Risks and benefits of intramedullary nail surgery: Is it safe or dangerous

Is Intramedullary Nailing Surgery Dangerous? Intramedullary nailing is a common surgical procedure used to treat complex fractures. It helps stabilize broken bones and speeds up the healing process. But is it really safe? And what are the potential risks involved?In this Dalili Medical article, we’ll explore all aspects of intramedullary nailing surgery — from its benefits to the possible complications. Whether you’re considering undergoing this procedure or simply want to learn more about its safety, this article will provide you with everything you need to make an informed decision.

What Is the Intramedullary Nail Procedure?

The intramedullary nail procedure is a surgical operation used to stabilize broken bones, such as the tibia, femur, or humerus. The goal of this procedure is to support fractured bones and speed up the healing process, allowing patients to walk and return to their daily activities faster compared to other methods like plates and screws, which usually require more time for bone healing.

What Is an Intramedullary Nail?

An intramedullary nail is a long, cylindrical metal rod designed to fit precisely inside the bone marrow cavity. It is inserted through the nearest joint to the fracture, such as the knee or shoulder, via a small surgical incision. These nails are made from strong materials like stainless steel or titanium, providing stable fixation and promoting efficient bone healing.

Is the Intramedullary Nail Surgery Painful?

The procedure is performed under local or general anesthesia, meaning the patient does not feel pain during surgery. Afterward, mild pain or discomfort may occur in the treated area, but it can be easily managed with prescribed painkillers under medical supervision.

How Long Does the Surgery Take?

Typically, the intramedullary nail surgery lasts 30 minutes to 1 hour, depending on the complexity and size of the fracture. After the procedure, the patient is monitored for a few hours to ensure no complications arise.

Can I Resume Normal Activities After the Surgery?

It’s not recommended to resume strenuous activities immediately after surgery. Heavy physical activities should be avoided for several weeks until the bone heals completely. However, light daily activities can be resumed after a short recovery period as advised by the doctor.

Are There Any Risks or Complications?

Like any surgical procedure, there are potential risks, including:

Infection at the surgical site
Persistent pain or discomfort
Swelling or irritation around the treated area
The need for nail removal if the bone does not heal properly

Can the Intramedullary Nail Be Removed?

In some cases, the intramedullary nail can be removed once the bone is fully healed. However, in many situations, it may remain in place if it doesn’t cause any discomfort or complications.

Does It Affect Bone or Joint Function?

If placed correctly, the intramedullary nail does not affect bone or joint function. Rarely, it may lead to stiffness or reduced movement in nearby joints due to prolonged immobility during recovery.

Can It Be Used in Children?

Yes, but with caution. Pediatric intramedullary nails are specially designed to accommodate growing bones without affecting natural bone development.

Can I Play Sports After the Procedure?

Initially, patients should avoid high-impact sports or activities that stress the affected bone. Gradual return to physical activity is possible after healing, but only with medical approval.

Can Infection or Contamination Occur?

In rare cases, infection may occur at the site of the nail. To prevent this, antibiotics and proper hygiene measures are used before and after surgery.

Can the Fracture Reoccur?

In most cases, the fracture does not recur once the bone has healed properly. However, a secondary fracture may happen if excessive pressure or trauma occurs before complete recovery.

How Long Before I Can Walk After Nail Removal?

Patients can typically walk carefully on the same day after nail removal, taking small steps at first. Full walking ability improves over the following 1–2 weeks, depending on the doctor’s assessment.

When Can I Walk After Nail Insertion in the Leg?

Most patients can start walking cautiously from the first day after surgery. Mobility improves significantly within two weeks, though full recovery time varies per case.

Is Pain Normal After the Surgery?

Yes, mild pain and swelling are normal in the first few days after surgery. These symptoms gradually fade as healing progresses.

Disadvantages of Intramedullary Nail Surgery

1. Risk of Infection

Like any surgery, infection may develop at the surgical site, delaying healing or requiring nail removal.
Prevention: Ensure the procedure is performed in a sterile environment following medical safety protocols.

