Intramedullary nails are metal rods used to align and stabilize fractured fragments of long bones such as the femur (thigh bone) and tibia (shin bone). The rods are passed through the bone marrow at the centre of these bones, across fracture sites. The rod is inserted through a small incision at either end of the bone and fixed at both ends with screws.
Fractures in children are usually treated by externally aligning the broken bones and immobilising with a cast. In some cases where fracture fragments are unstable and cannot be aligned, intermedullary nailing surgery is usually suggested. However, the rods can penetrate and damage bone physes, the ends of bone that grow and contribute to the height of a child. For this, flexible intramedullary nails have been devised which have the necessary properties of elasticity and stability. This technique uses 2 nails, bent and inserted just below the physes and through the marrow of the bone fragments. This is achieved through fluoroscopy, which guides your surgeon in precisely inserting the rods.
Intermedullary nailing acts as internal splints holding the fragments together, allowing early mobilization. It is associated with reduced chances of infection or delay in healing. High success rates are noted with intramedullary rods, however some complications may arise such as malalignment, irritation from the metal, and nerve damage. In children, flexible intramedullary nailing may be associated with certain complications that can arise from using nails that are too thin and a change in the orientation of the nails.