Influence of Nail Prominence and Insertion Point on Anterior Knee Pain After Tibial Intramedullary Nailing

Full article available online at Healio.com/Orthopedics. Search: 20140225-52 Chronic anterior knee pain is the most common complication after tibial nail insertion. Its etiology remains unknown, and multifactorial sources have been suggested. The authors believe that nail prominence and the insertion point of the nail are important in the development of anterior knee pain. The purpose of this retrospective study was to evaluate the roles of the insertion point and nail prominence in anterior knee pain after tibial intramedullary nailing using a transtendinous approach and a common nail type. A total of 108 patients with tibial shaft fractures underwent reamed intramedullary nailing using a transtendinous approach between 2006 and 2009. Mean followup was 26.8±5.0 months. A visual analog scale (0-100) was used to estimate anterior knee pain severity while patients performed 7 activities retrospectively. Radiographic assessments, including nail prominence and insertion point, were performed. Sixty (55.6%) patients experienced knee pain (group P) and 48 (44.4%) did not (group N). Significant differences were not found between the groups with respect to demographics, nail diameters, or fracture classifications. Less superior and more anterior nail prominences in radiographic assessments were significantly associated with anterior knee pain. When the insertion point was over the bottom half of the anterior cortex, the influence of anterior nail prominence was more obvious. Nail removal resulted in diminished pain during the 7 assessed activities. Nail insertion should be over the bottom half of the anterior cortex, with minimal anterior nail prominence. If anterior knee pain occurs, removal of the nail should be considered. The authors are from the Department of Orthopaedics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan. The authors have no relevant financial relationships to disclose. Correspondence should be addressed to: Kai-Cheng Lin, MD, Department of Orthopaedics, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Rd, Kaohsiung City, Taiwan ([email protected]). Received: June 21, 2013; Accepted: November 25, 2013; Posted: March 11, 2014. doi: 10.3928/01477447-20140225-52 Influence of Nail Prominence and Insertion Point on Anterior Knee Pain After Tibial Intramedullary Nailing Chun-Yu Chen, MD; Kai-Cheng Lin, MD; Shan-Wei Yang, PhD; Yih-Wen Tarng, PhD; Chien-Jen hSu, MD; Jenn-huei renn, PhD Figure: Lateral radiograph illustrating superior nail prominence (the distance from the proximal tip of the nail to the tibial plateau) (A) and anterior nail prominence (the distance from the anterior tip of the nail to the anterior tibial cortex) (B).