2. Inflammation or Tissue Irritation

The nail may cause irritation or inflammation in nearby tissues, especially in sensitive areas.
Prevention: Regular follow-up and appropriate treatment help reduce irritation.

3. Difficulty Removing the Nail

In some cases, nail removal can be challenging once the bone heals.
Prevention: Removal may require another surgery, which is typically more complex than the initial insertion.

4. Impact on Bone Growth in Children

In growing children, the nail may interfere with natural bone development.
Prevention: Use only when medically necessary and with specialized pediatric nails.

5. Reduced Joint Mobility

Some patients may experience stiffness or reduced motion near the joint.
Prevention: Physical therapy can help restore flexibility post-recovery.

6. Persistent Pain or Discomfort

Some patients may feel ongoing pain due to nail friction against the bone or tissue.
Relief: Painkillers can help manage symptoms under medical supervision.

7. Nail Movement

In rare cases, the nail may shift due to excessive motion or activity.
Prevention: Follow medical advice and avoid strenuous activities.

8. Risk of Secondary Fracture

If healing is incomplete, a secondary fracture may occur.
Prevention: Follow recovery instructions and avoid excess strain on the bone.

9. High Costs

Intramedullary nail surgery can be expensive due to specialized equipment and post-operative care.

10. Limited Sports Activity

Temporary restrictions may frustrate active individuals.
Prevention: Follow a gradual return-to-sports plan supervised by your doctor.

11. Rare Post-Operative Complications

In uncommon cases, blood clots may form due to limited movement after surgery.
Prevention: Early mobility and prescribed medication can reduce this risk.

⚙️ Main Uses of Intramedullary Nails

1. Fixation of Long Bone Fractures

Commonly used for fractures in:

Femur (thigh bone)
Tibia (shin bone)
Humerus (upper arm bone)

Unlike external plates and screws, the nail stabilizes the bone from inside.

2. Complex or Multiple Fractures

Provides strong internal stabilization for fragmented or multiple fractures.

3. Trauma-Related Fractures

Ideal for fractures from accidents such as car crashes or falls, allowing early mobility post-surgery.

4. Osteoporotic Fractures

In elderly patients with osteoporosis, nails evenly distribute load across the bone to prevent re-fracture.

5. Bone Lengthening Procedures

Used in limb lengthening surgeries to maintain bone alignment during growth.

6. Non-Union Fractures

When a fracture fails to heal naturally, the nail helps stimulate and stabilize bone healing.

7. Post-Tumor Bone Reconstruction

Inserted after bone tumor removal to reinforce and protect weakened bone.

???? Benefits and Advantages

1. Strong and Stable Fixation

Inserted within the bone marrow, providing durable and continuous stabilization.

2. Faster Bone Healing

Prevents bone movement, promotes collagen production, and speeds up healing.

3. Reduced Pain and Complications

Less pressure on surrounding tissues results in less pain and quicker recovery.

4. Long-Lasting Results

Provides permanent fixation, often eliminating the need for further surgeries.

5. Minimally Invasive

Performed through a small incision, causing minimal tissue damage.

6. Ideal for Complex Fractures

Offers high stability for irregular or multi-part fractures.

7. Shorter Recovery Time

Patients can begin walking with crutches early, shortening rehabilitation time.

8. Lower Infection Risk

Smaller incisions and reduced tissue exposure minimize infection risk.

Improving the Function of the Affected Limbs

The intramedullary nail helps restore the motor functions of the injured limb.
It also reduces joint stiffness and prevents muscle atrophy caused by prolonged immobility during the recovery period.

Possibility of Nail Removal After Healing

The intramedullary nail can be removed after full bone healing. However, in many cases, it remains in place if it does not cause any discomfort or complications.

Intramedullary Nailing Surgery: Steps and Key Details

1. Preoperative Preparation

Consultation and Evaluation:
Treatment begins with a thorough medical assessment by the orthopedic surgeon, who determines the type, location, and complexity of the fracture. For simple fractures, other fixation methods such as plates and screws may be used. However, for complex or long-bone fractures, the intramedullary nail is often the preferred option.

