{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:46:05Z","timestamp":1787755565027,"version":"build-2784847793"},"reference-count":56,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Tibial intramedullary nailing (IMN) is the standard treatment for tibial shaft fractures, yet anterior knee pain (AKP) remains common, affecting nearly 47% of patients. Despite the reported advantages of suprapatellar techniques, infrapatellar approaches\u2014medial parapatellar (MPP) and transpatellar (TP)\u2014remain the most commonly used methods for tibial IMN. This systematic review and meta-analysis compares MPP and TP approaches regarding pain, AKP incidence, range of motion (ROM), knee function, and fracture healing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, PubMed, Embase, Scopus, and Web of Science were searched up to November 2024. Randomized clinical trials (RCTs) and comparative observational studies in adults undergoing tibial IMN via MPP or TP approaches were included. Outcomes were AKP incidence, pain intensity, knee function, ROM, and union-related variables. Pooled mean differences (MDs) and risk ratios (RRs) were calculated using random-effects and common-effects models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Twelve cohort studies (782 patients) and 9 RCTs (462 patients) were included. Across cohort studies, MPP was associated with a significantly lower AKP risk at latest follow-up (RR = 0.76 [0.63; 0.90]) and at 6 months. Visual analog scale pain at 3-month postoperative also favored MPP (MD = \u22121.27 [\u22121.94; \u22120.60]) but did not reach the minimal clinically important difference. RCTs demonstrated similar trends toward lower pain and AKP with MPP, but without statistical significance. Functional outcomes and ROM generally favored MPP across both study designs, though findings were inconsistent and unsuitable for pooling. Fracture healing and union rates were comparable between approaches.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>The MPP approach for tibial IMN was linked to a lower incidence of AKP compared with the TP approach, while offering comparable or better functional outcomes, ROM, and pain intensity. These findings suggest MPP as the preferred infrapatellar approach in appropriate clinical settings. Nonetheless, high-quality studies with standardized outcome measures are essential to validate these findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      <jats:underline>Level III<\/jats:underline>\n                      (systematic review of RCTs and retrospective comparative studies). See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.rvw.25.00276","type":"journal-article","created":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T18:00:44Z","timestamp":1779300044000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Medial Parapatellar vs. Transpatellar Approach in Tibial Intramedullary Nailing"],"prefix":"10.2106","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4328-1370","authenticated-orcid":false,"given":"Sina","family":"Javidmehr","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-8511-4391","authenticated-orcid":false,"given":"Mohammad Reza","family":"Ramezanpour","sequence":"additional","affiliation":[{"name":"School of Medicine, Tehran University of Medical Sciences, Tehran, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-4310-711X","authenticated-orcid":false,"given":"Omid","family":"Bahrami","sequence":"additional","affiliation":[{"name":"School of Medicine, Tehran University of Medical Sciences, Tehran, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2934-6470","authenticated-orcid":false,"given":"Yasin","family":"Ramezanpour","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-8238-9723","authenticated-orcid":false,"given":"Mohammad Mahdi","family":"Haji Rahim Kashi","sequence":"additional","affiliation":[{"name":"School of Medicine, Tehran University of Medical Sciences, Tehran, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4135-7148","authenticated-orcid":false,"given":"Behnaz","family":"Behzadi","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Mahdiyeh Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4139-0071","authenticated-orcid":false,"given":"Arash","family":"Sharafat Vaziri","sequence":"additional","affiliation":[{"name":"Center for Orthopedic Trans-Disciplinary Applied Research, Tehran University of Medical Sciences, Tehran, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,5]]},"reference":[{"issue":"10","key":"r1-20260520","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1016\/j.mpsur.2007.07.004","article-title":"Fractures