KNEE PAIN AFTER TIBIAL NAILING

Objective: To determine the incidence and natural history of knee pain following tibial nailing. Design: A retrospective analysis of patient s treated by tibial nailing evaluating a consecutive series of patient s with isolated tibial shaft fractures. Setting: A level one trauma ce nter in Vancouver, British Columbia. Patients: A group of 107 consecut ive patients with IIO tibial fractures treated by interlocking tibial nailing. Intervention: Patients were contacted and interview ed by the authors. Clinical records and radiographs were analysed. Main Outcome Measurements: Incidence of knee pain; time of onset, relationship of nail position on radiographs to knee pain; relationship of knee pain t o site of nail insertion; response to nail removal. Results: At a mean follow-up period of thirty-two months (12-58 months), sixty-one (57%) patients (63 of 110 knees) had developed anterior knee pain. There wa s no correlation between nail protrusion and knee pain. Insertion of t he nail through the patella tendon was associated with a higher incide nce of knee pain compared to the paratendon site of nail insertion (77 % and 50% respectively). Of patients with knee pain, 80% (49/61) requi red nail removal. At a mean duration of 16 months following nail remov al. pain was completely relieved in 22 patients and partially relieved in 17. In the remaining 10 patients, there was no improvement. Conclu sions: Based on this data, we could recommend a parapatellar tendon in cision for nail insertion, and nail removal for those patients with a painful knee. The causes of knee pain after tibial nailing are multi-f actorial and require further study.