Character, Incidence, and Predictors of Knee Pain and Activity After Infrapatellar Intramedullary Nailing of an Isolated Tibia Fracture

Abstract

Objective-To study the activity and incidence of knee pain after sustaining a isolated tibia fracture treated with an infrapatellar intramedullary nail at one year. Design-Retrospective review of prospective cohort Setting-Multicenter Academic and Community hospitals Patients-437 patients with an isolated tibia fracture completed a 12 month assessment on pain and self-reported activity. Intervention-Infrapatellar Intramedullary Nail Outcomes-Demographic information co-morbid conditions, injury characteristics, and surgical technique were recorded. Knee pain was defined on a 1-7 scale with 1 being "no pain" and 7 being a "very great deal of pain." Knee pain > 4 was considered clinically significant. Patients reported if they were "able", "able with difficulty" or "unable" to perform the following activities: kneel, run, climb stairs, and walk prolonged. Variables were tested in multilevel multivariable regression analyses. Results-Knee Pain: 11% percent of patients reported a "good deal" to a "very great deal" of pain (> 4). 52% of patients reported "no" or "very little" pain at 12 months. Activity at 12 months: 26% and 29% of patients were unable to kneel or run, respectively. 31% and 35% of patients respectively stated they were able with difficulty or unable to use stairs or walk.

Nonoperative Management of Proximal Tibiofibular Joint Synostosis after Tibial Intramedullary Nailing

“…Knee pain after tibial IMN is a well-known complication with poorly delineated etiology, and it is impossible to attribute the knee pain in the current case to any one factor [17, 18], so the prospect remains that the synostosis or the presence of the implant impacted the pain in the patient. Alternate low probability causes of pain in this case include metal allergies leading to nonspecific deep generalized pain and metal corrosion not seen on imaging [19].…”