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Does nail extraction abolish anterior knee pain post intramedullary nailing of tibial and femoral fractures? A review of the current literature

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Abstract

Anterior knee pain is a common symptom and challenging problem to manage as described by many patients post intramedullary nailing of the tibia and also the femur. The current literature has been reviewed to ascertain the effect of intramedullary nail extraction on the incidence of anterior knee pain. Eleven publications appeared potentially eligible however, only eight of these met the inclusion criteria. A further four studies were found from the references of the previous papers. Analysis of 12 citations has been performed, identified from computerised databases and references. One investigator reviewed and qualitatively graded the content of each study and obtained the relevant data. Three studies all retrospective in design looking at intramedullary nailing of the femur showed that a total of 30 femoral nails were removed. From these we know 4/6 patients (from two studies) had complete resolution of symptoms. The post extraction pain status in the remaining 24 femoral nails was simply reported as “few patients had knee pain after removal [Braten et al.in injury 18 (1) :18-23, 2004]”. There were five retrospective and four prospective reviews of tibial nails. Only one study set out to look at pain post instrumentation removal. Out of a total of 289 tibial nails removed 113 or 39% of patients had complete resolution, 100 or 35% had partial resolution, 25% no resolution of symptoms. In 1% of cases was there deterioration in the patient’s symptoms. There are many limitations with regards to many of these studies, such as low sample sizes, retrospective analysis, ambiguous outcome measures and groups with incomplete follow-up. These results must be therefore be interpreted in the light of this. Further controlled studies, preferably randomised, controlled, prospective which take into account confounding variables are required in order to fully ascertain the true effect of intramedullary nail removal on the anterior knee pain experienced by so many.

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Acknowledgments

Conflict of interest statement: no funds were received in support of this study.

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  1. University of Coventry and Warwickshire Hospitals, Clifford Bridge Road, Coventry, CV2 2DX, UK

    Charlie Lewis

  2. 27 Brueton Avenue, Solihull, B91 3EN, UK

    Charlie Lewis

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  1. Charlie Lewis
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Correspondence to Charlie Lewis.

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Lewis, C. Does nail extraction abolish anterior knee pain post intramedullary nailing of tibial and femoral fractures? A review of the current literature. Eur J Orthop Surg Traumatol 18, 315–321 (2008). https://doi.org/10.1007/s00590-008-0305-x

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  • DOI: https://doi.org/10.1007/s00590-008-0305-x

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