Anterior Knee Pain After Tibial Nailing - Full Text View

Purpose

Anterior knee pain (AKP) is a common complication following intramedullary (IM) nailing of a tibial shaft fracture. The purpose of this prospective study was to determine if there is an association between AKP and nail position. The investigators have analyzed postoperative outcome results and the possible relationship between AKP according to the visual-analog scale (VAS) scale, and nail position marked as a distance from the tip of the nail to the tibial plateau (NP) and tuberositas tibiae (NT), measured postoperatively on L-L knee X-rays.

Condition	Intervention
Knee Pain	Procedure: Tibial intramedullary nailing

Study Type:	Observational
Study Design:	Observational Model: Cohort Time Perspective: Prospective
Official Title:	Nail Position Has an Influence on Anterior Knee Pain After Tibial Intramedullary Nailing

Resource links provided by NLM:

MedlinePlus related topics: Fractures

U.S. FDA Resources

Further study details as provided by University of Zagreb:

Primary Outcome Measures:

Anterior knee pain [ Time Frame: 1 year ] [ Designated as safety issue: No ]
Anterior knee pain was assessed postoperatively with the visual analog scale (VAS). Patients generally had pain when kneeling, at the insertion point of surgical screws, or at the back of knee upon flexing.

Enrollment:	50
Study Start Date:	January 2006
Study Completion Date:	December 2009
Primary Completion Date:	December 2009 (Final data collection date for primary outcome measure)

Groups/Cohorts	Assigned Interventions
Tibial shaft fractures Patients had tibial shaft fractures in the last 3 years. All were treated with intramedullary (IM) reamed nails with 2 or 3 interlocking screws.	Procedure: Tibial intramedullary nailing Patients' operations were performed using the peritendinous approach. A medial longitudinal incision was made, with care being taken not to damage the patellar tendon or its sheath. Standard proximal and distal locking screws were used. All patients were given postoperative instructions for thigh muscle rehabilitation and the same physiotherapy was performed after IM nailing during hospitalization. Nails were removed from some of the patients with the presence of knee pain or pain at the insertion points of the locking screws, however, no nails were removed earlier than one year postoperatively. Proof of the healed bone fracture was confirmed by radiologic examination. Other Names: tibial fractures intramedullary nailing

Groups/Cohorts

Assigned Interventions

Tibial shaft fractures

Patients had tibial shaft fractures in the last 3 years. All were treated with intramedullary (IM) reamed nails with 2 or 3 interlocking screws.

Procedure: Tibial intramedullary nailing

Patients' operations were performed using the peritendinous approach. A medial longitudinal incision was made, with care being taken not to damage the patellar tendon or its sheath. Standard proximal and distal locking screws were used. All patients were given postoperative instructions for thigh muscle rehabilitation and the same physiotherapy was performed after IM nailing during hospitalization. Nails were removed from some of the patients with the presence of knee pain or pain at the insertion points of the locking screws, however, no nails were removed earlier than one year postoperatively. Proof of the healed bone fracture was confirmed by radiologic examination.

Other Names:

tibial fractures
intramedullary nailing

Detailed Description:

The aim of this study was to determine the possible relationship between anterior knee pain (AKP) and nail position marked as a distance from tip of nail to tibial plateau (NP) and to the tuberositas tibiae (NT).

We evaluated postoperative outcome results of 50 patients in the last 3 years with healed fractures initially treated with intramedullary (IM) reamed nails with 2 or 3 interlocking screws on both parts of the nail and with the use of medial peritendinous incision for nail entry portal. Patients marked a point on the visual analog scale (VAS) that corresponded to the level of postoperative AKP felt. Two groups of patients were formed on the basis of AKP (pain level was neglected): groups A and B, with and without pain, respectively.

We found that the difference between the two groups concerning NP measurements was statistically significant, but not concerning NT measurements (P < 0.05). Patients were classified by pain with high accuracy (98%) according to a classification tree.

We conclude that the symptoms of AKP did not appear if the tip of the nail position was more than 6.0 mm from the NP and more than 2.6 mm from the NT. However, for better evaluation of these results it will be necessary to examine more postoperative patients with AKP.

Eligibility

Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	Yes
Sampling Method:	Non-Probability Sample

Study Population

The population consists of primary care hospital trauma patients with tibial shaft fractures treated with intramedullary nailing.

Criteria

Inclusion Criteria:

tibial shaft fractures
fracture treatment with intramedullary nailing with 2 or 3 interlocking screws on both ends of the nail

Exclusion Criteria:

amputated legs

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT01106963

Locations

Croatia
University of Zagreb School of Medicine, Department of Traumatology
Zagreb, Croatia, 10000

Sponsors and Collaborators

University of Zagreb

Investigators

Principal Investigator:

Nikica Darabos, MD, PhD

University of Zagreb School of Medicine

More Information

No publications provided

Responsible Party:	General Hospital Varazdin, National Health Insurance
ClinicalTrials.gov Identifier:	NCT01106963 History of Changes
Other Study ID Numbers:	AKP
Study First Received:	April 14, 2010
Last Updated:	April 19, 2010
Health Authority:	Croatia: Ethics Committee

Keywords provided by University of Zagreb:

knee
tibial fractures
pain
osteosynthesis
intramedullary nailing

ClinicalTrials.gov processed this record on June 18, 2013