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Humeral Intramedullary Nailing
Dr Kau Chung Yuan (许医生)
MBBS (S’PORE)
MRCS (Ireland)
MMed (Ortho)
FRCSEd (Ortho)
What is Humeral Intramedullary Nailing?
Humeral intramedullary nailing is a surgical procedure to treat fractures of the humerus, the long bone in the upper arm.
This technique involves the insertion of a specially designed nail or rod into the central canal of the humerus. The nail, typically made of titanium or stainless steel, provides internal support and stabilises the bone as it heals.
When is Humeral Intramedullary Nailing Needed?
Humeral intramedullary nailing is primarily indicated for treating certain types of fractures to the humerus where other methods may not be as effective. These indications include:
- Mid-Shaft Fractures
Often the preferred choice for mid-shaft fractures of the humerus, where the middle portion of the bone is affected. These fractures can be complex and difficult to stabilise with external casts or splints. - Comminuted Fractures
Provides necessary internal support to hold bone fragments together in cases where the bone is broken into multiple pieces (comminuted fractures). - Nonunion or Malunion
Used for fractures that have not healed correctly (nonunion) or have healed improperly (malunion), to realign and stabilise the bone. - Pathological Fractures
Offers the necessary support to weakened bones due to underlying conditions like osteoporosis or cancer. - Fractures in Polytrauma Patients
Allows for quicker mobilisation, crucial in managing patients with multiple injuries.
Benefits and Risks of Humeral Intramedullary Nailing
Benefits
- Stabilisation of the Fracture: Provides robust internal stabilisation, essential for the proper alignment and healing of the fractured bone.
- Minimally Invasive: Compared to other surgical methods, intramedullary nailing is less invasive, leading to reduced surgical trauma and potentially shorter hospital stays.
- Early Mobilisation: This technique often allows for earlier movement and rehabilitation of the arm, which is crucial for regaining strength and function.
- High Success Rate: Generally, this procedure has a high success rate in terms of bone healing and recovery of function.
- Decreased Risk of Infection: Intramedullary nailing, as an internal fixation method, inherently reduces the risk of infection. This is primarily because the implant is entirely beneath the skin, minimising exposure to external pathogens.
Risks
- Surgical Complications: As with any surgical procedure, there are risks of complications such as bleeding, infection, or adverse reactions to anaesthesia.
- Injury to Surrounding Structures: There is a risk of injury to nearby nerves or blood vessels during the procedure.
- Nonunion or Malunion: In some cases, the bone may fail to heal properly (nonunion) or heal in an incorrect position (malunion).
- Implant-Related Problems: There might be issues related to the implant, such as irritation, or the need for its removal in case of complications.
- Postoperative Pain: Some degree of pain is expected post-surgery, which may require pain management.
Preparing for Humeral Intramedullary Nailing
Proper preparation is crucial for the success of humeral intramedullary nailing. This preparation involves several steps, ensuring that the patient is ready for surgery and understands the procedure.
- Medical Evaluation
A thorough medical examination to assess overall health, including any underlying conditions that may affect the surgery. - Imaging Studies
X-rays, CT scans, or MRI may be required to provide detailed views of the fracture and aid in surgical planning. - Medication Review
Discussion of current medications, including any that might need to be stopped before surgery, such as blood thinners. - Allergy Check
Identification of any allergies, particularly to anaesthesia or surgical materials. - Fasting
Typically, patients are required to fast for a certain period before the surgery.
What Can You Expect During a Humeral Intramedullary Nailing?
Humeral intramedullary nailing is a surgical procedure that requires careful execution. Understanding what happens during the surgery can help patients prepare mentally and have realistic expectations.
- General or Regional Anesthesia: The type of anaesthesia used will be determined based on the patient’s health, preference, and the orthopaedic surgeon’s recommendation. General anaesthesia induces unconsciousness, while regional anaesthesia numbs a specific part of the body.
- Incision and Access: A small incision is made near the shoulder or elbow to access the humerus.
- Alignment of Fracture: The orthopaedic surgeon aligns the fractured bone fragments.
