Retrograde Fixation Nailing for Femur Shaft Fractures- Post-op Knee Pain (Re-post)

Pain & Rehab Forum [Moderated]
1

Just wanted to repost this since it got pushed to this forum from the medical Q&A and hasn’t received a response yet. Really interested to get some feedback from the experts on this.

Thanks!

Retrograde Fixation Nailing for Femur Shaft Fractures- Postoperative Knee Pain

07-25-2020, 08:34 PM

Have you guys ever come across any literature regarding postoperative knee pain following retrograde nail fixation of femur shaft fractures? I did a quick search and found just one systematic review from the Canadian Journal of Surgery basically saying there was significant evidence of increased post-op knee pain with retrograde nailing versus anterograde. The study did also find that anterograde nailing approaches yielded significantly higher levels of post-op hip pain and heterotopic ossification.

I’m just curious because I had a retrograde nail placed after fracturing my left femur back in 2007 and have since had intermittent issues (tibial platform bruising, etc) from it, especially during squat-type movements. I actually avoided all squat-type movements for years until starting to train SBD in earnest a couple of years ago. I have no issues whatsoever with my right knee.

What would your recommendation be at this point if this continues to be a training impediment for me going forward? My fitness goals at this point are very nonspecific. I simply want to increase strength as measured by SBD over time.

Thanks,

Stewart

2

I have never seen anything directly related to pain outcomes with variations in nailing. There are many factors in play as no two fractures are the same from injury to fixation to rehab outcomes. That being said, it is pretty common to have some residual knee pain after a fixation, especially with higher level activities. I would recommend you continue to train and you should not have any concerns in doing so. You may have a little residual weakness on the surgical side that you can test with something like an open chain knee extension or split squat. If this difference is greater than 20%, i.e. kicking out 100# on your right leg and 65# on your left, it may be worth programming in some isolated movements to try and close that gap some. Otherwise, you are fine to carry on with what you are doing.