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. Conclusion Clinically significant knee pain (>4/7) was present in 11% of patients one year after a tibia fracture. 31%-71% of patients had difficulty performing or were unable to perform routine daily activities of kneeling, running, and stair climbing or walking prolonged distances.

Comparison of Effects of Different Nail Tip Positions on Anterior Knee Pain After Intramedullary Interlocking Nailing for Tibial Shaft Fractures

“…16 Obremskey et al, found out that in their study smoking, comminuted fractures, and surgeons with less than 5 years of experience were some predictors of knee pain. 17,18 Darabos et al studied patients, who had undergone intramedullary nails and evaluated the distance from the tip of the nail to the tibial plateau and tibia tuberosity on lateral knee radiographs. It was concluded that the position of the tip of the nail and its adverse impact on the innervation pattern of the area dorsal to the patellar tendon could lead to anterior knee pain.…”

“…In one of the studies, 11% of the patients treated with intramedullary interlocking nails had clinically significant anterior knee pain after 1 year of follow-up. 5 Causes of anterior knee pain following intramedullary interlocking nail include skin incision, injury to the intra-articular structures, size of tibial plateau and damage to the infrapatellar branch of the saphenous nerve. 6 Several studies in the literature have shown that the position of the proximal nail tip may be one of the causative factors of anterior knee pain after tibia nailing.…”

Pain in Anterior Knee after Locked Nailing of Diaphyseal Tibia Fractures

“…Большое внимание авторы уделяют выбору доступа к точке введения стержня через связку надколенника или рядом с ней [20,22,28,29,30]. S.K.…”

“…Лечение боли в коленном суставе после интрамедуллярного остеосинтеза представляется трудной задачей. Большинство авторов сообщают, что удаление стержня не приводит к купированию болевого синдрома, а в ряде случаев даже ведет к его усилению [9,19,28]. Удаление стержня эффективно в тех случаях, когда он упирается в надколенник или в его связку [28].…”

Rates and timing of short-term complications following operative treatment of tibial shaft fractures

“…[ 8 – 11 ] However, IMN fixation is not without its own unique complication profile including higher rates of anterior knee pain ranging from 11% to 23% based on recent prospective studies and metanalyses. [ 12 – 17 ]…”