How Suprapatellar Nailing Improves Alignment in Proximal Tibial Fractures?

 Suprapatellar nailing has significantly improved the management of proximal tibial fractures by delivering more reliable alignment and smoother intraoperative control. Traditional infrapatellar nailing often struggles with these fractures due to short proximal segments, metaphyseal comminution, and off-axis entry, leading to valgus, varus, or procurvatum malalignment in up to 20–30% of cases. The suprapatellar approach, using a portal above the patella with the knee flexed, allows a straighter, more central guidewire and nail trajectory. This reduces coronal and sagittal plane deformities, with studies showing alignment within 2 degrees in over 90% of cases. Surgeons benefit from improved fluoroscopic visualization, easier reduction control, and shorter operative times. Clinically, patients experience less anterior knee pain, faster rehabilitation, and high union rates—around 95% by 16 weeks. Suprapatellar nailing is especially valuable in comminuted, proximal, or high-risk fractures, offering precise fixation and dependable outcomes.