Knee pain and associated complications after intramedullary nailing of tibial shaft fracture

INTRODUCTION: The treatment of choice for unstable diaphyseal fractures in the tibia is reamed insertion of an intramedullary nail (IMN). The most common complication to this treatment is chronic knee pain with reported rates ranging from 10% to 87% with a mean of 47.4% in meta-analyses.

METHODS: This study evaluates the long-term outcome after IMN insertion in adult patients with a tibial shaft fracture using the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire. The study includes patients operated on one of five Danish hospitals in a five-year period. The patients received a KOOS questionnaire with questions regarding knee-specific symptoms, stiffness, pain, function and quality of life. Data were subsequently compared to those of a reference population.

RESULTS: A total of 391 patients were enrolled from the trauma centre’s database search. 55 patients did not meet the inclusion criteria. Questionnaires were sent out to 336 patients and 223 (66%) responded. Mean age was 47.9 years at the time of surgery; 63% were men. The follow-up time ranged from 1.7 to 6.7 years.

CONCLUSIONS: With a follow-up time of more than six years after receiving an IMN, patients in this study experienced more knee-specific symptoms, pain, limitations in sports and daily living than a reference population who had not undergone surgery. The study population also reported poorer quality of life outcomes than the reference population.

FUNDING: none.

TRIAL REGISTRATION: Approved by the Danish Data Protection Agency. Clinical trials: NCT03649360.