Home Trauma & Fracture CareIntramedullary Nailing in India

Intramedullary Nailing in India

Advanced internal fixation technique using metal rods inserted into the bone marrow cavity to stabilize long bone fractures

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Overview

Intramedullary (IM) nailing is a modern surgical technique for treating fractures of long bones such as the femur, tibia, and humerus. This procedure involves inserting a metal rod (nail) into the medullary canal of the fractured bone to provide internal support and stability, allowing the bone to heal in proper alignment. At Arthroscenter, Dr. Gurudeo Kumar has performed over 1,500 successful intramedullary nailing procedures with a 96% union rate. Our advanced surgical facility uses latest-generation locked IM nails with minimally invasive insertion techniques, ensuring faster recovery, reduced soft tissue damage, and excellent functional outcomes. The procedure is particularly effective for diaphyseal (mid-shaft) fractures and offers significant advantages over traditional plating methods, including better biomechanical stability, preservation of blood supply, and earlier weight-bearing capability. Most patients can bear weight on the affected limb within 6-8 weeks and return to normal activities within 3-4 months.

Symptoms & Indications

This surgery may be recommended if you experience:

Severe pain at fracture site after injury

Visible deformity or abnormal angulation of limb

Inability to bear weight on affected leg

Inability to move affected arm (for humerus fractures)

Swelling and bruising around fracture area

Shortened limb appearance

Abnormal mobility or crepitus at fracture site

Open wound with bone visible (compound fracture)

Numbness or tingling (nerve involvement)

Compromised blood flow to extremity (rare but serious)

Procedure Details

Duration

1.5 to 3 hours depending on fracture complexity, bone involved, and whether reamed or unreamed technique

Anesthesia

General anesthesia or spinal/epidural anesthesia depending on fracture location and patient factors

Preparation for Surgery

Pre-operative assessment includes X-rays, CT scans if needed to assess fracture pattern, blood tests, ECG, and medical optimization. Patient is advised to fast 8 hours before surgery. Prophylactic antibiotics are administered. General or spinal anesthesia is planned based on fracture location and patient condition.

Surgical Steps

Patient positioned appropriately on fracture table with image intensifier access

Small skin incision made near the insertion point (proximal or distal end of bone)

Entry point created in bone using awl or drill under fluoroscopic guidance

Fracture reduction achieved through closed manipulation using traction and image guidance

Guide wire inserted across fracture site into distal fragment

Reaming of medullary canal performed (for reamed nails) to appropriate diameter

Appropriately sized IM nail inserted over guide wire across fracture

Proximal and distal interlocking screws inserted through nail holes for rotational stability

Final fluoroscopic images confirm proper nail position, fracture reduction, and screw placement

Small incisions closed with sutures, sterile dressing applied

Recovery Timeline

What to expect during your recovery journey

Week 1-2

Hospital Stay & Initial Recovery

Pain management, wound care, prevention of complications. Assisted mobilization with walker/crutches with partial weight bearing as tolerated. Physical therapy begins.

Week 3-6

Protected Mobilization

Gradual increase in weight bearing based on fracture healing (visible on X-rays). Continued use of assistive devices. Range of motion exercises. Wound healing complete.

Week 6-12

Progressive Weight Bearing

Most patients achieve full weight bearing by 8-10 weeks. Assistive devices gradually discontinued. Strengthening exercises intensified. Return to light daily activities.

Month 3-4

Functional Recovery

Return to most normal activities. Continued strengthening and conditioning. Fracture should show solid union on X-rays. Gait normalization.

Month 4-6

Advanced Rehabilitation

Return to work (desk jobs earlier, manual labor later). Sport-specific training for athletes. Full functional recovery expected for most patients.

Month 6-12

Complete Recovery & Follow-up

Full bone union expected. Return to all pre-injury activities including sports. Nail removal may be considered if symptomatic (usually after 12-18 months). Long-term follow-up as needed.