Anesthesia:
The procedure is performed under either general or local anesthesia, depending on the patient’s condition and the fracture site. For major or complex fractures, general anesthesia is typically used.

Pre-Surgery Preparation:
Before the operation, the surgical area is carefully sterilized to prevent infection. In some cases, patients may be advised to stop taking certain medications, such as blood thinners, prior to surgery.

2. Surgical Procedure Steps

Making the Incision:
The surgeon makes a small incision in the skin near the fracture site — typically in long bones like the femur or tibia.

Accessing the Bone Marrow Canal:
Using specialized surgical instruments, the surgeon opens the bone marrow canal to prepare a pathway for the intramedullary nail. The nail is then carefully inserted into the canal using a guided device for precision.

Fixing the Nail in Place:
Once positioned, the nail spans the fracture site and stabilizes the bone internally. In some cases, additional locking screws are used to secure the nail in place for better stability.

Closing the Incision:
After confirming the nail’s proper placement, the surgeon closes the incision with surgical stitches. A sterile dressing or adhesive strip may be applied to protect the wound.

3. Postoperative Care

Rest and Monitoring:
After surgery, the patient usually stays in the hospital for a few days for observation. Pain relievers are prescribed to manage discomfort during the initial recovery period.

Physical Therapy:
Regular follow-up X-rays are performed to monitor bone healing. Physiotherapy sessions are recommended to restore movement, flexibility, and muscle strength.

Follow-Up:
Scheduled checkups ensure proper healing and confirm that the nail is functioning correctly. In case of complications such as infection or nail displacement, additional interventions may be necessary.

4. Possible Complications After Intramedullary Nailing

While generally safe, some rare complications can occur, including:

Infection at the surgical site, which requires antibiotic treatment.
Nail displacement or breakage, though this is uncommon.
Delayed bone healing, which might require additional medical intervention.
Chronic pain, experienced by some patients long after surgery.

5. Nail Removal (In Certain Cases)

After full recovery, the surgeon may decide to remove the intramedullary nail if it is no longer needed. The removal is done through a minor surgical procedure using special tools and usually requires minimal downtime.

Exercises to Avoid After Intramedullary Nailing Surgery

1. High-Impact Exercises

Jumping activities (e.g., trampolining or jump squats) can put too much pressure on the treated bone.
Heavy pushing or pulling exercises (e.g., weightlifting) should be avoided as they can strain the healing area.

2. Sudden or Unstable Movements

Rapid twists or deep stretches (such as certain yoga poses) may stress the healing bone.
High-speed or quick direction-change exercises (like running, basketball, or soccer) increase the risk of injury.

3. Weight-Bearing on Lower Limbs

If the surgery was on the leg:

Avoid lunges and squats until cleared by your doctor.
Running or fast walking should be postponed until the bone is fully healed.

4. Core Exercises That Bend the Body

Avoid sit-ups and crunches during the first few weeks, especially after femur or tibia surgery.
Skip deep bending or stretching exercises that might stress the operated area.

5. Joint-Loading or Pressure Exercises

Avoid deep squats or heavy resistance training that strain the knee or hip joints.
Postpone push exercises using the affected limb until your doctor approves.

6. Balance-Dependent Exercises

Avoid single-leg stands or balance exercises on the operated limb early in recovery, as they may increase the risk of re-injury.

Recovery Tips After Intramedullary Nailing Surgery

Start Gradually:
Begin with light activities like gentle stretching, slow walking, or low-resistance exercises to enhance circulation and muscle tone.
Listen to Your Body:
If you feel pain or discomfort during exercise, stop immediately and consult your doctor.
Focus on Simple Mobility Exercises:
Early-stage exercises should emphasize gentle joint movements and deep breathing to improve blood flow and aid healing.
When to Begin Intensive Training:
Most patients can start more vigorous exercises after 6–12 weeks, depending on healing progress and medical advice.
Rest and Regular Follow-Up:
Get plenty of rest, avoid strenuous activity, and attend all follow-up appointments to ensure proper bone recovery.