatment ]Used to determine the precise location of the knee pain, as indicated and localized by the participant.
- EQ-5D Health Related Quality of Life Outcome Measure [ Time Frame: 4, 6,12 and 24 months post treatment ]5 dimensions: Mobility: self-care, usual activities, pain/discomfort and anxiety/depression
- WPAI:SHP (Work Productivity and Activity Impairment: Specific Health Problem [ Time Frame: 4, 6, 12 and 24 months post treatment ]A questionnaire pertaining to the effect of the participants tibial fracture on their ability to work and perform regular activities.
- Radiographic outcome [ Time Frame: Intra-operatively and 4, 6,12 and 24 months post treatment ]Blinded independent reviewer will adjudicate alignment, nail position and determination of union at one year, as well as change of position of the nail.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02750072
|Contact: Kyrsten D Payne, BScfirstname.lastname@example.org|
|University of Alberta Hospital||Recruiting|
|Edmonton, Alberta, Canada|
|Contact: Ailar Ramadi, PT, PhD (780) 492 6713 email@example.com|
|Principal Investigator: Matthew Menon, MD|
|Canada, British Columbia|
|Royal Columbian Hospital / Fraser Health Authority||Recruiting|
|New Westminster, British Columbia, Canada, V3L 3W7|
|Contact: Kyrsten D Payne, BSc 604-520-4963 firstname.lastname@example.org|
|Hamilton Health Sciences||Recruiting|
|Hamilton, Ontario, Canada, L8L 8E7|
|Contact: Federico Persico, MD, MHMc 905-527-4322 ext 44703 email@example.com|
|Principal Investigator: Brad Petrisor, MD|
|The Ottawa Hospital||Recruiting|
|Ottawa, Ontario, Canada, K1Y 4E9|
|Contact: Nicole Harris, BSc 613-737-8899 ext 19217 firstname.lastname@example.org|
|Principal Investigator: Steven Papp, MD|
|St. Michael's Hospital||Recruiting|
|Toronto, Ontario, Canada, M5C 1R6|
|Contact: Milena (Lynn) Vicente, RN, CCRP 416.864.6060 ext 2608 email@example.com|
|Principal Investigator: Aaron Nauth, MD|
|Hospital Universitari Vall d'Hebron||Recruiting|
|Barcelona, Spain, 08035|
|Contact: Yaiza Garcia firstname.lastname@example.org|
|Principal Investigator: Jordi Tomas, MD|
|Principal Investigator:||Darius G Viskontas, MD, FRCSC||Royal Columbian Hospital / Fraser Health Authority|
|Principal Investigator:||Trevor B Stone, MD, FRCSC||Royal Columbian Hospital / Fraser Health Authority|
|Principal Investigator:||Alan Johnstone, Professor||Aberdeen Royal Infirmary|