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Nails in Fracture Repair: Procedure, Benefits, and Outcomes

Nails in fracture repair are a common and effective method used by orthopedic surgeons to stabilize and heal broken bones. This procedure involves the insertion of metal nails or rods into the bone to provide stability and support during the healing process. Nails can be used in various types of fractures, including long bone fractures, hip fractures, and fractures of the tibia and fibula. This article will explore the procedure of nail insertion, the benefits of using nails in fracture repair, and the outcomes associated with this technique.

The Procedure of Nail Insertion

The procedure of nail insertion, also known as intramedullary nailing, involves the following steps:

  1. Preoperative Evaluation: Before the surgery, the orthopedic surgeon will conduct a thorough evaluation of the patient’s fracture, including imaging studies such as X-rays or CT scans. This evaluation helps determine the appropriate size and type of nail to be used.
  2. Anesthesia: The patient is typically placed under general anesthesia to ensure comfort and pain control during the procedure.
  3. Incision: The surgeon makes a small incision near the fracture site to access the bone.
  4. Reaming: A specialized tool called a reamer is used to create a pathway through the bone marrow cavity. Reaming helps enlarge the canal and prepares it for nail insertion.
  5. Nail Insertion: The orthopedic surgeon carefully inserts the nail into the bone through the incision. The nail is guided through the marrow cavity and positioned to align the fractured bone fragments.
  6. Locking: Depending on the type of nail used, additional screws or locking mechanisms may be inserted to secure the nail in place.
  7. Closure: The incision is closed using sutures or staples, and a sterile dressing is applied to the surgical site.

The entire procedure typically takes around one to two hours, depending on the complexity of the fracture and the experience of the surgeon. After the surgery, the patient is closely monitored for any complications and is usually advised to undergo physical therapy to regain strength and mobility in the affected limb.

Benefits of Using Nails in Fracture Repair

The use of nails in fracture repair offers several benefits compared to other methods of fixation, such as plates and screws. Some of the key advantages include:

  • Minimally Invasive: Intramedullary nailing is a minimally invasive procedure that requires only a small incision. This results in less tissue damage, reduced scarring, and faster recovery compared to open surgeries.
  • Biomechanical Stability: Nails provide excellent biomechanical stability by acting as an internal splint. They allow for early weight-bearing and promote faster healing of the fracture.
  • Preservation of Blood Supply: Unlike plates and screws, which may disrupt the blood supply to the bone, nails preserve the blood flow within the bone. This helps maintain the vitality of the bone and promotes healing.
  • Reduced Risk of Infection: The closed technique used in intramedullary nailing reduces the risk of infection compared to open surgeries. The nail acts as an internal barrier, protecting the bone from external contaminants.
  • Less Soft Tissue Disruption: Nails are inserted through the bone marrow cavity, minimizing disruption to the surrounding soft tissues. This reduces postoperative pain and accelerates the recovery process.

These benefits make nails a preferred choice for many orthopedic surgeons when it comes to fracture repair. However, the suitability of nails depends on various factors, including the type and location of the fracture, the patient’s age and overall health, and the surgeon’s expertise.

Outcomes of Nails in Fracture Repair

The use of nails in fracture repair has shown promising outcomes in terms of fracture healing, functional recovery, and patient satisfaction. Several studies have investigated the effectiveness of nails in different types of fractures, and the results have been generally positive.

One study published in the Journal of Orthopaedic Trauma compared the outcomes of intramedullary nailing and plate fixation in the treatment of tibial shaft fractures. The study found that patients treated with nails had a significantly higher rate of fracture union and a lower risk of infection compared to those treated with plates. Furthermore, patients who underwent nail fixation had better functional outcomes and a shorter time to return to work or daily activities.

In another study published in the Journal of Bone and Joint Surgery, researchers evaluated the outcomes of intramedullary nailing in the treatment of hip fractures in elderly patients. The study demonstrated that nail fixation resulted in a higher rate of fracture union, reduced postoperative complications, and improved functional outcomes compared to other fixation methods.

These studies highlight the positive outcomes associated with the use of nails in fracture repair. However, it is important to note that individual results may vary, and the success of the procedure depends on various factors, including the patient’s age, overall health, and compliance with postoperative rehabilitation.

Complications and Risks

While nails in fracture repair offer numerous benefits, like any surgical procedure, there are potential complications and risks involved. Some of the common complications associated with nail insertion include:

  • Infection: Although the risk of infection is relatively low, it can still occur. Infections may require additional treatment, such as antibiotics or, in severe cases, removal of the nail.
  • Malalignment: Improper positioning of the nail can lead to malalignment of the fractured bone fragments. This may require additional surgery to correct the alignment.
  • Nonunion: In some cases, the fracture may fail to heal properly, resulting in a nonunion. This may require further intervention, such as bone grafting or revision surgery.
  • Hardware Failure: Nails can break or loosen over time, especially in cases of high-impact activities or poor bone quality. Hardware failure may necessitate the removal or revision of the nail.
  • Nerve or Blood Vessel Injury: During the nail insertion, there is a small risk of injuring nearby nerves or blood vessels. This can lead to sensory or motor deficits in the affected limb.

It is important for patients to discuss these potential risks with their orthopedic surgeon before undergoing nail insertion. The surgeon will assess the individual’s specific case and provide appropriate guidance and recommendations.


Nails in fracture repair are a widely used and effective technique for stabilizing and healing broken bones. The procedure offers several benefits, including minimal invasiveness, biomechanical stability, preservation of blood supply, reduced risk of infection, and less soft tissue disruption. Numerous studies have demonstrated positive outcomes associated with the use of nails in fracture repair, with higher rates of fracture union, improved functional outcomes, and patient satisfaction. However, like any surgical procedure, there are potential complications and risks involved, such as infection, malalignment, nonunion, hardware failure, and nerve or blood vessel injury. It is crucial for patients to have a thorough discussion with their orthopedic surgeon to understand the procedure, its benefits, and the potential risks before making an informed decision.

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