title: Knee pain after tibial nailing: the role of nail prominence.
abstract: We analyzed the relationship between knee pain after tibial nailing and nail prominence. We identified 70 patients in our trauma registry with healed fractures initially treated with intramedullary nails. Subjective pain and function were measured with visual analog pain scales and Lysholm knee scores at a mean of 20 months after fracture. These scores were compared with nail prominence measured on postoperative radiographs. More than 49% of patients had knee pain. Subjective knee pain was more common in women and patients with a smaller plateau width. Anterior nail prominence was associated with increased pain at rest. Patients with superior nail prominence had increased pain with kneeling and walking. Nail prominence correlated with increased knee pain. We think surgeons can decrease, but not eliminate, the severity of knee pain after tibial nailing by burying the tip of the nail as reflected on lateral radiographs.
  
  
  METHODS
  Prognostic Study, Level II-1 (retrospective study). See the Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Partners Orthopaedic Trauma Service, Massachusetts General Hospital, Boston, MA 02118, USA.
authors.forename: Timothy
authors.initials: T
authors.lastname: Bhattacharyya
authors.forename: Khemarin
authors.initials: K
authors.lastname: Seng
authors.forename: Nader A
authors.initials: NA
authors.lastname: Nassif
authors.forename: Ilan
authors.initials: I
authors.lastname: Freedman
mesh_terms: D000328:Adult; D018771:Arthralgia / Q000000981:diagnostic imaging / Q000209:etiology*; D001858:Bone Nails / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007719:Knee Joint; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011859:Radiography; D012042:Registries; D012189:Retrospective Studies; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome