Knee and ankle function after displaced non-isolated fractures of the tibial shaft, a retrospective comparison between plate fixation and intramedullary nailing

Abstract

Knee and ankle function after tibial shaft fractures have not been evaluated comparing intramedullary nailing (IMN) and plate fixation (PF). In a retrospective case review study we evaluated 50 patients with history of closed tibial and fibular shaft fracture who have been treated by IMN or PF from 1999 to 2003. Twenty-five patients in each group evaluated for knee and ankle function using Iowa knee score, ankle rating score and VAS for the pain. 18.3±4.8 weeks after PF (mean follow up 35±11.7) and 16.4±4.6 weeks after IMN fixation (mean follow up 36.8±11.3) union has been achieved (P<0.17). The knee score was 89.4±10.4 in IMN group and 95.7±6.7 in PF one (P<0.01). The ankle rating score was 94.7±7.2 in IMN and 96.8±6.1 in PF (P<0.28). The nail to knee distance (average 14±5.2 mm) was significantly correlated to the knees' function and pain (r=0.599, P<0.002, r=0.583, P<0.002, respectively). T-test reveals that knees' function are significantly inferior with transpatellar approach in comparison with parapatellar one (86.1±10.6 vs. 95.3±7.4, P<0.01). Our study discloses that using plate may lead to better knee function, while IMN causes higher amount of knee pain with controversial reasons.

Anterior knee pain and functional outcome following different surgical techniques for tibial nailing: a systematic review

“…For fractures around the knee, there is currently no validated, reliable, and reproducible outcome measure. For patients with tibia fractures only, the disease-specific Short Musculoskeletal Function Assessment (SMFA) and the generic measure SF-36 have [24,26,33,48] are the most commonly used for this cause, but neither is validated for this specific patient population. Validation of (at least one of) these questionnaires in a patient population that include tibial fractures is, therefore, needed.…”

“…The Lysholm Scale [5, 9, 26, 45, 53, 56, 66, 73, 75, 77, 79-81, 83, 84], Iowa Knee Score [24,26,33,48], (Kujala) Anterior Knee Pain Scale (AKPS) [4,51,80,81], Functional Anterior Knee Pain Score [38,75,80], Oxford Knee Score [8,80] and International Knee Documentation Committee (IKDC Questionnaire) [80] were used for measuring the knee function after tibial nailing. Pooled estimates for the Lysholm Scale were 87 points (95% CI 81-94) for the infrapatellar technique and 85 points (95% CI 83-87) for the suprapatellar technique (Fig.…”

“…To measure ankle function, the following instruments were used: AOFAS ankle-hindfoot scoring system [67,77,78,82], Iowa Ankle Score (also known as Merchant and Dietz Ankle Function Score) [24,31,33,36,48], Olerud and Molander Ankle Score [36,76,82], Mazur Ankle Score [59], and Foot Function Index [54]. Pooled estimates for the AOFAS ankle-hindfoot scoring system and Iowa Ankle Score were 91 (95% CI 87-93) and 92 (95% CI 89-96) for the infrapatellar and suprapatellar technique, respectively.…”