Does fixation of femoral fractures using retrograde intramedullary nailing cause long-term knee pain: a systematic review of the literature

To perform a systematic review of the literature to discover if knee pain was a common complication in patients who underwent retrograde intramedullary fixation for femoral fractures and whether the pain persisted beyond fracture union and soft tissue healing. The literature search revealed eight articles which fit the inclusion criteria. These series were then compared and articles critiqued to allow conclusions to be drawn. Three articles compared antegrade and retrograde nails and five articles reviewed results of retrograde fixation only. Retrograde intramedullary nailing produced knee pain in 40-53% of patients compared with 20% in antegrade fixations during follow-up. These figures however, dropped substantially by final follow-up to 23-24% for retrograde and 12.5% for antegrade. Thirty-seven per cent of knee pain post operatively was associated with prominent metal work the majority of which resolved if the metal was removed. Retrograde intramedullary nailing for femoral fractures is associated with higher rates of anterior knee pain than antegrade nailing. Many cases of knee pain can be prevented with proper technique avoiding prominent metal work and many more cases settle in time with no intervention.