Complications Of Intramedullary Nailing

Abstract

Gerhard Küntscher is credited with the first use of this device (Intramedullary Nailing : IMN ) in 1939/1940 , during World War II, for soldiers with fractures of the femur. Several modifications and shapes were introduced subsequently for various bones. When placed in a fractured long bone, IM nails act as internal splints with load-sharing characteristics. Various types of load act on an IM nail : torsion, compression, tension and bending. Physiologic loading is a combination of all these forces. IM nails are assumed to bear most of the load initially, then gradually transfer it to the bone as the fracture heals. Intramedullary nails have multiple indications and contraindications. During this procedure, a specially designed metal rod is inserted into the marrow canal of the long bone and passes across the fracture to keep it in position. An intramedullary nail can be inserted into the canal either from above or below through a small incision. There are numerous types of complications such as: Infection and soft tissues complications. Deformity in the form of ( varus , valgus, recurvatum & malrotation ) . Malunion, nonunion & delayed union .Thromboembolism, pulmonary embolism, fat embolism & DVT . Shock . Compartment syndrome . Neurovascular complications & Hematoma formation. Malalignment & 2ry malalignment . Heterotropic ossification & excessive callus formation . Complication of fixation. Refracture & iatrogenic fracture . Plastic deformation & bending . Leg Length Discrepancy LLD (Leg shortening or lengthening ) . Contracture . Avascular Necrosis (AVN). Metal irritation & implant failure. Nail complications as ( diastasis, incarceration, malrotation, breakage, migration, malposition & complications with its removal ) . Skin necrosis. Joint pain, stiffness & disturbances. Muscle atrophy. Reamer breakage, deviation & cortex splitting due to reaming. General complications of any surgery as ( complications of anaesthesia, blood clotting, blood loss, thrombophlebitis & agranulocytosis, serum hepatitis, bladder and bowel problems ). Complications of some type of nails as: ESIN ( nail prominence, loss of reduction & tendon injury ) and Gamma nail ( lag screw cutout, distal screw breakage & loss of reduction ). So, Usage of Intramedullary Nailing system (IMN) is useful for fracture healing process , But take care of its multiple complications which must be considered during the operation