J Korean Orthop Assoc.  2009 Feb;44(1):61-67. 10.4055/jkoa.2009.44.1.61.

Anterior Knee Pain after Intramedullary Tibial Nailing

• Kim KT
• Sohn SK
• Kang MS
• Jin X
• Lee CW
• Wang L

• KMID: 2186379
• DOI: http://doi.org/10.4055/jkoa.2009.44.1.61

Abstract

PURPOSE: To document the incidence and analyze the causes of anterior knee pain following closed intramedullary nailing for tibial fractures.
MATERIALS AND METHODS
Between January 2005 and February 2007, 50 tibial fractures (48 patients) were treated using locked intramedullary nails. We examined the relationship between postoperative anterior knee pain and age, gender distribution, mechanism of injury, cause and type of fracture, method of patellar tendon incision, and position of the nails on radiography. Anterior knee pain was assessed using a visual analogue scale (VAS). Pearson chi-square test was used to assess the incidence of knee pain.
RESULTS
At a mean follow-up period of 16 months (range 13-30 months), 23 cases (46%) had developed anterior knee pain. Knee pain was more common in woman (p=0.000), but there was no statistically significant difference with regard to age, cause or type of fracture, reaming or incision technique. If the knee apex distance was below -30 mm on radiological analysis, there was no statistically significant increase in postoperative knee pain (p=0.000). Nail removal resolved or improved the symptoms in 77% of patients with anterior knee pain.
CONCLUSION
Based on these data, nail prominence correlated with increased knee pain. We believe surgeons can decrease the severity of knee pain after tibial nailing by burying the tip of the nail as reflected on lateral radiographs.

Keyword

Tibial shaft fracture; Intramedullary nailing; Anterior knee pain

MeSH Terms

Female
Follow-Up Studies
Fracture Fixation, Intramedullary
Humans
Incidence
Knee
Nails
Patellar Ligament
Tibial Fractures

Figure

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  Fig. 1 Measurement of the knee apex distance after IM nailing.

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  Fig. 2 Number of patients according to knee apex distance.

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