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Knee pain after tibial nailing

J F Keating1, R Orfaly, P J O'Brien

  • 1Department of Orthopaedic Trauma, Royal Infirmary, Edinburgh, Scotland.

Journal of Orthopaedic Trauma
|January 1, 1997
PubMed
Summary

Anterior knee pain affects 57% of patients after tibial nailing. A paratendon insertion site and nail removal can alleviate pain, but causes are multifactorial.

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Area of Science:

  • Orthopedic surgery
  • Trauma care
  • Musculoskeletal research

Background:

  • Tibial nailing is a common procedure for tibial shaft fractures.
  • Knee pain is a frequent complication following tibial nailing.

Purpose of the Study:

  • To determine the incidence and natural history of knee pain after tibial nailing.
  • To investigate factors associated with knee pain, including nail insertion site and protrusion.
  • To evaluate the effectiveness of nail removal for persistent knee pain.

Main Methods:

  • Retrospective analysis of 107 patients with 110 tibial fractures treated with interlocking tibial nailing.
  • Patient interviews, clinical record review, and radiographic analysis were performed.
  • Outcomes assessed included incidence of knee pain, time of onset, and response to nail removal.

Main Results:

  • 57% of patients developed anterior knee pain at a mean follow-up of 32 months.
  • Nail insertion through the patellar tendon was associated with a higher incidence of knee pain (77%) compared to the paratendon site (50%).
  • Nail removal relieved pain in 80% of affected patients, with complete relief in 22 and partial relief in 17.

Conclusions:

  • A parapatellar tendon incision is recommended for nail insertion to minimize knee pain.
  • Nail removal should be considered for patients experiencing persistent knee pain after tibial nailing.
  • The etiology of knee pain post-tibial nailing is complex and warrants further investigation.

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