Anterior Knee Pain after Intramedullary Tibial Nailing

Kyung Taek Kim; Sung Keun Sohn; Min Soo Kang; Xin Jin; Chul Won Lee; Lih Wang

doi:10.4055/jkoa.2009.44.1.61

Journal List > J Korean Orthop Assoc > v.44(1) > 1012955

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Kim, Sohn, Kang, Jin, Lee, and Wang: Anterior Knee Pain after Intramedullary Tibial Nailing

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2009; 44(1): 61-67.

Published online: 23 February 2009

DOI: https://doi.org/10.4055/jkoa.2009.44.1.61

Anterior Knee Pain after Intramedullary Tibial Nailing

Kyung Taek Kim, M.D., Sung Keun Sohn, M.D.^*, Min Soo Kang, M.D., Xin Jin, M.D.^*, Chul Won Lee, M.D.^*, Lih Wang, M.D.^*

Department of Orthopaedic Surgery, Dong-Eui Medical Center, Busan, Korea.

^*Department of Orthopaedic Surgery, College of Medicine, Dong-A University, Busan, Korea.

Address reprint requests to Lih Wang, M.D. Department of Orthopedic Surgery, College of Medicine, Dong-A University, 3-1, Dongdaesin-dong 3-ga, Seo-gu, Busan 602-715, Korea. Tel: +82.51-240-2593, Fax: +82.51-254-6757, libi33@dau.ac.kr

Abstract

Purpose

To document the incidence and analyze the causes of anterior knee pain following closed intramedullary nailing for tibial fractures.

Materials and Methods

Between January 2005 and February 2007, 50 tibial fractures (48 patients) were treated using locked intramedullary nails. We examined the relationship between postoperative anterior knee pain and age, gender distribution, mechanism of injury, cause and type of fracture, method of patellar tendon incision, and position of the nails on radiography. Anterior knee pain was assessed using a visual analogue scale (VAS). Pearson chi-square test was used to assess the incidence of knee pain.

Results

At a mean follow-up period of 16 months (range 13-30 months), 23 cases (46%) had developed anterior knee pain. Knee pain was more common in woman (p=0.000), but there was no statistically significant difference with regard to age, cause or type of fracture, reaming or incision technique. If the knee apex distance was below -30 mm on radiological analysis, there was no statistically significant increase in postoperative knee pain (p=0.000). Nail removal resolved or improved the symptoms in 77% of patients with anterior knee pain.

Conclusion

Based on these data, nail prominence correlated with increased knee pain. We believe surgeons can decrease the severity of knee pain after tibial nailing by burying the tip of the nail as reflected on lateral radiographs.

Keywords: Tibial shaft fracture, Intramedullary nailing, Anterior knee pain

Figures and Tables

Fig. 1

Measurement of the knee apex distance after IM nailing.

Fig. 2

Number of patients according to knee apex distance.

Table 1

Patient Demographics

^*SD, standard deviation; ^†J&W, Johner & Wruhs.

Table 2

Questionnaires in Postoperative Knee Pain Research

^*S, single choice; ^†M, multiple choice.

Please place a mark (√) at the point that corresponds to how you fell about your knee pain.

Table 3

Relationship of Knee Pain to the Time After Surgery

Table 4

Rate of Knee Pain Related to Risk Factors

^*J&W, Johner & Wruhs.

Table 5

Overall Incidence and Severity of Knee Pain (10-point Analog Scale)

Table 6

Incidence of Pain Associated with Different Activities in the Pain Group

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