Long-term quadriceps femoris functional deficits following intramedullary nailing of isolated tibial fractures

Abstract

This retrospective study assessed 5 male and 5 female patients, age 35.1±16 years, height 171.8±12 cm, and weight 75.5±18 kg (mean±SD) who were more than 1 year post isolated tibial fracture (18±6 months) and had been treated with an intramedullary tibial nail. Subjects completed a 12-question visual analog scale, a physical symptom and activity of daily living survey, and were also tested for bilateral isokinetic (60°/s) quadriceps femoris and hamstring strength. Knee pain during activity, stiffness, swelling, and buckling were the primary symptomatic complaints. Perceived functional task deficits were greatest for climbing or descending stairs, pivoting, squatting, and walking on uneven surfaces. Involved lower extremity knee extensor and flexor torque production deficits were 25% and 17%, respectively. Early rehabilitation focuses on maintaining adequate operative site bony fixation while providing controlled, progressive, and regular biomechanical loading to restore functionally competent tissue. Following adequate fracture healing, greater emphasis should be placed on lower extremity functional recovery including commonly performed activities of daily living and other functional tasks that are relevant to the patient's disability level. A cyclic rehabilitation program that progresses the weight-bearing environment to facilitate bone and soft tissue healing and neuromuscular re-education is proposed.

Incidence and aetiology of anterior knee pain after intramedullary nailing of the femur and tibia

“…Tibial nails should be positioned in a manner which minimises trauma to the extensor mechanism of the knee. 82 It has been suggested that pain causes reflex inhibition of quadriceps with subsequent atrophy and/or aplasia. 83 EMG studies have shown a modification of neuromuscular control of quadriceps in patients with anterior knee pain.…”

Anterior Knee Pain in Transtendinous and Paratendinous Approaches of Tibial Interlocking Nail: A Comparative Study

“…2,3 They found clear differences in quadriceps morphology in the nailed and unnailed limb. 9 Patients who had anterior knee pain at final follow up had lower functional scores than those who never had knee pain or those whose knee pain has disappeared over time.…”

Asymmetry in gait pattern following tibial shaft fractures – a prospective one-year follow-up study of 49 patients

“…Between the 6-and 12-month follow-up, gait asymmetry become almost normalized. Knee and ankle pain, joint stiffness, degenerative joint disease, rotational malalignment, complications due to soft tissue injury and muscle weakness are commonly reported following a tibial shaft fracture [2,4,6,25,26] and may affect development in gait asymmetry.…”