title: Local and Widespread Hyperalgesia After Isolated Tibial Shaft Fractures Treated with Intramedullary Nailing.
abstract: Knee pain is accepted as a common complication to intramedullary nailing of tibial fractures. However, no studies have systematically studied the pain sequel following tibial fractures. The objective of this study was to assess pain and hyperalgesia from 6 weeks to 12 months postoperatively after intramedullary nailing of tibial shaft fracture.
  
  
  
  A total of 39 patients were included in this 12-month follow-up study. After 6 weeks, 3, 6, and 12 months postoperatively the pain intensity was measured on a visual analog scale (VAS) and the pressure pain sensitivity was assessed bilaterally by pain pressure thresholds (PPTs).
  
  
  
  The mean age at the time of fracture was 42.9 years. Twelve months after surgery, the pain intensity for worst pain during the last 24 hours was 1.8 ± 2.7 cm. The PPTs progressively increased from 6 weeks after surgery to 12 months postoperatively for all PPT sites except for the forearm (P < 0.012). Moreover, the PPTs on the leg were generally reduced on the injured side compared with the non-injured side (P < 0.04).
  
  
  
  This study suggests that localized, distal, and bilateral hyperalgesia are common following an isolated tibial shaft fracture treated with intramedullary nailing, although no widespread (extrasegmental) hyperalgesia was detected. Such observations may be important for developing the most adequate rehabilitation procedure following a tibial fracture.
authors.affiliation: Departments of *Occupational Therapy and Physiotherapy, peter.larsen@rn.dk.
authors.forename: Peter
authors.initials: P
authors.lastname: Larsen
authors.affiliation: Orthopaedic Surgery, and.
authors.forename: Rasmus
authors.initials: R
authors.lastname: Elsoe
authors.affiliation: Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Denmark;
authors.forename: Thomas
authors.initials: T
authors.lastname: Graven-Nielsen
authors.affiliation: Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Denmark; Physiotherapy Department, University College of Northern Denmark, Aalborg, Denmark, Denmark.
authors.forename: Uffe
authors.initials: U
authors.lastname: Laessoe
authors.affiliation: Orthopaedic Surgery, and Clinical Medicine, Aalborg University, Denmark;
authors.forename: Sten
authors.initials: S
authors.lastname: Rasmussen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects*; D006801:Humans; D006930:Hyperalgesia / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000453:epidemiology / Q000209:etiology*; D013978:Tibial Fractures / Q000601:surgery*; D055815:Young Adult
keywords: Hyperalgesia; Intramedullary Nailing; Pain Sensitivity; Tibial Shaft Fracture;   Pain