Flexible Intramedullary Nailing - Technique

Introduction:

Flexible intramedullary nailing is the emerging surgical procedure that has revolutionized the management of long bone fractures. It helps stabilize the long bones and reduces the disruption of the adjacent soft tissues. The prominent long bones managed with this technique are the femur and tibia (long bones). It provides stability and alignment and helps in the healing process.

The critical components of the article include the biomechanical advantages of flexible nails, its functional recovery, patient selection criteria, postoperative complications, indications, contraindications, and complications associated with this approach. The technique is an advancement in the orthopedic field, which has promised improved patient outcomes and increased postoperative recovery.

What Is Flexible Intramedullary Nailing?

Flexible Intramedullary Nailing (FIN) is a surgical procedure used in orthopedic settings. The associated people who can manage this technique are children and adolescents. It is mainly well-suited for pediatric people whose long bones are growing. In the case of fractures of the long bones, there is a need for effective intervention. During this technique, the flexible nails are used and placed into the medullary canal of the fractured long bones. It helps in the mobilization of the affected bone.

What Are the Indications of Flexible Intramedullary Nailing?

The main indication of the flexible intramedullary nailing is the fractures of the long bones, such as the femur and tibia. It is mainly indicated in children. The common indications of flexible intramedullary nailing are as follows:

• Pediatric Fractures: The technique is frequently employed in children and adolescents with long bone fractures. It helps grow, accommodate, and remodel the children's bones.

• Closed Fractures: The fractured segment does not go into the skin.

• Stable Fractures: The fractures without displacement. The technique provides stability and less need for exposure of the fracture site.

• Diaphyseal Fractures: The technique is suitable for the fractures of the shaft regions of the long bones, like the femur and tibia shafts.

• Transverse Fractures: The technique is advised for stability maintenance.

• Multifragment Fractures: Multifragment fractures are common in children. Flexible intramedullary nailing is a suitable method for stabilizing the fractured segment.

• Soft Tissue Trauma: It is a minimally invasive approach indicated for patients who may benefit from decreased soft tissue trauma.

What Are the Contraindications of Flexible Intramedullary Nailing?

The flexible intramedullary technique is valuable and has several good features. However, the specific contraindications of flexible intramedullary nailing are as follows:

• Open Fractures: The surgical technique is contraindicated in cases of open fractures, where the fractured bones invade the nearby skin. In the case of open fractures, other surgical approaches are recommended.

• Severe Displacement of Fractures: In case of severe displacement of fractured segments, in which flexible nails cannot stabilize the fractured segment, the procedure is contraindicated. Other alternative fixation methods are indicated to stabilize the displaced fractured segments.

• Poor Bone Quality: Patients with poor bone quality, such as osteoporosis (bone disease). The technique does not provide sufficient stability or support for weakened bones.

• Pathological Fractures: If the cause of the fracture is any underlying bone disease or tumors, then the flexible intramedullary nailing will not be suitable. The other fixation methods are considered to stabilize the condition.

• Inadequate Alignment: The technique does not provide adequate alignment. If this technique is applied to achieve adequate alignment, the risk of injury to nerves and blood vessels is higher.

• Allergic to Material: The surgeon may not advise the technique to the patient who is allergic to the flexible nail material.

What Is the Procedure for Flexible Intramedullary Nailing?

The procedure of flexible intramedullary nailing is as follows:

• Patient Assessment: The surgeon may do a preoperative assessment of the patient by taking medical history, physical examination, and imaging studies to check the extent and type of fractures.

• Anesthesia: The surgeon may give general or regional anesthesia.

• Patient Positioning: The patient is prepared and lies on the table with the back toward the table.

• Incision: The surgeon may make a small incision near the fractured site.

• Guide Wire: The guide wire is inserted through the incision site. The fluoroscopic imaging technique will help guide the nails into the medullary canal of the long fractured bones.

• Flexible Nail Insertion: A flexible nail made of metal is inserted into the medullary canal.

• Flexible Nail Interlocking: The interlocking of flexible nails is done to enhance the stability of the fractures. The nails are connected to a specific point along their length.

• Wound Closure: After the placement of nails and alignment of fractures are done. The incisions are closed with the help of staples or sutures.

• Postoperative Monitoring: After surgery, the patient is monitored to check stability and signs of any complications.

What Are the Advantages of Flexible Intramedullary Nailing?

The advantages or benefits of flexible intramedullary nailing are as follows:

• It is a minimally invasive technique that reduces the trauma to the nearby soft tissues.

• The postoperative pain is less.

• It is associated with quicker recovery times.

• It contributes to a rapid healing process.

• It provides stability to the bone with minimal bone disruption.

• The technique is suitable for pediatric patients.

• It helps in early mobilization of the affected limb.

• It helps promote bone development and reduces the risk of injury to growth plates.

• It can be indicated for several types, such as transverse or oblique fractures.

• It reduces the chances of blood loss.

• As compared to other traditional surgeries, the hospital stay is less.

• Cost-effective technique.

• The patient can return to normal activities faster.

What Are the Risks or Complications of Flexible Intramedullary Nailing?

The risks and complications of flexible intramedullary nailing are as follows:

• Improper sterile techniques can lead to surgical site infections. To reduce this, proper sterile techniques need to be followed post-operatively.

• Sometimes, factors such as poor blood supply and inadequate stabilization can contribute to the nonunion of the fractured segments.

• The healing of the fractured bones in an incorrect alignment.

• Delay union of fractured segments due to compromised blood supply.

• Implant failure, such as loosening or breakage of flexible nails.

• Intramedullary nail migration.

• Risk of injury to nearby blood vessels and nerves.

• Risk of tissue damage.

• Allergic reaction to the materials used.

• Joint stiffness.

Conclusion:

In conclusion, fixed intramedullary nailing is a surgical procedure used to stabilize the femur and tibia, which are long bones. It is mainly prescribed for children. Various advantages are associated with the procedure, such as stabilization, reduced recovery time, cost-effectiveness, and reduced hospital stay. In addition, the associated risks are allergic reactions, nail migration, and delayed union. The advanced orthopedic procedure has enhanced patient outcomes and increased the procedure's effectiveness.