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Author Topic: Knee problems after tibial IM nailing  (Read 4003 times)

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Offline Kasix

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Knee problems after tibial IM nailing
« on: June 05, 2017, 01:14:17 PM »
Hello everyone!

I haven't found a similar topic so I am creating a new one.

Back in December 2016 I broke my tibia and fibula - distal part. It was a severe open fracture. I underwent a surgery to fix the leg with IM nail in tibia. To put the nail in they had to cut my knee open and go through the patella tendon. Bones united after 4 months but I developed a strange pain and stifness at the knee, under patella. I feel discomfort in almost all activities even walking but what causes the most pain is squats and raising the leg straight while seated. Symptoms and ultrasound indicate some changes (thickness and increased vascularity) in patella tendon, maybe tendonitis cause by overuse (cannot belive this, I have been treating my leg with kid gloves). Other structures are ok and I hadn't had any knee injury or pain before the fracture. I am waiting for another ultrasound to confirm since I cannot do MRI because od the hardware.

Obviously my leg muscles are weak but due to my knee problem I cannot excercise. I assume that my weak muscles might be contributing to the knee problem. I have just finished a 2-week round of celecoxib (NSAID) and I am doing PT, there's been a very little improvement.

Anyone has or had similiar problem? I am getting tired of this struggle. It has been almost 6 months, my leg at the fracture site is fine, I could forget about it, but this knee pain is holding me back in full recovery and returning to normal activities and sports which I love.

Thanks for any help, story sharing and advise!

Offline HobbledGirl

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Re: Knee problems after tibial IM nailing
« Reply #1 on: June 06, 2017, 07:30:11 PM »
I'm a little unclear about which area you broke-did you perhaps mean proximal (near the knee)?

Here is a study which seems to be relevant:

Note their comment at end:  Knee pain after intramedullary nailing is most likely related to the operative procedure in the nail insertion rather than the traumatic event which caused the injury.

Hope you are able to solve your problem!
1-4-17 accident on Segway in Madrid.
3-4-17 flight to US w/ full-length plaster splint & crutches I can't use. 😂
6-4-17 surgery for highly comminuted, 1.5 cm depressed Schatzker II TPF.  ORIF: plate, 7 screws, allograft.
29-6-17 WBAT, almost full ROM, -2 mm lateral plateau
16-7-17 Heel met behind

Offline leezard

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Re: Knee problems after tibial IM nailing
« Reply #2 on: June 06, 2017, 09:49:42 PM »
I've had similar issues with pain that all seems to be soft tissue related. My ACL needed to be screwed into place, and I have never been able to have a proper assessment done since the repair. I finally have a specialist appointment this month, but I'm not sure what they can do (if anything) after so long. When I kneel, I cannot sit on my left heel - my knee simply won't bend any further, despite a considerable amount of stretching, yoga, you name it. HOpefully they'll be able to find something that can help release it, since it's the cause of a fair bit of pain as well as limits in mobility.

It does sound similar to the feelings you have described, however. Hopefully they can find what it is and fix it!

6/6/09 - TPF (fell)
6/7/09 - surgery: plate; 9 screws
6/9/09 - d/c from hospital w/immobilizer; NWB
6/15/09 - staples removed
7/6/09 - start on ROM
8/6/09 - 20lbs WB, start PT
8/30/09 - stuck @ 75 degrees; start weaning brace; up to 60lbs WB
9/28/09 - D/C from OS care; 92 AROM; 105 PROM

Offline Kasix

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Re: Knee problems after tibial IM nailing
« Reply #3 on: June 07, 2017, 09:01:58 AM »
Thank you both for replies!!

I broke distal part of tibia and fibula, just above the ankle, faaaaar away from the knee.

I am aware that anterior knee pain is the most common complication after tibial nailing procedure, but I was told that my sympthoms are slightly different. That's why I am doing additional diagnostics to find what it is.

My range of motion at the knee is as it was before, it bends and I can sit on the heel. It is just this burning pain and strange tension (like there was a band or rope that streches) when bending and straightening the leg.

Leezard, good luck with your appointment. I hope you will finally find a solution to the problem as I can see in your footer it's been a long time struggle.

I will keep you posted on my knee situation.