- Insertion of the Nail: A specially designed nail is inserted into the intramedullary canal (central cavity) of the humerus. The length and diameter of the nail are chosen based on the size of the patient’s bone.
- Securing the Nail: The nail is secured in place with screws at both ends to stabilise the bone.
- Closure: The incision is closed with sutures or staples.
Dr. Kau Chung Yuan
MBBS (S’pore)
MRCS (Ireland)
MMed (Ortho)
FRCSEd (Ortho)
Dr Kau (许医生) is a Fellowship trained Orthopaedic Surgeon with a subspecialty interest in Hip and Knee surgery and has been in practice for more than 15 years.
He is experienced in trauma and fracture management, sports injuries, and joint replacement surgery.
- Fellow of the Royal College of Surgeons Edinburgh, Orthopaedics (FRCS, Edin) 2014
- Master of Medicine (Orthopaedics), Singapore (MMed) 2013
- Member of the Royal College of Surgeons Ireland (MRCS, Ire) 2009
- Bachelor of Medicine and Surgery (MBBS, Singapore) 2004
Postoperative Care and Rehabilitation
After undergoing humeral intramedullary nailing, the post-operative care and rehabilitation phase focuses on managing pain, preventing complications, and regaining function in the affected arm.
Immediate Post-Operative Care
- Monitoring: Patients are closely monitored for any immediate postoperative complications, such as bleeding or infection.
- Pain Management: Pain relief is provided through medications. This may include oral pain relievers or, in some cases, nerve blocks.
- Wound Care: Instructions on how to care for the surgical site to prevent infection are provided.
Rehabilitation
- Physiotherapy: Begins soon after surgery, often within the first few days. The goal is to restore range of motion, strength, and function in the affected arm.
- Exercises: Gradual introduction of exercises tailored to the patient’s specific needs and progression of healing. These may include range-of-motion exercises initially, progressing to strengthening exercises.
- Regular Check-ups: To monitor the healing process and adjust treatment plans as necessary. This often includes imaging studies to assess the position of the nail and the healing of the fracture.
Long-Term Care
- Activity Modification: Temporary restrictions on certain activities to allow the bone to heal properly.
- Nutrition and Bone Health: Adequate nutrition, including calcium and vitamin D, is important for bone health and healing.
- Possible Removal of the Nail: In some cases, the nail may need to be removed after the fracture has completely healed, though this is not always necessary.
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Frequently Asked Questions (FAQs)
How Long Does It Take to Recover from Humeral Intramedullary Nailing?
The recovery period for humeral intramedullary nailing typically ranges from a few months to a year, depending on the complexity of the fracture and the individual’s overall health. Active rehabilitation, which includes physical therapy and exercises, is crucial to regain full function.
Is Humeral Intramedullary Nailing a Painful Procedure?
Patients do not experience pain during humeral intramedullary nailing due to the use of anaesthesia.
Postoperative discomfort and pain are common but are effectively managed through prescribed pain relief medications and sometimes nerve blocks. The intensity of postoperative pain usually diminishes significantly within the first few weeks after surgery.
Are There Any Restrictions After the Surgery?
After humeral intramedullary nailing, patients are typically advised to avoid heavy lifting and high-impact activities for several weeks to months. The exact duration of these restrictions is determined by the orthopaedic surgeon based on the healing progress and the nature of the fracture.
Gradual reintroduction of normal activities is guided by pain tolerance and functional improvement during rehabilitation.
Can the Nail Used in the Surgery Be Left in Permanently?
The intramedullary nail inserted during the surgery can often be left in place permanently without causing any issues. However, if the nail leads to discomfort, irritation, or complications, it may be surgically removed once the fracture has completely healed.
The decision to remove the nail is made based on individual patient factors and symptoms.
What Are the Signs of Complications I Should Watch for After the Surgery?
Post-surgery, it is important to monitor for signs of complications such as persistent or increasing pain, redness, swelling, and fever, which could indicate infection.
Unusual discharge or drainage from the surgical site, numbness, or a significant decrease in mobility of the operated arm should prompt immediate medical attention. These symptoms might signal issues like hardware failure, nerve damage, or deep vein thrombosis.