of the tibial shaft (including acute compartment syndrome)","volume":"25","author":"McGrath","year":"2007","journal-title":"Surgery (Oxford)"},{"issue":"16","key":"r2-20260520","doi-asserted-by":"crossref","first-page":"e116.1","DOI":"10.2106\/JBJS.L.01223","article-title":"Tibial nailing with the knee semi-extended: review of techniques and indications: AAOS exhibit selection","volume":"95","author":"Rothberg","year":"2013","journal-title":"J Bone Joint Surg Am"},{"issue":"5","key":"r3-20260520","doi-asserted-by":"crossref","first-page":"949","DOI":"10.1097\/01.TA.0000092685.80435.63","article-title":"Outcomes in open tibia fractures: relationship between delay in treatment and infection","volume":"55","author":"Khatod","year":"2003","journal-title":"J Trauma"},{"issue":"6","key":"r4-20260520","doi-asserted-by":"crossref","first-page":"499","DOI":"10.55095\/achot2012\/072","article-title":"Tibial shaft fractures-management and treatment options. A review of the current literature","volume":"79","author":"Bode","year":"2012","journal-title":"Acta Chir Orthop Traumatol Cech"},{"issue":"28","key":"r5-20260520","doi-asserted-by":"crossref","first-page":"7874","DOI":"10.14260\/jemds\/2014\/2986","article-title":"Anterior knee pain in transtendinous and paratendinous approaches of tibial interlocking nail: a comparative study","volume":"3","author":"Tonk","year":"2014","journal-title":"J Evol Med Dental Sci"},{"issue":"5","key":"r7-20260520","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1302\/0301-620X.88B5.16875","article-title":"Incidence and aetiology of anterior knee pain after intramedullary nailing of the femur and tibia","volume":"88","author":"Katsoulis","year":"2006","journal-title":"J Bone Joint Surg Br"},{"issue":"4","key":"r8-20260520","first-page":"1140","article-title":"Anatomical assessment of the Hoffa fat pad during insertion of a tibial intramedullary nail: comparison of three surgical approaches","volume":"66","author":"Weninger","year":"2009","journal-title":"J Trauma"},{"key":"r9-20260520","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1097\/01.blo.0000223976.91089.08","article-title":"Knee pain after tibial nailing: the role of nail prominence","volume":"449","author":"Bhattacharyya","year":"2006","journal-title":"Clin Orthop Relat Res"},{"issue":"6","key":"r10-20260520","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1016\/S0020-1383(00)00024-3","article-title":"The clinical performance of a small diameter tibial nailing system with a mechanical distal aiming device","volume":"31","author":"Karachalios","year":"2000","journal-title":"Injury"},{"issue":"10","key":"r11-20260520","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1097\/00005131-200211000-00001","article-title":"Incision placement for intramedullary tibial nailing: an anatomic study","volume":"16","author":"Althausen","year":"2002","journal-title":"J Orthop Trauma"},{"issue":"4","key":"r12-20260520","doi-asserted-by":"crossref","first-page":"958","DOI":"10.1016\/j.injury.2015.12.025","article-title":"Surgical approaches to intramedullary nailing of the tibia: comparative analysis of knee pain and functional outcomes","volume":"47","author":"Bakhsh","year":"2016","journal-title":"Injury"},{"issue":"10","key":"r13-20260520","doi-asserted-by":"crossref","first-page":"1891","DOI":"10.1016\/j.injury.2018.07.004","article-title":"Intra-operative fluoroscopy time and radiation dose during suprapatellar tibial nailing versus infrapatellar tibial nailing","volume":"49","author":"Williamson","year":"2018","journal-title":"Injury"},{"key":"r14-20260520","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/j.ijsu.2018.01.026","article-title":"Suprapatellar versus infrapatellar approach for tibia intramedullary nailing: a meta-analysis","volume":"51","author":"Wang","year":"2018","journal-title":"Int J Surg"},{"issue":"1","key":"r15-20260520","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1186\/s12891-025-09162-1","article-title":"Comparison of suprapatellar and infrapatellar intramedullary nailing for tibial fractures: a systematic review and meta-analysis of randomized controlled trials","volume":"26","author":"Hu","year":"2025","journal-title":"BMC Musculoskelet Disord"},{"issue":"suppl 6","key":"r16-20260520","doi-asserted-by":"crossref","first-page":"110774","DOI":"10.1016\/j.injury.2023.05.005","article-title":"Is there a trend towards semi-extended knee positioning