Intramedullary Nailing

Overview

Intramedullary nailing is a surgical technique in which a metal rod is inserted into the medullary canal, the hollow center of a long bone, to stabilize a fracture. The nail spans the length of the fracture and is locked in place with screws at both ends, providing strong, load-sharing fixation that allows early weight bearing in many cases. This technique is the gold standard for treating fractures of the femur (thighbone) and tibia (shinbone), and is also used in certain fractures of the humerus (upper arm).

Our San Diego orthopedic trauma surgeons are experienced in all aspects of intramedullary nailing, including minimally invasive insertion techniques that minimize soft tissue disruption and promote faster healing. Because the nail is placed inside the bone rather than on its surface, there is typically less interference with the surrounding muscles and tendons compared to plate fixation.

When Is Intramedullary Nailing Used?

• Femoral shaft fractures — intramedullary nailing is the standard treatment for broken thighbones in adults
• Tibial shaft fractures — most shinbone fractures in the middle portion of the bone are treated with a nail
• Certain humerus fractures — some upper arm fractures benefit from nail fixation
• Pathologic fractures — fractures through bone weakened by tumor or metabolic disease may be stabilized with a nail
• Nonunion treatment — exchange nailing (replacing a previous nail with a larger one) is an effective treatment for certain nonunions

The Procedure

The procedure is performed under general or spinal anesthesia. A small incision is made at one end of the bone, away from the fracture site. The medullary canal is prepared with specialized reamers, and the nail is inserted down the center of the bone under fluoroscopic (X-ray) guidance. The fracture is aligned using a combination of positioning and reduction techniques, and locking screws are placed at each end of the nail to control rotation and maintain length. The entire procedure is typically performed through small incisions without directly exposing the fracture.

Recovery

• Days 1-3 — mobilization begins in the hospital; many patients start putting weight on the leg with crutches or a walker
• Weeks 2-6 — progressive weight bearing as tolerated; physical therapy for range of motion and strength
• Weeks 6-12 — advancing activity level as healing progresses on follow-up X-rays
• Weeks 12-16 — return to full activities for most patients, depending on fracture healing

The intramedullary nail typically remains in the body permanently, though removal may be performed if it causes symptoms after the fracture has fully healed.