Character, Incidence, and Predictors of Knee Pain and Activity after Infrapatellar Intramedullary Nailing of an Isolated Tibia Fracture

William Obremskey, Vanderbilt Orthopaedic Institute
Julie Agel, University of Washington, Seattle
Kristin Archer, Vanderbilt Orthopaedic Institute
Philip To, Vanderbilt Orthopaedic Institute
Paul Tornetta, Boston University
Mohit Bhandari, Hamilton Health Sciences
Gordon Guyatt
David W. Sanders, Western University
Emil H. Schemitsch, Saint Michael's Hospital University of Toronto
Marc Swiontkowski
Stephen Walter
Sheila Sprague, McMaster University
Diane Heels-Ansdell, McMaster University
Lisa Buckingham, McMaster University
Pamela Leece, McMaster University
Helena Viveiros, McMaster University
Tashay Mignott, McMaster University
Natalie Ansell, McMaster University
Natalie Sidorkewicz, McMaster University
Claire Bombardier
Jesse A. Berlin
Michael Bosse
Bruce Browner
Brenda Gillespie
Alan Jones
Peter O'Brien
Rudolf Poolman
Mark D. Macleod, Western University
Timothy Carey, Western University
Kellie Leitch, Western University
Stuart Bailey, Western University
Kevin Gurr, Western University
Ken Konito, Western University


© Copyright 2015 Wolters Kluwer Health, Inc. All rights reserved. Objective: To study the activity and incidence of knee pain after sustaining an isolated tibia fracture treated with an infrapatellar intramedullary nail at 1 year. Design: Retrospective review of prospective cohort. Setting: Multicenter Academic and Community hospitals. Patients: Four hundred thirty-seven patients with an isolated tibia fracture completed a 12-month assessment on pain and self-reported activity. Intervention: Infrapatellar intramedullary nail. Outcomes: Demographic information, comorbid conditions, injury characteristics, and surgical technique were recorded. Knee pain was defined on a 1-7 scale with 1 being "no pain" and 7 being a "very great deal of pain." Knee pain >4 was considered clinically significant. Patients reported if they were "able," "able with difficulty," or "unable" to perform the following activities: kneel, run, climb stairs, and walk prolonged. Variables were tested in multilevel multivariable regression analyses. Results: In knee pain, 11% of patients reported a "good deal" to a "very great deal" of pain (>4), and 52% of patients reported "no" or "very little" pain at 12 months. In activity at 12 months, 26% and 29% of patients were unable to kneel or run, respectively, and 31% and 35% of patients, respectively, stated they were able with difficulty or unable to use stairs or walk. Conclusions: Clinically significant knee pain (>4/7) was present in 11% of patients 1 year after a tibia fracture. Of note, 31%-71% of patients had difficulty performing or were unable to perform routine daily activities of kneeling, running, and stair climbing, or walking prolonged distances.