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[raku]

Dear friend. What is your opinion about nailing?

[raku]

Retrograde femoral nailing.

In this group, there were five retrospective studies,44,55,56,58,61 seven prospective studies,32,42,43,46,53,54,60 two case studies49,57 and one systematic review of the literature59 giving a total of 516 fractures. The mean follow-up was 15.9 months (956 to 2446). The mean incidence of knee pain was 25.6% (1.1%43 to 55%57) at the end of the follow-up. The most common causes of knee pain related to RFN were the protrusion of distal locking screws and impingement of the nail on the patellar tendon and/or the articular surface of the tibial plateau. In the very few cases in which the metalwork had been removed, there was an improvement of the symptoms in all of the six patients in the study of Gellman et al55 and the one patient in that of Herscovici and Whiteman.46
Retrograde femoral nailing.
In this group, there were five retrospective7,15,30,44,51 and three prospective studies43,53,54 describing a total of 1063 patients. Of these, 1011 (95.1%) had a reamed nailing. The mean follow-up period was 18.3 months (29.1 weeks43 to 45.7 months51). The mean incidence of knee pain was 18.6% at the end of follow-up, ranging between 8.7%43 and 37%.51 Only four authors gave information about the localisation and aetiology of the knee pain. The site of the locking screw was mentioned as well as diffuse femoral pain from the presence of the implant in the medullary canal or from prominence of the metalwork.15,30,43,51 In these studies there was no record of removal of implants in the symptomatic patients.

[raku]

  tibia nailing
In this group, 11 retrospective11,22,45,47,48,50,62,63,65,66,70 and nine prospective studies1,5,8,12,52,64,67–69 had a total of 1469 fractures. Of the 1460 patients, 629 had symptoms of anterior knee pain independent of the approach used. The mean follow-up was 23.9 months (7.267 to 5765). The mean incidence of anterior knee pain at the end of the follow-up was 47.4% (10%67 to 86%52). The most frequent cause of pain was the longitudinal division of the patellar tendon during the transtendinous approach, the entry point of the nail and the protrusion of the nail proximally. In 11 of the 20 studies the nail had been removed because of the pain,1,5,12,45,47,50,52,63,66–68 but in four no details were given regarding the outcome of removal.1,5,12,66 In eight studies the knee pain either persisted or the patients were partially relieved after removal of the nail11,45,47,50,52,63,67,68 and in two the pain was worse after this procedure.45,52 Information regarding the follow-up after extraction of the nail was available only from the study of Toivanen et al.52 In seven studies describing 228 patients, 111 noticed an improvement, or disappearance of the pain after removal of the nail.45,47,50,52,63,67,68

Quote from https://online.boneandjoint.org.uk/doi/full/10.1302/0301-620X.88B5.16875