Learning About Intramedullary Nailing

Intramedullary (IM) nailing is surgery to repair a broken bone. The doctor uses a special rod to hold the bone in place while it heals.

This surgery is used to repair breaks in the middle part (marrow cavity) of the body’s longer bones. These bones include the thighbone (femur), the shinbone (tibia), and the upper arm bone (humerus).

The rod is usually made of titanium or stainless steel. The rod can stay in your bone long-term. But your doctor can remove it after your bone has healed, if needed.

IM nailing is usually done in a hospital by an orthopedic surgeon. This is a medical doctor who specializes in bone, muscle, and joint surgery. The surgery may take 1 to 2 hours or longer. You will get medicine to make you sleep during the surgery.

How the surgery is done will depend on which bone is broken. Your doctor will:

• Move the pieces of bone back into their normal position. This is often done without making a cut (incision) in the skin. But sometimes the doctor needs to make a cut over the bone to be able to move the pieces back into place.
• Make a cut in the skin over the broken bone for placing the rod.
• Use a tool called a reamer to slightly widen the middle part of the bone. This is done to make room for the rod.
• Place the rod through the middle of the bone.
• Use screws at the top and bottom ends of the rod. The screws attach the rod to the bone and hold the rod in place.
• Close up the skin with stitches or staples.

Depending on which bone was broken and your health, you may have to stay in the hospital for a few days. You’ll likely start physical therapy right away and continue doing it to get stronger. Physical therapy will help keep your muscles strong and your joints flexible while your bone is healing.

It’s normal to have some pain for 2 to 3 weeks after surgery and mild pain for up to 6 weeks after. Your doctor may prescribe pain medicine to help reduce the pain. You may also need to take blood thinner medicine to prevent blood clots and antibiotics to prevent an infection.

Your doctor will let you know when it’s okay to move or put weight on the repaired bone. Depending on which bone was repaired, you may need to use crutches or a walker until you can walk safely on your own.

You may need to have stitches or staples removed a week or so after surgery. And you’ll need follow-up imaging tests, such as an X-ray, to make sure your bone is healing.

It may take 3 to 6 months or longer for your bone to heal. How soon you can return to your daily activities, like work or driving, depends on which bone you broke. It also depends on how quickly your bone heals.

Most people do well after IM nailing, but sometimes problems can happen, such as:

• Infection.
• Bleeding.
• Nerve damage.
• Blood clots.
• Fat clots.
• Bones that remain out of position or that don’t heal well.
• Pain.
• A broken rod.

Sometimes people need another surgery. Talk to your doctor if you have questions about the risks of this surgery.