Pain in Anterior Knee after Locked Nailing of Diaphyseal Tibia Fractures

Cover Page

Abstract

The relevance of the study is determined by the high incidence of pain in the anterior knee after the locked nailing of the diaphyseal tibia fracture. The etiology and pathogenesis of this complication remain unclear. Most authors believe that the cause of this complication is a combination of several factors. Material and Methods. The study included 70 patients with consolidated diaphyseal tibia fractures undergone closed blocked nailing through the patellofemoral ligament. The results of the surgery were studied in the time frame of 2 to 4 years (average 36.96±12.05 months). Patients were divided into groups according to the presence or absence of pain in the anterior knee, the type of tibial fractures, the location of the nail in the proximal tibia metaphysis. The evaluation of the outcomes was carried out with the SF-36 questionnaire and the knee X-ray. The significance of differences in the samples was determined by the Pearson’s and Student’s criteria, and Fisher’s exact criterion. Results. The incidence of pain in the anterior knee was 46%. This complication led to a decrease in the patients’ quality of life to a greater extent and in most parameters than in the patient without pain, namely, physical components of health by 10% (p = 0.024), physical activity by 8.8% (p = 0.024), role-based functioning due to physical condition by 14.1% (p = 0.001). The intergroup analysis revealed that the extension of the end of the nail beyond the proximal tibial metaphysis was one of the factors that determeded the development the pain (p<0.05). There were differences in the frequency of pain in groups with different depths of immersion of the nail into the proximal metaphysis (p<0.05). The closer to the tibial plateau the proximal end of the nail was located, the more often the pain occurred in the postoperative period. In the patients with type C diaphyseal fractures, pain in the knee was much more common than in patients with type A and B fractures (p<0.05). Conclusion. The quality of life of the patients with pain in the anterior knee after locked nailing was characterized by a decrease in physical activity and role functioning in society. The main cause of the pain was the projection of the nail beyond the bone borders of the tibial metaphysis or the location of its proximal end in the subchondral area. The type of diaphyseal tibia fracture according to the AO / ASIF classification was a factor that determined the incidence of pain in the anterior knee.

About the authors

V. V. Pisarev

Ivanovo State Medical Academy; Ivanovo Regional Hospital for War Veterans

Author for correspondence.
Email: drpisarev@mail.ru

Vasily V. Pisarev — Dr. Sci. (Med.), Professor, Department of Traumatology and Orthopedics, Ivanovo State Medical Academy; Head of Department, Ivanovo Regional Hospital for War Veterans

