Intramedullary nailing has revolutionized the management of tibial diaphyseal fractures. However, anterior knee pain remains a common complication. Although knee pain causes are still largely unknown, there is evidence to suggest that adhesions resulting from soft tissue damage may contribute to it. We describe a simple cost-effective technique that utilises a syringe to protect the patellar ligament and Hoffa's fat pad during intramedullary nailing of the tibia.
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