In this article, we will talk about the most common questions asked about intramedullary nailing.
What is intramedullary nailing?
Intramedullary nailing is a surgical procedure that involves the placement of a rod into the canal (medulla) of a long bone. in some places you will find it being called IM nailing.
Intramedullary nailing can be done for practically all the long bones in the body.
However, it tends to be reserved for the bones in the upper limbs like the humerus, radius and ulna and those in the lower limbs which are the femur, tibia and fibula.
IM nailing is a type of internal fixation of bones meaning that the implants are placed inside the body. The surgery can be open surgery where the bone (fracture site) is exposed during the surgery. This is then termed open reduction internal fixation.
In closed surgery, only small incisions are made in order to insert the implant but no part of the fracture is exposed.
uses of IM rods
-The general rule is that a nail is inserted in the bone to confer more stability either due to;
- Fracture secondary to trauma
- Bone tumors that weaken the bone
- Following corrective surgeries
-IM rods are used during limb lengthening procedures. These are surgical operations used to grow a bone to a desired length.
Types of IM nailing surgeries.
These types get their names depending on the entry point of the nail/rod into the bone. There are two types.
Antegrade nailing
In antegrade nailing, a nail is introduced into the bone through the upper part of the bone. For example, in antegrade nailing of the femur, the nail is introduced through the top part of the femur, through either the piriformis fossa or the greater trochanter.
The greater trochanter and the piriformis fossa are parts of the femur.
Retrograde Nailing
In retrograde nailing, a nail is introduced into the bone through the lowermost part of the bone. For example, in retrograde nailing of the femur, the nail is introduced through the knee joint in the bottom part of the femur.
Procedure of IM nailing
The surgeon will clearly explain to you what to expect from the surgery and seek your consent to carry out the operation.
You will be given anesthesia to prevent you from feeling pain during the surgery. Then the site to be operated will be cleaned. Small incisions will be made on the skin till the bone.
By the guidance of intra-operative xray imaging known as fluoroscopy, the intramedullary nail will be introduced into the bone and locked with interlocking screws or bolts to prevent rotation of the nail or bone.
The surgical sites are then washed and stitched or stapled. These wounds are dressed with sterile dressing and you are discharged to the ward.
IM nailing complications
Complications related to the surgery include;
- Infection
- Blood loss during surgery
- Nerve injury
- Blood clot formation
Complications related to the implant;
- Release of metal ions into the bloodstream
- Fracture of the implant
Contraindications to IM nailing
- If a patient is not in the best physiological state to undergo surgery, then intramedullary nailing is contraindicated.
- Infection in bone is a contraindication to this surgery.
Will the nail stay in my bone permanently?
Technically, placement of a rod in the bone should not be permanent. Once the implant is done serving its purpose, then it can be removed.
For example, most nails are placed following a fracture and after about 2years when the bone has fully healed, they are removed.
However, that doesn’t always apply as some implants are left in the bones for a life span and cause no harm.
Doing MRI (magnetic resonance imaging) when with an IM nail
Having a nail is not a contraindication for doing an MRI. As this study explains, unless the image required is of the immediate implant site, which might cause lots of artifacts in the images obtained, an MRI of different sections of the body is not an issue.
IM nailing versus use of a plate(plating)
Just like nailing, plating is a kind of internal fixation for bones. For plating, a thin metallic bar is placed onto the bone and secured with screws. Plating is most commonly employed for fractures in close proximity to joints because they provide a more rigid and anatomical fixation which is required in these regions.
When is the intramedullary nail fit for removal?
Except when complications arise, an intramedullary nail should stay in the bone till there are signs of complete bone healing on an xray. These include bridging of the fracture gap and the presence of a callus at the fracture site.
Normally an intramedullary nail can be removed from about 18 months and beyond.
In conclusion, intramedullary nailing is a safe surgical procedure that involves the placement of a rod inside the bone canal of a long bone. Some of the indications for its use are; fracture of a long bone, tumor in the bone.
Your doctor should take you through the procedure and issues associated with this kind of surgery.