Ivanovo

Russian Federation

References

  1. Väistö O., Toivanen J., Kannus P., Järvinen M. Anterior knee pain after intramedullary nailing of fractures of the tibial shaft: an eight-year follow-up of a prospective, randomized study comparing two different nailinsertion techniques. J Trauma. 2008;64(6):1511-1516. doi: 10.1097/TA.0b013e318031cd27.
  2. Väistö O., Toivanen J., Kannus P., Järvinen M. Anterior knee pain and thigh muscle strength after intramedullary nailing of a tibial shaft fracture: an 8-year followup of 28 consecutive cases. J Orthop Trauma. 2007;21(3): 165-171. doi: 10.1097/BOT.0b013e31803773cd.
  3. Court-Brown C.M., Gustilo T., Shaw A.D. Knee pain a ter intramedullary tibial nailing: its incidence, etiology, and outcome. J Orthop Trauma. 1997;11(2):103-105. doi: 10.1097/00005131-199702000-00006.
  4. Katsoulis E., Court-Brown C., Giannoudis P.V. Incidence and aetiology of anterior knee pain after intramedullary nailing of the femur and tibia. J Bone Joint Surg Br. 2006;88(5):576-580. doi: 10.1302/0301-620X.88B5.16875.
  5. Bishop J.A., Campbell S.T., Eno J.T., Gardner M.J. Knee Pain After Intramedullary Nailing of Tibia Fractures: Prevalence, Etiology, and Treatment. J Am Acad Orthop Surg. 2018;26(18):e381-e387. doi: 10.5435/JAAOS-D-18-00076.
  6. Cartwright-Terry M., Snow M., Nalwad H. The s ity and prediction of anterior knee pain post tibial nail insertion. J Orthop Trauma. 2007;21(6):381-385. doi: 10.1097/BOT.0b013e3180caa138.
  7. Al Hussainy H., Deeb A., Choudhary A. Anterior knee pain following intramedullary nailing of tibial shaft fractures: does bony portal point in the sagittal plane affect the outcome? Eur J OrthopSurg Trauma. 2005;15:113-117. doi: 10.1007/s00590-004-0210-x.
  8. Orfaly R., Keating J.E., O’Brien P.J. Knee pain after tibial nailing: does the entry point matter? J Bone Joint Surg Br. 1995;77(6):976-977.
  9. Bhattacharyya T., Seng K., Nassif N.A., Freedman I. Knee pain after tibial nailing: the role of nail prominence. Clin Orthop Relat Res. 2006;449:303-307. doi: 10.1097/01.blo.0000223976.91089.08.
  10. Song S.Y., Chang H.G., Byun J.C., Kim T.Y. Anterior knee pain after tibial intramedullary nailing using a medial paratendinous approach. J Orthop Trauma. 2012;26(3): 172-177. doi: 10.1097/BOT.0b013e3182217fe6.
  11. Leliveld M.S., Verhofstad M.H. Injury to the infrapatellar branch of the saphenous nerve, a possible cause for anterior knee pain after tibial nailing? Injury. 2012;43(6):779-783. doi: 10.1016/j.injury.2011.09.002.
  12. Toivanen J.A., Väistö O., Kannus P., Latvala K., Honkonen S.E., Järvinen M.J. Anterior knee pain after intramedullary nailing of fractures of the tibial shaft. A prospective, randomized study comparing two different nail-insertion techniques. J Bone Joint Surg Am. 2002;84(4):580-585. doi: 10.2106/00004623-200204000-00011.
  13. Tahririan M.A., Ziae E., Osanloo R. Significance of the position of the proximal tip of the tibial nail: An important factor related to anterior knee pain. Adv Biomed Res. 2014;3:119. doi: 10.4103/2277-9175.133187.
  14. Karladani A.H., Ericsson P.A., Granhed H., Karlsson L., Nyberg P. Tibial intramedullary nails — should they be removed? A retrospective study of 71 patients. Acta Orthop. 2007;78(5):668-671. doi: 10.1080/17453670710014374.
  15. Амирджанова В.Н., Горячев Д.В., Коршунов Н.И., Ребров А.П., Сороцкая В.Н. Популяционные показатели качества жизни по опроснику SF-36 (результаты многоцентрового исследования качества жизни «МИРАЖ»). Научно-практическая ревматология. 2008;46(1):36-48. doi: 10.14412/1995-4484-2008-852.
  16. Uzümcügil O., Doğan A., Yalçinkaya M., Kabukçuoğlu Y.S. [The relationship between anterior knee pain occurring after tibial intramedullary nailing and the localization of the nail in the proximal tibia]. Acta Orthop Traumatol Turc. 2009;43(5):386-389. (In Turkish). doi: 10.3944/AOTT.2009.386.
  17. Lefaivre K.A., Guy P., Chan H., Blachut P.A. Long-term follow-up of tibial shaft fractures treated with intramedullary nailing. J Orthop Trauma. 2008;22(8):525-529. doi: 10.1097/BOT.0b013e318180e646.
  18. Soraganvi P.C., Anand-Kumar B.S., Rajagopalakrishnan R., Praveen-Kumar B.A. Anterior Knee Pain after Tibial Intra-medullary Nailing: Is it Predictable? Malays Orthop J. 2016;10(2):16-20. doi: 10.5704/MOJ.1607.004.
  19. Mohapatra N.C., Sahoo U.S. Evaluation of chronic anterior knee pain following interlocking nailing of diaphyseal fractures of tibia. J Orthop Traumatol Rehabil. 2018;10:120-123. doi: 10.4103/jotr.jotr1818.
  20. Rai S.K., Wani S.S., Rohit V., Naveen Sh. Occurrence of аnterior knee pain transpatellar and medial parapatellartendor approaches in fracture tibia nailing. A randomized controlled study. Int J Orthop Traumatol. 2017;3(2):605-608.
  21. Serbest S., Tiftikçi U., Çoban M., Çirpar M., Dağlar B. Knee pain and functional scores after intramedullary nailing of tibial shaft fractures using a suprapatellar approach. J Orthop Trauma. 2019;33(1):37-41. doi: 10.1097/BOT.0000000000001337.
  22. Väistö O., Toivanen J., Kannus P., Järvinen M. Anterior knee pain and thigh muscle strength after intramedullary nailing of tibial shaft fractures: a report of 40 consecutive cases. J Orthop Trauma. 2004;18(1):18-23. doi: 10.1097/00005131-200401000-00004.
  23. Gaines R.J., Rockwood J., Garland J., Ellingson C., Demaio M. Comparison of insertional trauma between suprapatellar and infrapatellar portals for tibial nailing. Orthopedics. 2013;36(9):e1155-1158. doi: 10.3928/01477447-20130821-17.
  24. Keating J.F. Invited commentary: anterior knee pain after intramedullary nailing of the tibia: biomechanical effects of the nail entry zone and anterior cortical bone loss. J Orthop Trauma. 2013;27(1):41-42. doi: 10.1097/BOT.0b013e318267faff.
  25. Daraboš N., Banić T., Lubina Z., Daraboš A., Bilić V., Sabalić S. Precise nail tip positioning after tibial intramedullary nailing prevents anterior knee pain. Int Orthop. 2013;37(8):1527-1531. doi: 10.1007/s00264-013-1944-z.
  26. Choo S.K., Oh H.K., Choi H.W., Song J.G. Anterior knee pain after intramedullary nailing for tibial shaft fractures. J Korean Fract Soc. 2011;24(1):28-32. doi: 10.12671/jkfs.2011.24.1.28.
  27. Jankovic A., Korac Z., Bozic N.B., Stedul I. Influence of knee flexion and atraumatic mobilisation of infrapatellar fat pad on incidence and severity of anterior knee pain after tibial nailing. Injury. 2013;44 Suppl 3:S33-39. doi: 10.1016/S0020-1383(13)70195-5.
  28. Obremskey W., Agel J., Archer K., To P., Tornetta P. 3rd. SPRINT investigators. Character, incidence, and predictors of knee pain and activity after infrapatellar intramedullary nailing of an isolated tibia fracture. J Orthop Trauma. 2016;30(3):135-141. doi: 10.1097/BOT.0000000000000475.

Statistics

Views

Abstract: 620

Dimensions

Article Metrics

Metrics Loading ...

PlumX


Copyright (c)



This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies