Chronic knee pain after unreamed intramedullary nailing of tibia and its risk factors

Authors: P. Dráč
Authors‘ workplace: Traumatologické oddělení FN Olomouc ;  Department of Traumatology, University Hospital Olomouc
Published in: Úraz chir. 13., 2005, č.1


The purpose of the study was to investigate factors affecting the origin of chronic knee pain in patients with unreamed tibial nail. 118 patients (119 fractures) meeting the entry criteria were reexamined with an average followup of 55 months. We found no significant dependence of the development of chronic knee pain on the investigated factors. As suggested by the different outcomes of previously published studies, the cause of the complaints is probable multifactorial. Nail removal resolved or improved the symptoms in some cases only. There was large group of patients with persistent pain many years after hardware removal. Patients need to be made aware of the possible occurrence of complications.

Key words:
chronic knee pain, intramedullary nailing of tibia, UTN.


1. ALHO, A., EKELAND, A., STROMSOE, K. et al. Locked intramedullary nailing for displaced tibial shaft fractures. J Bone Joint Surg. 72B, 1990, 5, 805–809.

2. ALTHAUSEN, P.L., NIMAN, R., FINKEMEIER Ch.G. et al. Incision placement for intramedullary tibial nailing: An anatomic study. J Orthop Trauma. 16, 2002, 10, 687–690.

3. COURTBROWN, C.M., GUSTILO, T., SHAW, A.D. Knee pain after intramedullary tibial nailing: its incidence, etiology, and outcome. J Orthop Trauma. 11, 1997, 2, 103–105.

4. GUSTILO, R.B., MENDOZA, R.M., WILLIAMS, D.N. Problems with the management of type III (severe) open fractures. J Trauma. 24, 1984, 8, 742–746.

5. HARDY, J.R., GREGG, P.J., WOOD, C. Knee pain after tibial nailing. J Bone Joint Surg. 78B, 1996, 4, 510.

6. HERNIGOU, P., COHEN, D. Proximal entry for intramedullary nailing of the tibia. J Bone Joint Surg. 82B, 2000, 1, 33–41.

7. KARLADANI, A.H., GRANHED, H., EDSHAGE, B. Displaced tibial shaft fractures. Acta Orthop Scand. 71, 2000, 2, 160–167.

8. KARLSTRÖM, G., OLERUD, S. External fixation of severe open tibial fractures with the Hoffmann Frame. Clin Orthop. 1983, 180, 68–77.

9. KEATING, J.F., ORFALY, R.., O'BRIEN, P.J. Knee pain after tibial nailing. J Orthop Trauma. 11, 1997, 1, 10–13.

10. KOVAL, K.J., CLAPPER, M.F., BRUMBACK, R.J. Complications of reamed intramedullary nailing of the tibia. J Orthop Trauma. 5, 1994, 3, 184–189.

11. LEACH, R.E. Fractures of the tibia and fibula. In: ROCKWOOD, C.A. Jr., GREEN, D.P., eds. Fractures in Adults. 2nd ed, vol. 2. Philadelphia: Lippincott, 1984. 1593–1663.

12. McCONNELL, T., TORNETTA, P., TILZEY, J., CASEY, D. Tibial portal placement: the radiographic correlate of the anatomic safe zone. J Orthop Trauma. 15, 2001, 3, 207–209.

13. McCORMACK, D., MULCAHY, D.M., McELWAIN, J.P. Knee pain after tibial nailing. J Bone Joint Surg. 78B, 1996, 4, 511.

14. MIRANDA, H., VIIKARIJUNTURA, E., MARTIKAINEN, R. et al. A prospective study on knee pain and its risk factors. Osteoarthritis Cart. 10, 2002, 8, 623–630.

15. MÜLLER, M.E., NAZARIAN, S., KOCH, P. et al. The comprehensive classification of fractures of long bones. Berlin – Heildelberg: SpringerVerlag, 1990. 201 s.

16. ORFALY, R., KEATING, J.F., O'BRIEN, P.J. Knee pain after tibial nailing: does the entry point matter? J Bone Joint Surg. 77B, 1995, 6, 976–977.

17. TOIVANEN, J.A., VÄISTŐ, O., KANNUS, P. et al. Anterior knee pain after intramedullary nailing of fractures of the tibial shaft. A prospective, randomised study comparing two different nailinsertion techniques. J Bone Joint Surg. 84A, 2002, 4, 580–585.

Surgery Traumatology Trauma surgery
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account