title: Anterior knee pain after intramedullary tibial nailing.
abstract: BACKGROUND
  Currently, intramedullary nailing is a well-accepted method for treating tibial shaft fractures, but some patients complain of anterior knee pain after surgery. Multiple factors may influence this troublesome complication.
  
  
  METHODS
  This was a retrospective analysis of the medical records of 200 patients who were treated with intramedullary nailing after tibial shaft fractures. Sixty-four patients complained of knee pain after surgery. We evaluated the knee pain in relation to the surgical approach, radiographic readings, and the type of nail used.
  
  
  RESULTS
  Among the 64 patients, 45 (70%) received central approaches and 19 (30%) received paramedial approaches (p = 0.0002); 46 patients (72%) showed nail protrusions on radiographs and only 18 patients (28%) were without nail impingement (p = 0.0001). Forty-three patients (67%) received Kuntscher nail fixation and just 21 patients (33%) had interlocking nail fixation (p = 0.0015).
  
  
  CONCLUSIONS
  The use of the central patellar tendon splitted approach, nail protrusion observed on radiographs, and the insertion of a non-locking intramedullary nail were all significant risk factors for anterior knee pain after surgery. All these risk factors should be avoided in tibial nailing to decrease the problem of postoperative knee pain.
authors.affiliation: Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Taipei, R.O.C.
authors.forename: S W
authors.initials: SW
authors.lastname: Yu
authors.forename: Y K
authors.initials: YK
authors.lastname: Tu
authors.forename: K F
authors.initials: KF
authors.lastname: Fan
authors.forename: J Y
authors.initials: JY
authors.lastname: Su
mesh_terms: D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects*; D006801:Humans; D007717:Knee; D010146:Pain / Q000209:etiology*; D012189:Retrospective Studies; D013978:Tibial Fractures / Q000601:surgery*