Response to comments on: Comparison of suprapatellar versus infrapatellar approaches of intramedullary nailing for distal tibia fractures

Thanks very much for your interest in the article “Comparison of suprapatellar versus infrapatellar approaches of intramedullary nailing for distal tibia fractures” [1]. We agree with Dr. Lu’s opinion that the description of the ideal starting point and Fig. 2B was not matched in our manuscript. In order to strength our statement, we provided a more rigorous Figure to match our opinion that the ideal starting point for tibial nailing of the SP approach is in the intersection of tibial midline and tibial plateau articular surface. As demonstrated by Bible et al. [2], twin peaks anteroposterior position (AP) images is safe for a starting point according to tibia-based referencing for proximal tibia radiographs. Too lateral a start can cause varus, in the tibia fractures, whereas too medial a starting point can create valgus [2]. Therefore, we recommend the ideal enter point as being “in the intersection of tibial midline and tibial plateau articular surface” at AP image and at the anterior edge of the tibial plateau on the lateral view. The ideal starting point in Fig. 2B we provided is slightly lower. We now correct Fig. 2B to provide a more accurate lateral starting point.

Replaced Figure 2B Starting point under fluoroscopic guidance