Skip to main content

Advertisement

Log in

MRI of the knee after locked unreamed intramedullary nailing of tibia

  • Original Article
  • Published:
La Chirurgia degli Organi di Movimento Aims and scope Submit manuscript

Abstract

We analysed the reason for knee pain after intramedullary (IM) nailing with standard MRI sequences at a mean of 27 months (range 2–45) after nail removal in eleven patients with a mean age of 30 years (range 15–52). Knee pain was assessed in four grades. All our patients had signal changes of fluid in the nail channel, areas of low signal intensity in Hoffa’s fat pad and subcutaneous low signal nodes in front of a thickened patellar ligament. Ten patients had low signal adhesions from the nail insertion towards the patellar ligament. Six patients had severe knee pain and even marked adhesions. Two patients had no knee pain; one of these two had minimal adhesions and the other one no adhesions. Five of the patients had a meniscal tear and/or local cartilage reduction. The degree of adhesions from the nail insertion in the tibia towards the patellar ligament was proportional to the degree of knee pain. No sign of acute inflammation was found.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Alberts KA, Loohagen G, Einarsdottir H (1999) Open tibial fractures: faster union after unreamed nailing than external fixation. Injury 30:521–522

    Article  Google Scholar 

  2. Anglen JO, Mark Blue J (1995) A comparison of reamed and unreamed nailing of tibia. J Trauma 39:352–354

    Article  Google Scholar 

  3. Bono CM, Levine RG, Rao JP, Behrens FF (2001) Nonarticular proximal tibia fractures: treatment options and decision making. J Am Acad Orthop Surg 9:176–186

    PubMed  CAS  Google Scholar 

  4. Keating JF, Phil M, O’Brien PJ et al (1997) Locking intramedullary nailing with and without remaing for open fractures of the tibial shaft: a prospective randomized study. J Bone Joint Surg Am 79:339

    Article  Google Scholar 

  5. Shannon FJ, Mullet H, O’Rourke K (2002) Unreamed intramedullary nailing versus external fixation in grade III open tibial fractures. J Trauma 52:652

    Google Scholar 

  6. Singer RW, Kellam JF (1995) Open tibial diaphyseal fractures: Results of unreamed locked intramedullary nailing. Clin Orthop Relat Res 315:115–117

    Google Scholar 

  7. Whittle AP, Russel TA, Taylor JC, Lavelle DG (1992) Treatment of open fractures of the tibial shaft with the use of interlocking nailing without remaing. J Bone Joint Surg Am 74:1166–1168

    Google Scholar 

  8. Schandelmaier P, Krettek C, Rudolf J et al (1997) Superior results of tibial rodding versus external fixation in grade IIIB fractures. Clin Orthop Relat Res 342:169

    Article  Google Scholar 

  9. Georgiadis GM (1995) Tibial shaft fractures complicated by compartment syndrome. J Trauma 38:449–451

    Google Scholar 

  10. Koval KJ, Clapper MF, Brumback RJ et al (1991) Complications of reamed intramedullary nailing of the tibia. J Orthop Trauma 5:184–189

    PubMed  CAS  Google Scholar 

  11. Karlström G, Olerud S (1974) Fractures of the tibial shaft: a critical evaluation of treatment alternatives. Clin Orthop Relat Res 105:82–115

    PubMed  Google Scholar 

  12. Court-Brown CM, Gustilo T, Shaw AD (1997) Knee pain after intramedullary tibial nailing: its incidence, etiology, and outcome. J Orthop Trauma 11:103–105

    Article  PubMed  CAS  Google Scholar 

  13. Keating JF, Orfaly R, O’Brien PJ (1997) Knee pain after tibial nailing. J Orthop Trauma 11:10–13

    Article  PubMed  CAS  Google Scholar 

  14. Toivanen JA, Vaisto O, Kannus P et al (2002) Anterior knee pain after Intramedullary nailing of fractures of the tibial shaft. A prospective, randomized study comparing two different nail insertion techniques. J Bone Joint Surgery Am 84:580–585