during intramedullary tibial nailing in Latin America? A survey among 990 orthopaedic surgeons","volume":"54","author":"Pires","year":"2023","journal-title":"Injury"},{"issue":"1","key":"r17-20260520","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1186\/s12891-020-03883-1","article-title":"Lateral position: a friendly surgical position for intramedullary nailing of tibial shaft fractures via infrapatellar approach","volume":"22","author":"Zhao","year":"2021","journal-title":"BMC Musculoskelet Disord"},{"issue":"1","key":"r18-20260520","doi-asserted-by":"crossref","first-page":"838","DOI":"10.1186\/s13018-024-05338-y","article-title":"Comparison of the efficacy of intramedullary nailing via the lateral parapatellar approach versus the infrapatellar approach in the treatment of tibial metaphyseal-diaphyseal junction fractures","volume":"19","author":"Cao","year":"2024","journal-title":"J Orthop Surg Res"},{"issue":"7","key":"r19-20260520","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1007\/s00402-019-03154-2","article-title":"Decrease surgery time by using an alternative lateral parapatellar approach for tibia shaft fracture nailing","volume":"139","author":"Ladurner","year":"2019","journal-title":"Arch Orthop Trauma Surg"},{"issue":"1","key":"r20-20260520","doi-asserted-by":"crossref","first-page":"31909","DOI":"10.52965\/001c.31909","article-title":"A review of proximal tibia entry points for intramedullary nailing and validation of the lateral parapatellar approach as extra-articular","volume":"14","author":"Patel","year":"2022","journal-title":"Orthop Rev"},{"issue":"4","key":"r21-20260520","first-page":"694","article-title":"Comparative analysis of anterior knee pain in transpatellar and medial parapatellar tendon approaches in tibial interlocking nailing","volume":"28","author":"Ahmad","year":"2016","journal-title":"J Ayub Med Coll Abbottabad"},{"issue":"6","key":"r22-20260520","first-page":"530","article-title":"Comparison of trans patellar approach and medial parapatellar tendon approach in tibial intramedullary nailing for treatment of tibial fractures","volume":"61","author":"Sadeghpour","year":"2011","journal-title":"JPMA J Pak Med Assoc"},{"key":"r23-20260520","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"issue":"6","key":"r24-20260520","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1136\/emermed-2020-209567","article-title":"Population, Intervention, Comparison, Outcomes and Study (PICOS) design as a framework to formulate eligibility criteria in systematic reviews","volume":"37","author":"Amir-Behghadami","year":"2020","journal-title":"Emerg Med J"},{"issue":"1","key":"r25-20260520","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1186\/s13643-016-0384-4","article-title":"Rayyan: a web and mobile app for systematic reviews","volume":"5","author":"Ouzzani","year":"2016","journal-title":"Syst Rev"},{"key":"r26-20260520","doi-asserted-by":"crossref","first-page":"i4919","DOI":"10.1136\/bmj.i4919","article-title":"ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions","volume":"355","author":"Sterne","year":"2016","journal-title":"BMJ"},{"key":"r27-20260520","doi-asserted-by":"crossref","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: a revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"issue":"1","key":"r28-20260520","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1002\/jrsm.1411","article-title":"Risk\u2010of\u2010bias VISualization (robvis): an R package and Shiny web app for visualizing risk\u2010of\u2010bias assessments","volume":"12","author":"McGuinness","year":"2021","journal-title":"Res Synth Methods"},{"issue":"7650","key":"r29-20260520","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1136\/bmj.39489.470347.AD","article-title":"GRADE: an emerging consensus on rating quality of evidence and strength of recommendations","volume":"336","author":"Guyatt","year":"2008","journal-title":"BMJ"},{"issue":"3","key":"r30-20260520","first-page":"40","article-title":"meta: an R package for meta-analysis","volume":"7","author":"Schwarzer","year":"2007","journal-title":"R News"},{"issue":"6","key":"r31-20260520","doi-asserted-by":"crossref","first-page":"1785","DOI":"10.1177\/0962280216669183","article-title":"Optimally estimating the sample mean from the sample size, median, mid-range, and\/or mid-quartile range","volume":"27","author":"Luo","year":"2018","journal-title":"Stat Methods Med Res"},{"issue":"1","key":"r32-20260520","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1186\/1471-2288-14-135","article-title":"Estimating the sample mean and standard deviation from the sample size, median, range and\/or interquartile range","volume":"14","author":"Wan","year":"2014","journal-title":"BMC Med Res Methodol"},{"issue":"11","key":"r33-20260520","doi-asserted-by":"crossref","first-page":"2647","DOI":"10.1177\/0363546516680607","article-title":"The therapeutic effect of intra-articular normal saline injections for knee osteoarthritis: a meta-analysis of evidence level 1 studies","volume":"45","author":"Saltzman","year":"2017","journal-title":"Am J Sports Med"},{"issue":"4","key":"r34-20260520","doi-asserted-by":"crossref","first-page":"580","DOI":"10.2106\/00004623-200204000-00011","article-title":"Anterior knee pain after intramedullary nailing of fractures of the tibial shaft: a prospective, randomized study comparing two different nail-insertion techniques","volume":"84","author":"Toivanen","year":"2002","journal-title":"J Bone Joint Surg Am"},{"issue":"6","key":"r35-20260520","first-page":"1511","article-title":"Anterior knee pain after intramedullary nailing of fractures of the tibial shaft: an eight-year follow-up of a prospective, randomized study comparing two different nail-insertion techniques","volume":"64","author":"V\u00e4ist\u00f6","year":"2008","journal-title":"J Trauma"},{"issue":"4","key":"r36-20260520","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1016\/S0968-0160(98)00013-1","article-title":"Insertion site for intramedullary tibial nails, and its relationship to anterior knee pain","volume":"5","author":"Lovell","year":"1998","journal-title":"Knee"},{"issue":"1","key":"r37-20260520","doi-asserted-by":"crossref","first-page":"119","DOI":"10.4103\/2277-9175.133187","article-title":"Significance of the position of the proximal tip of the tibial nail: an important factor related to anterior knee pain","volume":"3","author":"Tahririan","year":"2014","journal-title":"Adv Biomed Res"},{"issue":"3","key":"r38-20260520","doi-asserted-by":"crossref","first-page":"233","DOI":"10.4103\/eoj.eoj_40_24","article-title":"The medial parapatellar approach reports earlier knee recovery than the transpatellar approach for intramedullary nailing of tibial fractures","volume":"59","author":"Abulsoud","year":"2024","journal-title":"Egypt Orthop J"},{"key":"r39-20260520","doi-asserted-by":"crossref","first-page":"001","DOI":"10.17352\/ojor.000019","article-title":"Comparision of transpatellar and medial parapatellar tendon approach in tibial intramedullary nailing for treatment of fracture shaft of tibia","volume":"5","author":"Rijal","year":"2020","journal-title":"Open J Orthop Rheumatol"},{"issue":"1","key":"r40-20260520","doi-asserted-by":"crossref","first-page":"43","DOI":"10.18203\/issn.2455-4510.IntJResOrthop20223310","article-title":"Comparative study of range of motion and anterior knee pain in parapatellar versus trans patellar approach in tibia nailing","volume":"9","author":"Deokar","year":"2022","journal-title":"Int J Res Orthop"},{"issue":"1","key":"r41-20260520","doi-asserted-by":"crossref","first-page":"259","DOI":"10.52403\/ijshr.20230137","article-title":"Outcome of medial parapatellar versus transpatellar tendon approach of intramedullary nail insertion techniques in tibial shaft fractures","volume":"8","author":"Hadi Mohsen","year":"2023","journal-title":"Int J Sci Healthc Res"},{"key":"r42-20260520","doi-asserted-by":"crossref","first-page":"39","DOI":"10.31782\/IJCRR.2021.131325","article-title":"A comparative study of the functional outcome of patellar tendon splitting and medial parapatellar approaches in intramedullary interlocking nailing of tibia","volume":"13","author":"V","year":"2021","journal-title":"Int J Curr Res Rev"},{"issue":"4","key":"r43-20260520","first-page":"8082","article-title":"Contrast of average frontal knee agony among medcial parapatellar ligament method against transpatellar ligament method in tibial medullary tacking for action of tibial channel crack","volume":"6","author":"Rabbani","year":"2019","journal-title":"Indo Am J P Sci"},{"issue":"7","key":"r44-20260520","first-page":"1105","article-title":"A study on post-operative knee pain (VAS) and SCAR scale following inter locking nail for tibia using medial para patellar and midline trans patellar approaches","volume":"15","author":"Kumar","year":"2023","journal-title":"Int J Pharm Clin Res"},{"key":"r45-20260520","first-page":"2","article-title":"Comparison of anterior knee pain following tibia ILN in patellar tendon split and retraction