title: Recommendations for avoiding knee pain after intramedullary nailing of tibial shaft fractures.
abstract: BACKGROUND
  The objective of this study is to analyze the proximal tibiofibular joint in patients with knee pain after treatment of tibial shaft fractures with locked intramedullary nail.
  
  
  RESULTS
  The proximal tibiofibular joint was analyzed in 30 patients, who reported knee pain after tibial nailing, and standard radiograph and computed tomography were performed to examine the proximal third of the tibia. Twenty patients (68.9%) presented the proximal screw crossing the proximal tibiofibular joint and 13 (44.8%) had already removed the nail and/or screw. Four patients (13.7%) reported complaint of knee pain. However, the screw did not reach the proximal tibiofibular joint. Five patients (17.2%) complained of knee pain although the screw toward the joint did not affect the proximal tibiofibular joint.
  
  
  CONCLUSIONS
  When using nails with oblique proximal lock, surgeons should be careful not to cause injury in the proximal tibiofibular joint, what may be one of the causes of knee pain. Thus, the authors suggest postoperative evaluation performing computed tomography when there is complaint of pain.
authors: Department of Orthopaedic Surgery, Federal University of Minas Gerais and Felício Rocho Hospital, Belo Horizonte, MG, Brazil. robinsonesteves@ig.com.br.
authors: Pedro José
authors: PJ
authors: Labronici
authors: Robinson Esteves
authors: RE
authors: Santos Pires
authors: José Sérgio
authors: JS
authors: Franco
authors: Hélio Jorge
authors: HJ
authors: Alvachian Fernandes
authors: Fernando Baldy
authors: FB
authors: Dos Reis