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Updated: May 29, 2026

Treatment with Locking Intramedullary Nailing for Intertrochanteric Fracture of the Femur Utilizing a New Awl with a Distal Positioner
Published on: June 6, 2025
Knee pain correlates with union after tibial nailing
Scott P Ryan1, Paul Tornetta, Cassandra Dielwart
1Boston University Medical Center, Department of Orthopaedic Surgery, Boston, MA 02118, USA.
Objectives:
The purpose of this study is to evaluate the change in quantitatively scored knee pain during union.
Design:
This is a retrospective review of prospectively collected data over a 15-year period.
Setting:
Academic medical center.
Patients:
All patients treated with an intramedullary nail were evaluated for knee pain and union. Four hundred twenty-eight patients with 443 tibia fractures were included.
Intervention:
All tibia fractures were treated with an intramedullary nail.
Outcomes:
Patient-based knee pain was scored from 0 to 3. Fracture union was also graded using a modified Hammer score based on cortical bridging and remodeling.
Results:
We found a significant inverse association between pain and union score (P < 0.01). In contradistinction, there was not a correlation between time from surgery and pain (P = 0.13). Because union score and time were related, a model was created with both parameters. This model demonstrated a statistical correlation with union score (P < 0.01), but not for time from surgery (P = 0.18).
Conclusions:
We postulated that knee pain may correlate with either union or time from surgery. We found a statistically significant, negative correlation between knee pain and fracture union. There was no such association between pain and time from surgery.
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