Offline Kasix

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Re: Knee problems after tibial IM nailing
« Reply #4 on: June 13, 2017, 09:24:06 AM »
The mystery has been solved!!!

My patellar tendon hasn't stopped healing after the surgery that was six months ago. Now it is a patological process since it should have healed a while ago. There is an increased vascularity and granulation so the scar tissue is still bulding up. The tendon is 9 mm thick which is almost 4 times more than my healthy one (2,6 mm). There is also some fiber tissue on the side of Hoffa's fat pad. The good thing is that the thickness seem to be going down (3 weeks ago was 12 mm) and I feel a little improvement. Maybe it is getting better.

Not sure about the treatment, have to consult with OS, but I was told that calming down the patellar tendon should make my pain go away.

Offline missmyknee

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Re: Knee problems after tibial IM nailing
« Reply #5 on: October 21, 2017, 08:42:36 AM »
Hi there

I just saw this post because I don't get on the website very often.  I had the same thing happen when I broke my tib-fib. I wrote a series of blogs on KNEEguru, which you can find thru the link I am posting . They are all under the "missmyknee" name. Read thru all of them. You will find how my IM nailing thru my patella tendon ruined a perfectly healthy knee for life
4Fx Clsd red
IMrod fib plate
derotate osteotmy tibfib
IPCS patbaja
DeLeeOsteotmy,LOA,LR Zplasty,bongrf,chondrplty
chondrplty,LOA,fatpad remvd
openLOA,neurectmy,ITB Zplasty,fabela
PLC recon,revison,LOA,synovec
MCL,revison LOA
openLOA,prox Zplasty
openLOA, 6 neuromas excised,synov
3 Fusions

Offline swapnilmha

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Re: Knee problems after tibial IM nailing
« Reply #6 on: July 25, 2018, 11:13:26 AM »
Hello Kasix, I am too going through somewhat similar what you were going through. I had my IM nailing done on October 2017, and have started gaining the pain under the knee since december 2017. Its been 7 months now i am dealing with the knee pain. Whenever i step my right leg, it pains.
Exercising/Stretching relieves the pain temporarily.

Please help understand what is the real issue & how did you tackle it?


Offline Ashraf

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Re: Knee problems after tibial IM nailing
« Reply #7 on: July 05, 2021, 08:55:33 PM »
I was bumped by a van that failed to stop at an intersection while I was cycling. My leg was crushed between the bonnet and the frame of my bicycle. I suffered a comminuted displaced fracture of my right tibia and fibula, broken displaced scapula and a fractured rib. My accident was on the 7th of November 2020. The surgeon did my op the next day on the 8th. He inserted a rod through my tibia- ORIF IM nailing. I was discharged from hospital five days later.
Staples were removed after 3 weeks. An X-ray was done 7 weeks post op. Doc said there was no union and was a bit concerned. At 11 weeks he did another X-ray and said there was no improvement and he may consider a bone graft pending the next check up. Finally at 15 weeks there was callous formation so we avoided the bone graft. At 19 weeks there was good progress of healing. At my last appointment two weeks ago everything looks good and Iím on the mend. About 10 days ago I started having very bad pain just below my knee. I spoke to my Doc and he said it could be where he cut me. I am back on crutches as the knee pain does not allow me to put weight on it.
Weight bearing details:
I did not weight bear for the first 7 weeks post op as my physiotherapist was very conservative and afraid I might refracture.
My Doc only insisted that I weight bearing at the 7 week check up so some miscommunication between doc and physio.
I changed my physio to a lower limb physio specialist that made a big difference and got me off crutches after just 3 sessions.

My Physio and I have decided to get a second opinion as my doc is not really interested in my knee pain and wants to wait for more tibia healing before he does anything. With COVID on the rise here in South Africa there are no elective procedures anyway for the next 4 to 5 weeks. There is a possibility that the IM nail has moved up closer to my knee and thatís either touching the fat pad or tendon.

I was doing very well with riding a stationary bicycle and doing light leg presses and calf raises in the gym. This setback worries me as I hope I am not damaging my knee while my tibia heals. My doc indicated that he wants to remove all the hardware only after a pass the 1 year mark since the crash.

Has anyone had a similar problem?