Post-Surgery Complications of Tibial Intramedullary Fixation

Complications following internal fixation of the tibia?

Hello Dr.
Shi, I suffered a comminuted fracture of the tibia and fibula in a car accident last July.
The attending physician used internal fixation for the tibia and added a steel plate for the fibula.
After the surgery, I noticed a tingling sensation in my knee.
The attending physician advised me that I should not kneel on the floor in the future, even after the screws are removed.
At that time, I did not realize the severity of the situation.
It wasn't until three months later that I discovered the tingling in my knee persisted post-surgery, feeling as if it was still under anesthesia.
Even when I press on my knee, I have little sensation, and this has continued to the present day.
I reported this situation to my attending physician, who responded that this is a surgical risk and that I was unfortunate to have injured the knee nerve.
When I asked what could be done, he said there was nothing that could be done.
I would like to ask Dr.
Shi: 1.
Are there any methods to recover from this tingling sensation in my knee? 2.
Since I have been using a knee brace for protection since the surgery, will I need to wear a knee brace for the rest of my life? (My purpose for wearing the knee brace is to stabilize the knee; without it, I feel swelling and discomfort in my knee while walking, as if blood circulation is poor.) 3.
Given my situation, how long would it be appropriate to wait before removing the screws?

Hong, 30~39 year old female. Ask Date: 2016/04/13

Dr. Shi Guozheng reply Orthopedics

Intramedullary nails typically cause pain at the entry point in the tibia, while numbness is less common.
You might consider taking some active B12 to see if it helps with recovery.
Generally, the sensation of numbness may take about a year to improve, and the intramedullary nail can be removed after approximately one year.

Reply Date: 2016/04/13

More Info

Post-surgery complications following tibial intramedullary fixation can be quite complex, especially in cases involving significant trauma such as a comminuted fracture of the tibia and fibula. Your experience of persistent numbness in the knee area is concerning and highlights the potential for nerve injury during surgery, which can occur due to direct trauma or compression from hardware.

1. Recovery from Numbness: The numbness you are experiencing could be due to damage to the peroneal nerve, which is a branch of the sciatic nerve that runs near the knee. Recovery from nerve injuries can vary widely. In some cases, nerves can regenerate and sensation may return over time, but this can take months or even years. Physical therapy may help improve function and potentially aid in recovery. Techniques such as neuromuscular re-education, sensory re-education, and strengthening exercises can be beneficial. However, if the numbness persists, it may be worthwhile to consult a neurologist or a specialist in nerve injuries for further evaluation and management options.

2. Use of Knee Brace: Wearing a knee brace post-surgery is common, especially if you feel instability or discomfort without it. The purpose of the brace is to provide support and limit excessive movement that could lead to further injury. Whether you will need to wear the brace indefinitely depends on your recovery progress and the stability of your knee. If you continue to experience swelling and discomfort without the brace, it may indicate that your knee is not yet ready to bear full weight or function without support. Regular follow-ups with your orthopedic surgeon can help assess your knee's stability and guide decisions about the necessity of continued brace use.

3. Timing for Hardware Removal: The decision to remove the intramedullary nails or screws typically depends on several factors, including the healing progress of the bone, the presence of any complications, and your overall function. Generally, hardware is removed when the bone has healed sufficiently, which can take anywhere from 6 to 12 months post-surgery. However, if you are experiencing significant discomfort or complications related to the hardware, earlier removal may be considered. Your orthopedic surgeon will evaluate your specific situation, including imaging studies and your functional status, to determine the best timing for hardware removal.

In summary, while numbness and discomfort post-surgery can be frustrating, it is important to maintain open communication with your healthcare providers. They can offer tailored advice based on your individual recovery and may suggest interventions to help improve your symptoms. Regular follow-ups, physical therapy, and possibly consultations with specialists can provide a comprehensive approach to managing your post-surgical complications.

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