Open reduction and internal fixation are two methods for treating
fractures: extramedullary fixation and intramedullary fixation.
Steel plate and screw internal fixation technology belongs to
extramedullary fixation. A biocompatible and high-strength implant
is inserted into the medullary cavity of the distal or proximal end
of the bone to achieve fracture end fixation, which is called
intramedullary fixation. Intramedullary fixation has been used for
the treatment of fractures for over 100 years. It has been used in
China since the end of the 1990s and has been widely used in
clinical practice. Good intramedullary nailing is a necessary skill
for orthopedic doctors.
Characteristics of intramedullary nails
Advantages:
1. Intramedullary nails can control the axial force line at the
fracture site; Locking intramedullary nails have a better effect on
preventing fracture rotation and reducing the risk of
intramedullary nail breakage.
2. Adopting closed nail piercing technology reduces soft tissue
detachment and avoids exposing the fracture site, reducing the
infection rate during surgery.
3. Closed nailing preserves the hematoma of the fracture, reduces
damage to the blood supply of the periosteum, and at the same time,
debris generated during pulp expansion deposits at the fracture
site, which has the effect of autologous bone grafting.
4. The intramedullary nail generally does not need to be removed,
even if it needs to be removed, only a small incision can be made
at the corresponding position of the locking nail and one end of
the intramedullary nail.
5. The intramedullary nail has a stress dispersing effect between
the damaged bone to avoid stress shielding.
Intramedullary nails are generally suitable for the following
situations of long bones:
1. Fracture of the shaft of the tubular bone
2. Non union after long shaft fracture
3. Abnormal healing of long shaft fractures
4. Bone elongation/shortening of long bones
5. Pathological fracture of the middle segment of the long bone
6. Joint fusion
7. Joint end fractures in special parts of the long bone (femoral
neck, intertrochanteric, femoral condyle, etc.)
