Intramedullary Nailing - Process, Application, and Risks

What Is Intramedullary Nailing?

Intramedullary nailing, most frequently utilized in long bones, functions as an internal splint for fractures. They were first used in 1939, and their load-sharing feature seems to foster a biomechanical environment that encourages high unionization rates. Cross-sectional geometry, rod length, the existence of a longitudinal groove, and the elastic modulus of the material all have a part in determining the stiffness of the build. This is especially true of an intramedullary device's features.

What Is the Process for Intramedullary Nailing?

1. There are several varieties of intramedullary nails in use, as well as accompanying surgical methods.

2. One major point of contention is whether the nail should be placed in the canal at the hip and driven down the canal (antegrade nailing), as opposed to the knee and pushed up the canal (retrograde nailing).

3. The effects of various nail types, such as interlocking nails (which have locking bolts placed across the bone at the ends of the nail to secure it in position) and ender nails, in which two or more nails are placed within the medullary cavity in a specific way to hold them in place, have also been the subject of disagreement.

4. An intramedullary nail's stiffness depends on the wall thickness but is related to the fourth power of the rod radius. Although longitudinal slots had the advantage of expanding like a spring following the intramedullary canal's diameter, they drastically reduced torsional stiffness and were thus abandoned.

5. The distance between a fracture's proximal and distal ends is known as the working length of the fracture.

6. As the working length is altered, the bending and torsion forces acting on the bone-rod construct affect the amount of interfragmentary motion.

What Will Occur During the Procedure of Intramedullary Nailing?

• For the duration of the operation, general anesthesia may be administered to keep patients sleeping and pain-free.

• They can be prescribed medication to reduce pain in nerves close to the surgical site. If patients are having a leg bone treated, an anesthetic may be administered to their spine.

• In the event of a spinal injection, patients will be awake but pain-free. Often, tiny skin incisions are used during surgery.

• A guidewire will be inserted into the bone's core by the surgeon. The bone may be made hollow using a gadget. The shattered ends of the bone will then be aligned by the surgeon.

• To keep the bones aligned, the nail will then be placed into the hollow portion of the bone. To hold the nail in place, locking screws will be inserted on both ends.

What Will Occur Following Surgery?

• If patients received a spinal injection during surgery, their legs can be paralyzed for six to 12 hours thereafter. The leg may be swollen and painful as a result of the operation.

• This is typical, and it will pass in a few days. To lessen the discomfort and swelling, patients could be given medication.

• On the day of surgery or the day after, they will need to move around. Blood clots will be less likely as a result.

• Moreover, it stresses the bone. Weight-bearing is crucial for bone strength. Before applying their entire weight on the bone, one might need to wait for it to heal.

• One could be required to use crutches or other assistance equipment by medical professionals.

• Exercises for deep breathing assist to clear the airways and lower the chance of developing a lung infection. Inhale deeply, then hold the breath for as long as possible. After exhaling, cough vigorously.

• An incentive spirometer could be provided to encourage people to breathe deeply. Take a slow, deep breath in while holding the plastic piece in the mouth; after letting the air out, cough. Ten times every hour, perform the exercises.

• To improve blood flow and avoid blood clots, a pressure stocking will be applied. This stocking is quite long and narrow. The legs are under strain and the blood drains from the lower leg veins. To assist avoid clots, patients could also be given blood-thinning medication.

• One could learn some leg-healing exercises from a physical therapist. The workouts can also support muscular growth and maintain joint flexibility.

What Are the Benefits of Intramedullary Nailing?

The benefits involved with intramedullary fixation are

• Brief hospital stay.

• Instant weight bearing,

• Simpler recovery.

• No pin track issues.

• Quick healing of the fracture.

• Early return of the leg to function.

• As opposed to external fixation, intramedullary nail fixation typically results in higher union rates.

What Are the Risks Associated With an Intramedullary Nail?

• An allergic response to the anesthetic or the antibiotics is possible. Having compartment syndrome is possible.

• When muscles experience an excessive amount of pressure, this syndrome results. Muscles and tissues are not able to get blood.

• Serious, potentially permanent nerve and muscle damage can result from this.

• There is a chance that the fracture will mend improperly. It is possible that the fracture's ends will not properly connect. This might obstruct healing.

• The utilized nail or rod might break or bend. If this occurs, one could require surgery once more.

• Numbness brought on by the injury may be transitory or permanent. Also, the location where the screws were put may be itchy.

• The other risks involved with intramedullary fixation are

• Infection.

• Hardware failure.

• Delayed bone healing.

• Neurovascular injury.

• Increased fat embolism risk.

• The probable intramedullary infection spread.

• Higher infection and blood loss rates.

• An obstacle to achieving the proper alignment.

What Is the Duration of Intramedullary Nail Surgery?

Although intramedullary nailing has great fusion rates, it is a technically challenging treatment that generally takes up to 6 hours to complete, results in substantial blood loss, and frequently has complications. Yet, this procedure is appealing to certain patients because of the high rate of fusion and the majority of patients' ability to bear their full weight quickly after surgery. The capacity to consistently accomplish union, early patient mobilization, restoration, and maintenance of normal length and alignment, and preservation of a healthy, functional range of motion in the hip and knee are all treatment objectives.

Conclusion

An intramedullary nail is a metal rod inserted into a bone's medullary cavity and across the fracture to provide substantial support for the fractured bone. When significant bone loss prevents compression from being applied across large sections of cancellous bone, such as after tumor removal or a failed total knee arthroplasty, intramedullary nailing procedures may be more appropriate. To maintain the anatomical integrity of fracture sites and to create a favorable environment for fracture healing, intramedullary nailing is used. This could enhance functionality and lessen long-term side effects like arthritic discomfort. Moreover, nailing helps to prevent damage to the soft tissues near the bone from being done during surgery, preserving the blood flow that is necessary for fracture healing and successful functional recovery.