References
1. Thomas Mueckley, Oliver
Gonschorek, and Volker Buehren,
“Compression Nailing of Long Bones,”
European Journal of Trauma, 2003;
29:113-28.
Understanding Your
Intramedullary Nail
A Patient’s Guide
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is not dispensing medical advice. Please speak to your doctor to decide which type
of surgery is right for you. Only your doctor can make the medical judgment which
products and treatments are right for your own individual condition. As with any
surgery, trauma carries certain risks. Your surgeon will explain all the possible
complications of the surgery, as well as side effects. Additionally, the lifetime of a
trauma product is not infinite and varies with each individual. Also, each patient
will experience a different post-operative activity level, depending on their own
individual clinical factors. Your doctor will help counsel you about how to best
maintain your activities in order to potentially prolong the lifetime of the device.
Such strategies include not engaging in high-impact activities, such as running,
as well as maintaining a healthy weight.
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Advanced Care for
Broken Bones
More than likely, you’re already familiar
with the non-surgical approaches that
physicians use to help fractures heal. A
doctor applies casts, braces, or splints
around the affected area in order to hold
the broken bone securely in position and
provide support while the body repairs
itself. In some cases however, particularly
fractures of the long bones, today’s best
orthopaedic treatment includes securing
the fracture internally with a metal
intramedullary nail implanted by surgical
procedure.
Your doctor has provided you with this
booklet to answer some of the questions
you may have about your broken bone and
fracture treatment. It will also help you
better understand what to typically expect
over the next few days and weeks as you
leave the hospital, begin physical therapy
and follow up with your orthopaedic
surgeon and physical therapist.
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What is an
Intramedullary Nail?
To align the fractured bones and provide
optimal healing support, the orthopaedic
surgeon makes a small incision through
the skin and tissue closest to one end
of the broken bones. The surgeon then
inserts a small rod-like nail device into
the hollow center of the bone, called the
medullary cavity. The intramedullary nail
forms a self-contained internal splint to
stabilize the fracture. This is often done for
fractures of the tibia (see below), femur
(thigh), and humerus (shoulder).
An initial
fractured tibia
bone (broken)
at time of
injury.
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Potential advantages of the
intramedullary nail
• Provides durable, strong and flexible
support.
• Allows more exact alignment of the
fractured bones for faster healing and
may lead to earlier weightbearing.1
• May lead to earlier joint motion for
reduced stiffness.1
• Encourages more natural-like motion in
uninjured muscles and neighboring joints.
A tibial nail
inserted (the
fracture gap
closed) with
healing taking
place.
A large callus
around the
fracture
indicating
healing is well
underway.
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In the Hospital
What Now?
Together, you and your orthopaedic surgeon
will decide on a course of aftercare that’s
most appropriate for you. The full length
of your care may span several months.
Rehabilitation will begin in the hospital
and continue with outpatient physical
therapy sessions, as well as at home.
Understanding your care may help
you feel more comfortable throughout
the healing process.
How do I care for the new
incision sites?
At first, a hospital medical professional
will take care of your incision sites. Like
any other wound, they must be cared for
every day to avoid complications that may
include infection. As your health allows,
you will probably learn how to care for
the incision sites yourself.
The steps required to care for your wounds
at home are described on page 9 within
the section “At Home. Where Do I Go
from Here?”
Why take additional X-rays?
Fracture
line healed
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Side view of
tibial nail:
fracture
healed
Following surgery, your surgeon will take
X-rays every few weeks to confirm that
the fracture is healing appropriately. Keep
in mind that everyone heals differently.
You will heal at your own pace based
upon a number of factors that your
surgeon can discuss with you. Your
surgeon will keep you informed about
your progress each step of the way.
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In the Hospital
What Now?
(continued)
At Home
Where Do I Go from Here?
How does physical therapy
help me heal?
Prior to being discharged, be sure to ask
for an at-home recovery plan. Should you
have questions later, contact your surgeon
directly. The information that follows can
help you make a smooth transition home
while your fracture heals.
Since motion and muscle strength play
an important role in fracture healing, the
right exercises can significantly aid in your
recovery. Of course, the fracture itself may
hinder the use of your injured limb. Your
doctor’s choice of an intramedullary nail
gives you the potential to begin moving
earlier than treatment with an external
cast or brace.
A physical therapist will work closely with
you to select the most appropriate treatment
and exercises to help you restore your range
of motion and rebuild muscle strength.
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How do I care for the healing
incision sites?
You may find it helpful to enlist the support
of a friend or family member while you
adjust to caring for yourself at home. You
will need clean gauze pads or a clean cloth,
plain soap, clean water, clean towels and
a shower or hand sprayer to clean and
protect your incision sites while they heal.
Most patients prefer using the shower in
the bathroom, but you will use a location
where you feel the most secure and have
access to a faucet sprayer or spray bottle.
This is what your doctor will typically advise:
1. Spread all of your supplies on a clean
towel for easy access.
2. Either sit on a stool in the shower or use
the spray faucet or spray bottle in the sink.
3. Wash your hands.
4. Remove the bandages from the incision
sites.
5. Gently wipe away any dried blood with a
saline-moistened gauze pad.
6. Inspect the sites for signs of infection such
as redness, excessive or prolonged drainage,
or pus. It’s normal to see some clear and/or
blood-tinged drainage in the first few days
after surgery while the incision is closing.
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At Home
Where Do I Go from Here?
(continued)
7. Place a fresh, dry dressing on the site
and secure it.
8. Once the incision has closed and all
drainage stops, the bandages do not have
to be replaced and the incision site can
remain open to the air.
9. Wet the incision sites with clean
lukewarm water.
10. Clean the sites with soap and water
using a gauze pad or clean cloth.
11. Remove any “crusty” material from
the wound.
12. Wash everything again.
13. Dry the skin with a clean towel or gauze.
14. Let any remaining secretions dry.
15. If the site is still draining, place a clean,
dry gauze pad over the site and secure it.
What precautions should I take?
Although your bone is not fully healed
and you should keep your surgeon’s
precautions in mind – like avoiding
activities that could cause a fall – your
doctor will likely advise you to engage in
as much normal movement as possible.
Your physician will advise you based
on your injury and recovery. Remember
the instructions from your orthopaedic
surgeon with regard to mobilization,
weightbearing and physical therapy.
Further precautions
your surgeon will likely give:
• Avoid contact with animals.
• Avoid contact with dust and dirt.
• Avoid unnecessary handling of your
incision sites.
What if I suspect a skin infection?
Even if you follow all the precautions, the
skin around the incision sites may become
infected. Symptoms of infection include
local reddening and/or swelling of the skin,
pain and fever. If these symptoms progress,
contact your physician. You may require
oral antibiotics to control the infection.
Will your nail be removed?
In general, after a year the soft tissues
improve and the fracture heals enough that
your orthopaedic surgeon may remove the
intramedullary nail. When your doctor
decides the time is right, the nail may be
removed in either an outpatient or day
surgery center.
Following removal of your intramedullary
nail, you’ll need to care for the incision sites
just as you did when the nail was implanted.
For more information,
contact your physician.
• Be careful with stairs, rugs and loose
shoelaces.
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