Ulnar Nerve Division in a Displaced Supracondylar Fracture: a Case Report

VOL. 77-B. No. 6, NOVEMBER 1995 This had been by a paratendinous incision in 65 fractures and a patellar-tendon-splitting incision in 36. The position of the nail in relation to the tibial plateau and anterior cortex was measured on postoperative lateral radiographs. The patients were reviewed to discover the incidence of knee pain and the need for nail removal. Results. Sixty-one of the 107 patients (56%) developed troublesome knee pain in the area of nail insertion. When a paratendinous insertion had been used 33 of 65 fractures (51%) were associated with subsequent knee pain. When nail insertion was through the tendon 28 of 36 knees (78%) developed subsequent pain. This difference was significant (chi-squared test with Yates’ correction, p < 0.01). There was no significant difference between the two groups in the mean distance of the nail from the plateau or the extent of nail protrusion beyond the anterior tibial cortex. In 49 patients (46%) the pain was troublesome enough to require removal of the nail. At a mean of 16 months after removal, pain was completely relieved in 22 patients. Seventeen had only partial relief, and the remaining ten had no improvement. The pain relief after nail removal was not related to the entry point (Mann-Whitney test, p = 0.36). Discussion. Tibial nailing has been associated with excellent results in most reports but there has been some concern about knee pain. In our series this was the most common complication, and the response to nail removal was unpredictable; only 45% of the patients had complete relief. Nail position in relation to the anterior cortex and tibial plateau had no influence on knee pain. We took particular care to avoid excessive prominence of the nail at the entry site; this may explain this lack of influence. The use of a patellar-tendon-splitting approach for nail insertion was associated with a much higher risk of subsequent pain and our findings suggest that a paratendinous approach helps to reduce this. We now avoid splitting the patellar tendon for the insertion of tibial nails.