Intramedullary nailing

Last revised by Travis Fahrenhorst-Jones on 13 Jun 2023

Intramedullary nailing is an internal fixation technique mainly used for the surgical management of long bone diaphyseal fractures and more recently, also in metaphyseal and periarticular fractures.

Indications of intramedullary nailing are the following 1,2:

  • extra-capsular proximal femur fractures, femoral diaphyseal fractures and distal femur fractures

  • humeral shaft fractures

  • tibial shaft fractures, proximal and distal tibia fractures

  • metaphyseal fractures

Contraindications of intramedullary nailing include the following 2:

  • open epiphysis

  • small medullary canal

  • deformity e.g. prior malunion

  • grossly contaminated open or infected fractures

  • fracture in line of locking screws

  • an associated femoral neck fracture

The surgical technique encompasses several steps including the following 2,3:

  • appropriate insertion or entry point (e.g. piriformis fossa, trochanter, intercondylar notch)

  • determination of nail length and diameter

  • exact anatomic reduction and securing reduction during the following steps

  • reaming

  • nail insertion

  • interlocking

Nail position, fragment position, and fracture healing can be assessed with anteroposterior and lateral radiographs.

The radiological report should include a description of the following features:

Complications of intramedullary nailing include the following 1-3:

General complications associated with surgery:

The use of intramedullary nailing provides stability and is associated with preservation of the surrounding muscle and soft tissues and involves only a small amount of soft-tissue dissection 1. Interlocking can provide control of length and rotation 2-4.

Advantages of intramedullary nailing include 1-4:

  • less-invasive implant insertion

  • long implants for spanning complex fractures

  • enhanced revascularization due to preserved soft-tissue sheathing

  • load sharing fixation with less requirement for additional support and earlier rehabilitation

  • lower risk for wound complications

  • can be combined with internal fixation methods as wire cerclage, buttress plates, etc.

Disadvantages include technical and intraoperative complications such as reaming complications (destruction of the medullary contents, fat embolism) 1.

Bircher reported an intramedullary fixation with ivory pegs in 1886, HeyGroves used metallic nailing with unsatisfactory results in 1918 1.

Successful surgical management with intramedullary nailing or ‘marrow nailing’ was introduced in 1939 by Küntscher (Kuntscher nail). The ‘interlocking nail’ was introduced in 1972 after its predecessor the ‘detensor nail’ in 1968 also by Küntscher, to solve problems with the treatment of comminuted fractures 1.

ADVERTISEMENT: Supporters see fewer/no ads

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.