title: Semi-extended nailing of metaphyseal tibia fractures: alignment and incidence of postoperative knee pain.
abstract: OBJECTIVE
  To review a large series of tibial metaphyseal fractures treated with nailing in semi-extension (20-30 degrees) using a superomedial portal. To report on the quality and maintenance of reduction. To compare knee pain at final follow-up with a group nailed in hyperflexion (>90 degrees) with a standard inferior incision and parapatellar approach.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Academic medical center.
  
  
  METHODS
  One hundred eighty-five consecutive tibia fractures were treated with intramedullary nails. Eighty-four patients with fractures affecting the proximal (50) or distal (34) metaphysis were nailed with the knee in semi-extension. One hundred one with diaphyseal fractures were nailed in standard hyperflexion and were used as a comparison group.
  
  
  METHODS
  Knee pain was recorded at the final follow-up and graded on a 0-3 scale as per Court-Brown. Alignment was measured on full-length biplanar radiographs immediately postoperative and compared with the same radiographs at union.
  
  
  RESULTS
  There was no statistical difference in the number of patients without knee pain at union (P = 0.7). Radiographic angulation at the fracture was <5 degrees in all patients immediately postoperative, and no patient lost reduction. The average follow-up was 2.3 years.
  
  
  CONCLUSIONS
  Knee pain after semi-extended tibial nailing was similar in frequency compared with standard nailing. There were no significant angulatory deformities, and no losses of reduction for both proximal and distal metaphyseal fractures nailed with the semi-extended technique.
  
  
  METHODS
  Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: *Department of Orthopaedic Surgery, Tufts University School of Medicine, Boston, MA; and †Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA.
authors.forename: Scott P
authors.initials: SP
authors.lastname: Ryan
authors.forename: Brandon
authors.initials: B
authors.lastname: Steen
authors.forename: Paul
authors.initials: P
authors.lastname: Tornetta
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017760:Bone Malalignment / Q000209:etiology; D015331:Cohort Studies; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D015994:Incidence; D007719:Knee Joint; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology; D012189:Retrospective Studies; D013978:Tibial Fractures / Q000150:complications / Q000601:surgery*; D055815:Young Adult