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Character, Incidence, and Predictors of Knee Pain and Activity After Infrapatellar Intramedullary Nailing of an Isolated Tibia Fracture

Obremskey, William MD, MPH, MMHC; Agel, Julie MA, ATC; Archer, Kristin DPT; To, Philip MD; Tornetta, Paul III MDfor the SPRINT Investigators


In the article that appeared on page 135 of the March 2016 issue of the Journal of Orthopaedic Trauma, one of the authors' names was listed incorrectly. The correct information is as follows: Obremskey W, Agel J, Archer KR, et al; SPRINT Investigators.

Journal of Orthopaedic Trauma. 30(5):e185, May 2016.

Journal of Orthopaedic Trauma: March 2016 - Volume 30 - Issue 3 - p 135–141
doi: 10.1097/BOT.0000000000000475
Original Article

Objective: To study the activity and incidence of knee pain after sustaining an isolated tibia fracture treated with an infrapatellar intramedullary nail at 1 year.

Design: Retrospective review of prospective cohort.

Setting: Multicenter Academic and Community hospitals.

Patients: Four hundred thirty-seven patients with an isolated tibia fracture completed a 12-month assessment on pain and self-reported activity.

Intervention: Infrapatellar intramedullary nail.

Outcomes: Demographic information, comorbid conditions, injury characteristics, and surgical technique were recorded. Knee pain was defined on a 1–7 scale with 1 being “no pain” and 7 being a “very great deal of pain.” Knee pain >4 was considered clinically significant. Patients reported if they were “able,” “able with difficulty,” or “unable” to perform the following activities: kneel, run, climb stairs, and walk prolonged. Variables were tested in multilevel multivariable regression analyses.

Results: In knee pain, 11% of patients reported a “good deal” to a “very great deal” of pain (>4), and 52% of patients reported “no” or “very little” pain at 12 months. In activity at 12 months, 26% and 29% of patients were unable to kneel or run, respectively, and 31% and 35% of patients, respectively, stated they were able with difficulty or unable to use stairs or walk.

Conclusions: Clinically significant knee pain (>4/7) was present in 11% of patients 1 year after a tibia fracture. Of note, 31%–71% of patients had difficulty performing or were unable to perform routine daily activities of kneeling, running, and stair climbing, or walking prolonged distances.

Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

*Vanderbilt Orthopaedic Institute, Nashville, TN;

University of Washington Seattle, WA; and

Boston University, Boston, MA.

Reprints: William Obremskey, MD, MPH, MMHC, Vanderbilt Orthopaedic Institute, MCE, South Tower, Suite 4200, Nashville, TN 37232-8828 (e-mail:

Research grants were received from the following: Canadian Institutes of Health Research #MCT-38140 (PI: Gordon Guyatt); National Institutes of Health (NIAMS-072 and R01-AR48529) (PI: Marc Swiontkowski); Orthopaedic Research and Education Foundation of the American Academy of Orthopaedic Surgeons (PI: Paul Tornetta, III); Orthopaedic Trauma Association (PI: Mohit Bhandari); Hamilton Health Sciences Research Grant (PI: Mohit Bhandari); and Zimmer Corp. (PI: Mohit Bhandari). Mohit Bhandari was also funded, in part, by a Canada Research Chair in Musculoskeletal Trauma (McMaster University, Hamilton, ON, Canada). The funding sources had no role in influencing the project or article. Diane Heels-Ansdell, MSc (Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada), analyzed the data under the supervision of Stephen Walter (Senior Biostatistician).

Presented in part at the Annual Meeting of the Orthopaedic Trauma Association, October 2012, Minneapolis, MN.

The authors report no conflict of interest.

SPRINT investigators are listed in the Appendix.

Accepted October 14, 2015

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