Long bone fractures of the leg and arm bones are very common orthopedic injuries that often require surgical fixation to heal properly. Over the past few decades, intramedullary nailing has become the gold standard technique for stabilizing fractures of the femur, tibia and humerus. This article will discuss the technique of intramedullary nailing, its advantages over other fixation methods and the future of this minimally invasive surgical method.
What is Intramedullary Nailing?
Intramedullary nailing involves the insertion of a metal nail into the hollow center of the fractured bone, known as the intramedullary canal. The specially designed nails come in various diameters and lengths to match the dimensions of different bones. During surgery, small incisions are made around the knee or elbow and a drill is used to ream the medullary canal and insert the nail. The ends of the nail protrude from the bone and interlocking screws are placed across the fracture site to secure the nail and stabilize the bone fragments.
Advantages of Intramedullary Nailing
Some key advantages of intramedullary nailing over other fixation techniques include:
Minimally Invasive Technique
Intramedullary nailing uses a less invasive surgical approach compared to open reduction and plate fixation. Only small incisions are needed for nail insertion and screw placement. This leads to less soft tissue disruption, less blood loss, faster recovery and reduced risk of wound complications.
Load Sharing and Early Weight Bearing
The nail acts like an internal splint and allows physiological loading of the bone fragments which enhances fracture healing. Fracture stability under daily loading speeds up recovery. Patients are often allowed to bear weight immediately or soon after surgery, depending on the bone and fracture pattern.
Less Hardware Irritation and Removal
Plates and screws used in plate fixation often cause irritation under the skin which results in pain and required later removal surgery. Intramedullary nails stay buried deep in the bone and avoid soft tissue prominence issues. Nails rarely require later removal.
Improved Alignment and Rotation Control
Advanced nail designs coupled with interlocking screws precisely control all planes of motion including shortening, angulation, rotation and translation. This provides anatomic fracture reduction and stable fixation critical for proper healing.
Applications and Technique Refinements
Over the decades, intramedullary nailing has been refined for fractures of the femur, tibia and humerus with excellent clinical outcomes. Recent advances like statically locked nails, cephalomedullary nails and intramedullary hip screw fixation have expanded its use to more complex fracture patterns. Modern imaging tools also aid precise nail insertion and screw placement.
Future Directions
Research continues to optimize implant designs for fracture stability and minimize invasiveness. Long term studies evaluate any nail materials issues. Technique enhancements target fractures previously not considered ideal for nailing like distal tibia/fibula and proximal humerus fractures. Nail modifications facilitate bone grafting and accelerate fracture healing. Navigation systems may someday guide precise nail insertion. Overall, Intramedullary Nail remains the gold standard for most long bone fractures due to its clear advantages.
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