Removal of interlocking intramedullary nail for relieve of knee pain after tibial fracture repair

Abstract

To investigate the effects of intramedullary nail removal after tibial fracture repair. Sixty patients at our hospital were enrolled in a prospective study and divided into moderate/severe knee pain (visual analog scale (VAS) ≥ 4) and mild/no knee pain (VAS < 4) groups after interlocking intramedullary nailing. Variables studied included the distance from the tip of the nail to the tibial plateau and the front of the tibia on a normalized lateral X-ray, the VAS score of knee and ankle pain, the range of motion of the knee and ankle, and Johner-Wruhs criteria before, 6 weeks after operation, and at the last follow-up. Fifty-seven patients were followed for a mean of 8.4 (2-17) months. In patients with moderate or severe knee pain intramedullary nail removal led to significant pain reductions ( p < 0.05). A significantly shorter distance from the tip of the nail to the tibial plateau (<10 mm) and the anterior border of tibia (<6 mm) was found in the 24 patients with moderate or severe knee pain. Knee pain VAS scores significantly lowered 6 weeks postoperatively and at the last follow-up, compared to before the operation ( p < 0.05). However, no significant changes occurred with respect to ankle pain VAS scores, range of motion, and Johner-Wruhs criteria ( p > 0.05). For patients complaining knee pain after interlocking intramedullary nailing of tibial fractures, especially with a short distance from the tip of the nail tail to the tibial plateau (<10 mm) and the anterior border of the tibia (<6 mm) removal of the intramedullary nails relieved the pain significantly.