Orthopedic Nail Implants Surgical Techniques

🦴 ORTHOPEDIC NAIL IMPLANTS

🔧 SURGICAL TECHNIQUE (INTRAMEDULLARY NAILING)

Intramedullary (IM) nails are used for long bone fractures, providing load-sharing fixation with minimal soft tissue disruption.

1. 📋 Preoperative Planning

Clinical Evaluation

• Assess:

  • Fracture type (transverse, oblique, comminuted)

  • Open vs closed fracture

  • Soft tissue condition

• Indications:

  • Femur, tibia, humerus fractures

  • Segmental fractures

  • Pathological fractures

Imaging

• X-ray (AP & lateral views)

• CT scan (complex fractures)

Planning

• Select:

  • Nail type (interlocking, reconstruction, expert nails)

  • Nail length and diameter

• Determine:

  • Entry point

  • Locking configuration

2. 🛏️ Patient Positioning & Setup

Femur Nailing

• Supine on fracture table

• Traction applied

Tibia Nailing

• Supine, knee flexed

Humerus Nailing

• Supine or beach-chair

Setup

• C-arm fluoroscopy

• Sterile draping

• Prophylactic antibiotics

3. 📍 Fracture Reduction

Techniques

• Traction

• Manual manipulation

• Use of reduction tools

Goals

• Restore:

  • Length

  • Alignment

  • Rotation

👉 Confirm reduction under fluoroscopy.

4. 🔩 Entry Point Creation

Steps:

1. Make small incision

2. Identify anatomical entry point:

   • Femur: piriformis fossa / greater trochanter

   • Tibia: proximal tibial plateau

3. Insert awl or entry reamer

4. Confirm position under C-arm

5. 🪡 Guidewire Insertion

Steps:

1. Insert guidewire into medullary canal

2. Advance across fracture site

3. Ensure central positioning in distal fragment

👉 Guidewire is critical for accurate nail placement.

6. ⚙️ Canal Preparation (Reaming)

Steps:

1. Perform sequential reaming

2. Increase diameter gradually

3. Maintain alignment

Notes:

• Reamed or unreamed technique depending on case

• Irrigation to avoid thermal damage

7. 🧱 Nail Insertion

Steps:

1. Select appropriate nail size

2. Mount nail on insertion handle

3. Insert over guidewire

4. Advance gently using:

   • Manual pressure

   • Mallet (if required)

Key Points:

• Avoid excessive force

• Maintain fracture reduction

8. 🔒 Proximal Locking

Steps:

1. Use targeting jig

2. Drill through proximal holes

3. Insert locking screws

4. Tighten securely

9. 🔒 Distal Locking

Techniques:

• Freehand under fluoroscopy

Steps:

1. Identify distal holes using C-arm

2. Drill across both cortices

3. Insert locking screws

👉 Ensure rotational stability.

10. 🔄 Compression / Dynamization (Optional)

• Use compression screws or slots

• Allows controlled fracture compression

11. ⚖️ Final Assessment

Check:

• Alignment (AP & lateral)

• Rotation

• Limb length

• Implant positioning

12. 🧼 Wound Closure

• Irrigation

• Layered closure

• Sterile dressing

13. 🏥 Postoperative Protocol

Immediate Care

• Pain management

• Antibiotics

• Limb elevation

Mobilization

• Early joint movement

• Weight-bearing:

  • Depends on fracture stability

14. ⚠️ Complications & Prevention

Complication Prevention

Malalignment

Proper reduction

Infection

Sterile technique

Fat embolism

Gentle reaming

Non-union

Stable fixation

Hardware failure

Correct nail size

15. 🔓 Implant Removal (if required)

Steps:

1. Remove locking screws

2. Attach extraction device

3. Remove nail carefully

16. ✅ Key Surgical Principles

• Central nail placement

• Stable locking

• Minimal soft tissue damage

• Accurate entry point

• Maintain fracture biology

🌟 Advantages of IM Nailing

• Load-sharing fixation

• Early mobilization

• Minimally invasive

• High union rates

📌 Conclusion

Intramedullary nail systems from Jindal Medi Surge provide strong, reliable fixation for long bone fractures, ensuring:

• Faster recovery

• Improved alignment

• Reduced complications