Anterior Knee Pain after Tibial Intra-medullary Nailing: Is it Predictable?

Introduction: Intramedullary nailing has been used frequently for the treatment of tibial diaphyseal fractures. Chronic anterior knee pain has been considered the most frequent post-operative complication of this technique. We investigated the relationship between anterior knee pain and position of nail tip in proximal tibia. Methods: 103 patients were selected among patients who underwent interlocking nailing in our institution. Patients with other factors that might cause anterior knee pain were excluded. In all patients intramedullary nailing was done using transpatellar approach. The patients were evaluated in two groups, 42 patients had anterior knee pain (Grup A), whereas 61 patients did not have pain (Group B). The distance from nail tip from tibial plateau was measured on lateral radiographs. Nail prominence from anterior tibial cortex was also measured. Results: The two groups were similar with respect to gender and follow up period. Out of 42 patients who had knee pain 21 (50%) had nail tip within proximal third distance from plateau to tibial tuberosity. Twenty-four patients (42%) among knee pain group had nail prominence of more than 5mm from anterior tibial cortex followed by 12 patients (29%) within 5mm and 12 patients (29%) nail tip buried within the anterior cortex. Conclusion: A greater incidence of knee pain was found when nail was prominent more than 5mm and when it is in the proximal third distance from tibial plateau to tuberosity. Patients should be aware of high incidence of knee pain when the nail tip is placed in proximal third and prominence of more than 5mm.

Administration of TLR7 agonist, resiquimod, in different types of chicken induces a mixed Th1 and Th2 response in the peripheral blood mononuclear cells.

This study evaluated the variation in immune response in peripheral blood mononuclear cells (PBMCs) of broiler, White Leghorn (WL) and Kadaknath breeds of chicken following administration of TLR7 agonist, resiquimod (R-848). Expression of different immune related genes viz., interferon-ß (IFN-ß), IFN-γ, IL-1ß, IL-4, TLR7 and iNOS was assessed by quantitative real time PCR over a period of 24 h. The results indicated that there was a significant up-regulation in the relative expression of immune response genes post R-848 administration (P < 0.01). In conclusion, the transcriptional expression of IFN-ß, IFN-γ, IL-1ß, IL-4, iNOS and TLR7 genes in the PBMCs was significantly up-regulated over 24 h in broiler, WL and Kadaknath breeds of birds after the administration of R-848. Overall, R-848 induced a mixed Th1 and Th2 response in PBMCs of chicken origin ex vivo.