Removal of interlocking intramedullary nail for relieve of knee pain after tibial fracture repair: A prospective study

Abstract

Objective: To investigate the effects of intramedullary nail removal after tibial fracture repair. Methods: 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. Results: 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 (<10mm) and the anterior border of tibia (<6mm) 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). Conclusion: 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.