Recommendations for avoiding knee pain after intramedullary nailing of tibial shaft fractures

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Abstract

Background

The objective of this study is to analyze the proximal tibiofibular joint in patients with knee pain after treatment of tibial shaft fractures with locked intramedullary nail.

Findings

The proximal tibiofibular joint was analyzed in 30 patients, who reported knee pain after tibial nailing, and standard radiograph and computed tomography were performed to examine the proximal third of the tibia. Twenty patients (68.9%) presented the proximal screw crossing the proximal tibiofibular joint and 13 (44.8%) had already removed the nail and/or screw. Four patients (13.7%) reported complaint of knee pain. However, the screw did not reach the proximal tibiofibular joint. Five patients (17.2%) complained of knee pain although the screw toward the joint did not affect the proximal tibiofibular joint.

Conclusion

When using nails with oblique proximal lock, surgeons should be careful not to cause injury in the proximal tibiofibular joint, what may be one of the causes of knee pain. Thus, the authors suggest postoperative evaluation performing computed tomography when there is complaint of pain.

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Most cited references 20

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Interlocking intramedullary nailing with and without reaming for the treatment of closed fractures of the tibial shaft. A prospective, randomized study.

B. O’Brien, P Blachut, H Broekhuyse … (1997)

One hundred and fifty-two patients who had 154 closed fractures of the shaft of the tibia were prospectively randomized to management with interlocking intramedullary nailing either with or without reaming. Thirteen patients who had been randomized to treatment without reaming were switched to the group that had reaming because of technical reasons; these patients were excluded from the analysis of the results. An additional five patients were lost to follow-up. Thus, seventy-two patients (seventy-three fractures) who had been managed with nailing with reaming and sixty-three patients (sixty-three fractures) who had been managed with nailing without reaming were available for follow-up at an average of twelve months (range, three to thirty-three months) postoperatively. The two groups were similar with regard to demographics and the configurations of the fractures. The average total duration of the procedures performed without reaming was eleven minutes shorter than that of the procedures done with reaming (p = 0.0013). The duration of fluoroscopy was not significantly different between the two groups (p = 0.35, Mann-Whitney test). The average estimated blood loss was identical for the two groups. Seventy fractures (96 per cent) that were treated with nailing with reaming and fifty-six (89 per cent) that were treated with nailing without reaming united without the need for an additional operation (p = 0.19). Because of the small sample size, the study has insufficient power (34.7 per cent) to detect this difference if it is real. There was only one deep infection, which developed after nailing without reaming. The nail fractured after one procedure with reaming. A screw fractured after two procedures with reaming and after ten without reaming (p = 0.012); multiple screws fractured after three procedures in the latter group. Malunion occurred after three nailing procedures with reaming and after two without reaming. Four malunions were of very proximal fractures and one was of a very distal fracture. Seventeen screws and twenty-four nails were removed after nailing with reaming, and twenty screws and nineteen nails were removed after nailing without reaming; neither of these prevalences was significantly different between the two groups (p = 0.27 and 0.89; chi-square test). We concluded that there are no major advantages to nailing without reaming as compared with nailing with reaming for the treatment of closed fractures of the shaft of the tibia. There was a higher prevalence of delayed union and breakage of screws after nailing without reaming.

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Knee pain after intramedullary tibial nailing: its incidence, etiology, and outcome.

C Court-Brown, T Gustilo, A Shaw (2015)

To establish the incidence and clinical effects of anterior knee pain after intramedullary nailing of the tibia. A retrospective study. The Royal Infirmary of Edinburgh, Scotland. 169 patients who presented with a tibial diaphyseal fracture and were treated by intramedullary nailing. All patients were treated with a reamed Grosse Kempf tibial nail. Anterior knee pain was assessed with an analogue scale and functional outcome was examined using a series of routine daily activities. Anterior knee pain was found in 56.2% of patients. The only distinguishing feature between patients with and without pain was that the patients who had pain were significantly younger. Most patients had mild pain but there was considerable functional impairment with 91.8% of patients experiencing pain on kneeling and 33.7% having pain even at rest. Nail removal resolved or improved the symptoms in almost all cases. Anterior knee pain is a significant complication of intramedullary nailing of the tibia.

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Treatment of tibial fractures by reaming and intramedullary nailing.

Paul Johnson, Sarah Bone (1986)

We treated 112 fractures of the tibia by manipulative reduction, reaming of the medullary canal, and fixation of the fracture fragments with an intramedullary nail. Seventy-six of the fractures were acute, and eight of these were second or third-degree open fractures. The other thirty-six fractures had a non-union, osteotomy for malunion, or failure of other types of treatment. Follow-up of 100 fractures showed union in all but one, which was in a drug abuser who had an amputation due to infection. The main complication was infection, which was successfully treated in six of seven fractures. The method of treatment, employing either closed or open technique and recently making use of interlocking bolts to stabilize one or both principal fracture fragments on the nail, is an excellent one for unstable acute fractures and for secondary procedures in fractures that are not associated with infection. The infection rate was increased with the open surgical technique. The few contraindications to its use are described.

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Author and article information

Journal

Journal ID (nlm-ta): Patient Saf Surg

Title: Patient Safety in Surgery

Publisher: BioMed Central

ISSN (Electronic): 1754-9493

Publication date Collection: 2011

Publication date (Electronic): 1 December 2011

Volume: 5

Page: 31

Affiliations

[1 ]Department of Orthopaedic Surgery, Santa Tereza Hospital, Petrópolis, RJ, Brazil

[2 ]Department of Orthopaedic Surgery, Federal University of Minas Gerais and Felício Rocho Hospital, Belo Horizonte, MG, Brazil

[3 ]Department of Orthopaedic Surgery, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil

[4 ]Department of Orthopaedic Surgery, Federal University of São Paulo, São Paulo, SP, Brazil

Article

Publisher ID: 1754-9493-5-31

DOI: 10.1186/1754-9493-5-31

PMC ID: 3247032

PubMed ID: 22133204

SO-VID: 3e60b586-5e47-40d8-bec7-7aae3601e733

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Recommendations for avoiding knee pain after intramedullary nailing of tibial shaft fractures

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Abstract

Background

Findings

Conclusion

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Most cited references 20

Interlocking intramedullary nailing with and without reaming for the treatment of closed fractures of the tibial shaft. A prospective, randomized study.

Knee pain after intramedullary tibial nailing: its incidence, etiology, and outcome.

Treatment of tibial fractures by reaming and intramedullary nailing.

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