Intramedullary Nail Fixation
A metal rod is inserted into the medullary canal of a long bone and locked with screws — the gold standard for femur, tibia, and humerus shaft fractures, enabling immediate weight-bearing and rapid mobilisation.
What is Intramedullary Nail Fixation?
An intramedullary (IM) nail is a metal rod that is introduced into the hollow medullary canal of a long bone, spanning the fracture and providing internal splinting from within the bone itself. Proximal and distal interlocking screws prevent rotation and shortening, providing a stable, weight-bearing construct. Intramedullary nailing is the gold-standard treatment for most femur and tibia shaft fractures, and is increasingly used for humerus, clavicle, and forearm fractures. The key advantage is that nailing is typically performed as a closed procedure — the fracture site is not opened, preserving the fracture haematoma and local biology that drive healing.
How the Procedure Works
Fracture Reduction
Patient positioned on a traction table; the fracture is reduced under fluoroscopic guidance — without opening the fracture site.
Entry Portal
A small incision is made at the nail entry point — piriformis fossa or trochanter for femur; tibial tuberosity for tibia.
Canal Preparation
The medullary canal is reamed to the appropriate diameter, creating a tight fit for the nail.
Nail Insertion
The IM nail is advanced across the fracture under fluoroscopic control until correctly positioned.
Interlocking & Mobilisation
Proximal and distal locking screws prevent rotation; weight-bearing begins the following day.
Outcomes
Who Needs This Treatment?
- →Closed technique — fracture site not opened, biology preserved
- →Immediate or same-week weight-bearing for lower limb fractures
- →Nail within the bone — protected from impact forces
- →Minimal blood loss compared to open plating
- →Nail removal generally not required once union is confirmed
- →Excellent biomechanical stability for long bone shaft fractures
"Intramedullary nailing is elegant surgery. We reduce the fracture without opening it, insert a nail through a small stab incision, lock it in place, and the patient walks the next day. Preserving the fracture biology by keeping it closed is one of the most important principles in fracture surgery."
— Dr. Satish Reddy Gandavarapu, Senior Orthopaedic & Trauma Surgeon, Lux Hospitals, Hyderabad
Common Questions
Frequently Asked
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