Treatments & Therapies

Intramedullary nail osteosynthesis – treatment, effects & risks

Intramedullary nail osteosynthesis

An intramedullary nail osteosynthesis is a surgical procedure for the treatment of tubular bone fractures. In this method, the surgeon inserts an intramedullary nail into the medullary space of the bone.

What is intramedullary nail osteosynthesis?

Intramedullary nail osteosynthesis is also known as intramedullary nailing. This refers to a surgical method in which an elongated metal pin such as a bone nail or medullary nail is inserted into the bone marrow of the damaged bone. In this way, the supply of a broken tubular bone takes place by promoting callus formation and thus the healing of the bone.

From 1887, tubular bones such as the femur were fixed in an intramedullary manner. In 1916, some physicians also resorted to bones of cattle or ivory. In 1925, the three-lamella naile was introduced, which was used for fractures of the femoral neck. In 1940, the German surgeon Gerhard Küntscher (1900-1972), who is considered the inventor of intramedullary nailing, triggered fierce controversy at the presentation of his medullary nail at a conference of the German Society of Surgery. At the time, the bone marrow was considered untouchable and irreplaceable for bone vitality.

Over the years, however, intramedullary nail osteosynthesis has been able to convince with therapeutic successes. Thus, the injured limb could be loaded faster by the medullary nail, which shortened the stay in the hospital. The patient’s ability to work could also be restored more quickly. In contrast, the other treatment methods contained numerous complications that were now avoided with intramedullary nail osteosynthesis.

In the 50s, the introduction of the drilled medullary nailing took place, which became the standard method for the treatment of shaft fractures of the shin. Although it is not necessary from a medical point of view, the medullary nail is removed after the fracture has healed. Thus, its locking screws can have a disruptive effect.

Function, impact & goals

Nowadays, intramedullary nails made of inert titanium are used. With the help of these implants, a static or dynamic locking and compression on the gap of the fracture can be achieved.Indications for intramedullary nail osteosynthesis are open or closed fractures of large tubular bones such as the shinbone, the femur and the humerus. Intramedullary nail osteosynthesis is also useful for special treatments. For this purpose, different special implants are available, which have special properties.

The most common areas of application of intramedullary nail osteosynthesis are short oblique fractures or transverse fractures, such as on the thigh. The first step of the procedure is the reposition of the bone. The surgeon brings bone fragments that have shifted back to their original position. Depending on how long the fracture is, the surgeon guides the medullary nail over a small skin incision from the end of the bone to the inside of the bone.

In intramedullary nail osteosynthesis, a distinction is made between two different procedures. These are the undrilled and the drilled medullary nail. If a drilled medullary nail is used, the surgeon first drills the medullary space of the bone. The next step is to drive an elongated hollow nail into the medullary space. If, on the other hand, an undrilled medullary nail is used, drilling the medullary space is not necessary. In addition, the surgeon uses a massive nail, which is thinner. The undrilled medullary nail is used to treat severe open fractures.

By inserting an undrilled nail, the blood vessels located in the bone marrow can be spared. Through the medullary space, new bone substance is produced and the bone is supplied with blood. If an injury to the medullary space occurs due to a drilled nail, this is often disadvantageous for the healing process.

There are also differences between the intramedullary nail types in the locking. For example, an undrilled nail necessarily requires a locking screw, while the locking of the drilled nail is optional. The locking refers to the fixing of the medullary nail at one end of the bone with bolts or screws. Physicians differentiate between static and dynamic locking.

As part of the static locking, the intramedullary nail is fixed at both ends, which ensures a stable connection. As a result, the bone fragments cannot give way. In the case of dynamic locking, the nail is attached only to the bone end near the fracture. The connection is therefore less rigid. Which type of nail is ultimately more suitable, the surgeon decides according to the extent, shape and position of the fracture.

Risks, side effects & dangers

Despite its numerous benefits, intramedullary nail osteosynthesis can also trigger some complications. These primarily include pseudarthrosis and malpositions. Pseudarthrosis is when the bone fails to heal after surgery.

It is also referred to as pseudo-joint or pseudo-joint. The bones affected by pseudarthrosis are usually the thigh and lower leg bones. The complication is manifested by and constant functional limitations. In addition, the mobility of the affected limb is considered abnormal. For treatment, further osteosynthesis usually has to be carried out.

Another common complication of intramedullary nail osteosynthesis is primary or secondary malpositions. Thus, external rotation malpositions can occur when using both drilled and undrilled intramedullary nails. The reason for this is usually an incorrect execution of the intramedullary nail osteosynthesis by the surgeon. In rare cases, a fracture of the bolt can also cause a primary deformity.

Other possible complications include fat embolisms, infections or implant failure. Especially with open fractures, the risk of infection is high. Implant failure occurs when a fracture of the intramedullary nail or a fracture of the medullary nail occurs.

Lisa Newlon
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Hello! I am Lisa Newlon, and I am a medical writer and researcher with over 10 years of experience in the healthcare industry. I have a Master’s degree in Medicine, and my deep understanding of medical terminology, practices, and procedures has made me a trusted source of information in the medical world.