Tips for Faster Recovery

Follow weight-bearing restrictions strictly to prevent displacement or implant failure

Use prescribed assistive devices (walker, crutches) until cleared by surgeon

Attend all physical therapy sessions for optimal functional recovery

Keep surgical wounds clean and dry until healed

Report any signs of infection (fever, increased pain, redness, drainage) immediately

Take prescribed medications including antibiotics and pain relievers as directed

Ensure adequate nutrition with high protein and calcium intake for bone healing

Avoid smoking and alcohol as they impair bone healing

Perform prescribed exercises regularly to prevent stiffness and muscle atrophy

Attend scheduled follow-up appointments for X-rays and healing assessment

Avoid high-impact activities until cleared by your surgeon

Consider nail removal only if symptomatic or as advised by surgeon

Frequently Asked Questions

Common questions about this procedure

Q1.What types of fractures are treated with intramedullary nailing?

IM nailing is most commonly used for diaphyseal (mid-shaft) fractures of long bones including femoral shaft fractures, tibial shaft fractures, and humeral shaft fractures. It can also be used for some metaphyseal fractures and certain pathological fractures. Dr. Kumar will determine if your fracture pattern is suitable for IM nailing based on X-rays and CT scans.

Q2.What are the advantages of IM nailing over plate fixation?

IM nailing offers several advantages: it is a load-sharing device that better withstands forces, requires smaller incisions (minimally invasive), preserves blood supply to fracture site, allows earlier weight-bearing, has lower infection rates, and provides better biomechanical stability for shaft fractures. However, the choice depends on fracture pattern and location.

Q3.When can I start walking after femur or tibia IM nailing?

For femoral nailing, partial weight bearing with crutches typically starts within days after surgery, progressing to full weight bearing by 6-8 weeks. For tibial nailing, the timeline is similar but depends on fracture pattern. Some stable fracture patterns allow immediate weight bearing as tolerated. Your surgeon will provide specific guidelines based on your fracture and nail stability.

Q4.Will the nail need to be removed later?

Not necessarily. Many patients keep the nail permanently without problems. Nail removal is considered if: you develop symptoms like pain or irritation, you require MRI for other conditions, you have skin sensitivity over the nail, or as per your preference after complete healing (usually 12-18 months). Nail removal is a simpler procedure than initial insertion.

Q5.What is the difference between reamed and unreamed IM nailing?

Reamed nailing involves enlarging the medullary canal to fit a larger, stronger nail, providing better stability but temporarily disrupting blood supply. Unreamed nailing uses a smaller nail without canal preparation, preserving blood supply but providing less stability. Dr. Kumar chooses based on bone size, fracture pattern, and patient factors. Both techniques have excellent outcomes.

Q6.How long does bone healing take after IM nailing?

Most long bone fractures achieve solid union in 3-4 months with IM nailing. However, complete bone remodeling continues for up to 12 months. X-rays at regular follow-ups will show progressive healing. Factors affecting healing time include fracture severity, bone involved, patient age, nutrition, smoking status, and compliance with rehabilitation protocols.

Q7.What are the risks and complications of IM nailing?

While IM nailing is generally safe, potential complications include: infection (1-2%), non-union or delayed union (2-5%), malunion with residual deformity, nail or screw breakage, knee or shoulder pain from nail insertion point, nerve or blood vessel injury (rare), and compartment syndrome (rare). Dr. Kumar uses advanced techniques to minimize these risks.

Q8.Can I have an MRI scan with an IM nail in place?

Most modern IM nails are made of titanium or stainless steel and are MRI-compatible, though they may cause some image artifact. The nail itself is not a contraindication for MRI. However, inform the radiologist about your implant. If high-quality MRI images are critical for your area, nail removal may be considered after fracture healing.

Q9.How much does intramedullary nailing cost at Arthroscenter?

The cost varies depending on bone involved (femur, tibia, humerus), nail type (reamed/unreamed, locked/unlocked), hospital stay duration, and any additional procedures needed. Arthroscenter accepts PMJAY and BSKY insurance which may cover most costs. We also offer flexible payment plans. Book a ₹999 consultation with Dr. Kumar for accurate cost estimation based on your specific case.

Q10.What is the success rate of IM nailing at Arthroscenter?

Dr. Gurudeo Kumar has performed over 1,500 IM nailing procedures with a 96% union rate and excellent functional outcomes. Our infection rate is below 1%, and patient satisfaction is over 95%. We use latest-generation interlocking nails and advanced fluoroscopic guidance to ensure optimal nail placement and fracture reduction, resulting in superior outcomes compared to traditional methods.

Considering This Surgery?

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