    Google Scholar 

  15. Gustillo RB, Mendoza RM, Williams DN (1984) Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. J Trauma 24:740–743

    Google Scholar 

  16. Müller ME, Nazarian S, Koch P, Schatzker J (1990) The comprehensive classification of fractures of long bones. Springer-Verlag, Berlin, Heidelberg, New York

    Google Scholar 

  17. Greenspan A (1999) Orthopaedic radiology. Lippincott Williams Wilkins, Philadelphia, pp 52–54

    Google Scholar 

  18. Winquist RA, Hansen ST Jr (1980) Comminuted fractures of the femoral shaft treated by intramedullary nailing. Clin Orthop N Am 11:633–648

    CAS  Google Scholar 

  19. Lindgren U, Svensson O (1996) Ortopedi. Almqvist & Wiksell Medicin/Liber, Stockholm, p 145

    Google Scholar 

  20. Cotran RS, Kumar V, Robbins SL (1999) Robbins pathologic basis of disease. Saunders, Oxford, pp 50–86

    Google Scholar 

  21. Teller P, König H, Weber U, Hertel P (2003) MRI atlas of orthopedics and traumatology of the knee. Springer-Verlag, Berlin, New York, p 163

    Google Scholar 

  22. Schild H, Muller HA, Menke W (1982) Computer tomography after medullary nailing of the tibia. ROFO Fortschr Geb Rontgenstr Nuklearmed 137:554–560

    PubMed  CAS  Google Scholar 

  23. Braten M, Nordby A, Terjesen T, Rossvoll I (1992) Bone loss after locked intramedullary nailing. Computed tomography of the femur and tibia in 10 cases. Acta Orthop Scand 63:310–314

    Article  PubMed  CAS  Google Scholar 

  24. Kroger H, Kettunen J, Bowditch M et al (2002) Bone mineral density after the removal of intramedullary nails: a cross-sectional and longitudinal study. J Orthop Sci 7:325–330

    Article  PubMed  CAS  Google Scholar 

  25. Glotzer W (1993) Measuring intraosseous pressure and osseous venography of the patella in anterior knee pain. Part II. Unfallchirurgiie 96:271–281

    CAS  Google Scholar 

  26. Mao BY (1993) The change of intraosseous pressure in the femur and tibia near knee and knee pain. Zhonghua Wai Ke Za Zhi 31:593–595

    PubMed  CAS  Google Scholar 

  27. Miltner O, Siebert CH, Schneider U et al (2003) Patellar hypertension syndrome in adolescence: a three-year follow up. Arch Orthop Trauma Surg 123:455–459

    Article  PubMed  CAS  Google Scholar 

  28. Schneider U, Breusch SJ, Thomsen M et al (2000) A new concept in the treatment of anterior knee pain: patellar hypertension syndrome. Orthopedics 23:581–586

    PubMed  CAS  Google Scholar 

  29. Ellis H (1958) Disability after tibial shaft fractures, with special reference to Volkmann’s ischemic contracture. J Bone Joint Surg Br 40:190

    PubMed  Google Scholar 

  30. Horne G, Iceton J, Twist J, Malony R (1990) Disability following fractures of the tibial shaft. Orthopedics 13:423–426

    PubMed  CAS  Google Scholar 

  31. McMaster MJ, James JI (1976) Disability of the hindfoot after fracture of the tibial shaft. J Bone Joint Surg 58:90–93

    CAS  Google Scholar 

  32. Mulhall KJ, Dowdall J, Grannell M, McCabe JP (1999) Tibial spine fractures: an analysis of outcome in surgically treated type III injuries. Injury 30:289–292

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gustafsson, J., Toksvig-Larsen, S. & Jonsson, K. MRI of the knee after locked unreamed intramedullary nailing of tibia. Chir Organi Mov 91, 45–50 (2008). https://doi.org/10.1007/s12306-007-0008-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12306-007-0008-1

Keywords

Navigation