insertion","volume":"6","author":"Ahmad","year":"2016","journal-title":"Group"},{"issue":"2","key":"r46-20260520","doi-asserted-by":"crossref","first-page":"399","DOI":"10.5455\/rmj.20230327072228","article-title":"Comparative prospective study of knee pain in medial pararpatellar and transpatellar entry for interlocking nail fixation of tibia fracture","volume":"48","author":"Zaki","year":"2023","journal-title":"Rawal Med J"},{"issue":"8","key":"r47-20260520","first-page":"e17404","article-title":"Comparison of medial parapatellar and transpatellar tendon approach in intramedullary interlocking nailing for tibial fracture: a retrospective analysis","volume":"13","author":"Khan","year":"2021","journal-title":"Cureus"},{"issue":"1","key":"r48-20260520","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1007\/s00068-018-0988-6","article-title":"Comparison of three different approaches for anterior knee pain after tibia intramedullary nailing","volume":"46","author":"Ozcan","year":"2020","journal-title":"Eur J Trauma Emerg Surg"},{"issue":"1","key":"r49-20260520","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1097\/00005131-199701000-00004","article-title":"Knee pain after tibial nailing","volume":"11","author":"Keating","year":"1997","journal-title":"J Orthop Trauma"},{"issue":"3","key":"r50-20260520","doi-asserted-by":"crossref","first-page":"179","DOI":"10.5152\/EurJTher.2018.595","article-title":"Anterior knee pain after intramedullary nailing of tibial fractures: medial parapatellar versus transtendinous approach","volume":"25","author":"Keke\u00e7","year":"2019","journal-title":"Eur J Ther"},{"issue":"2","key":"r51-20260520","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1007\/s002640050216","article-title":"Patellofemoral contact forces and pressures during intramedullary tibial nailing","volume":"22","author":"Devitt","year":"1998","journal-title":"Int Orthop"},{"issue":"6","key":"r52-20260520","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1016\/j.aott.2018.07.008","article-title":"Ultrasonographic comparison of bilateral patellar tendon dimensions in patients treated via intramedullary tibial nailing using a transpatellar approach","volume":"52","author":"Erin\u00e7","year":"2018","journal-title":"Acta Orthop Traumatol Turc"},{"issue":"3","key":"r53-20260520","first-page":"189","article-title":"Comparison of intramedullary nail and plate fixation in distal tibia diaphyseal fractures close to the mortise","volume":"20","author":"Yavuz","year":"2014","journal-title":"Ulus Travma Acil Cerrahi Derg"},{"issue":"1","key":"r54-20260520","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1007\/s00590-016-1856-x","article-title":"Influence of sagittal plane malpositioning of the patella on anterior knee pain after tibia intramedullary nailing","volume":"27","author":"Turkmen","year":"2017","journal-title":"Eur J Orthop Surg Traumatol"},{"issue":"6","key":"r55-20260520","doi-asserted-by":"crossref","first-page":"634","DOI":"10.5152\/j.aott.2020.20232","article-title":"Effects of morphological changes in the patellar tendon on the development of anterior knee pain after intramedullary nailing for tibial shaft fractures: a retrospective comparative study","volume":"54","author":"Ceyhan","year":"2020","journal-title":"Acta Orthop Traumatol Turc"},{"issue":"1","key":"r56-20260520","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1186\/s13018-018-0846-6","article-title":"Comparison of suprapatellar and infrapatellar intramedullary nailing for tibial shaft fractures: a systematic review and meta-analysis","volume":"13","author":"Yang","year":"2018","journal-title":"J Orthop Surg Res"},{"issue":"4","key":"r57-20260520","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1097\/BCO.0000000000000763","article-title":"Changing practice patterns: flexed versus semi-extended positioning for tibial nailing","volume":"30","author":"Goodnough","year":"2019","journal-title":"Curr Orthop Pract"}],"container-title":["JBJS Reviews"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.RVW.25.00276","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:45:05Z","timestamp":1787751905000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.RVW.25.00276"}},"subtitle":["A Systematic Review and Meta-Analysis of Pain and Function"],"short-title":[],"issued":{"date-parts":[[2026,5]]},"references-count":56,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.rvw.25.00276","relation":{},"ISSN":["2329-9185"],"issn-type":[{"value":"2329-9185","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5]]}}}