Intramedullary Nailing of Humeral Shaft Fracture

What is Intramedullary Nailing of Humeral Shaft Fracture

Intramedullary (IM) nailing is a procedure in which a metal rod or wire (nail) is placed inside the bone between your shoulder and your elbow (humerus). The nail holds the broken (fractured) bone in place while it heals.

IM nailing may be done for a fracture that happened suddenly due to injury (acute fracture) or as a result of a disease (pathological fracture). Humerus fractures may be very painful and may make moving your arm very difficult.

Tell a health care provider about:

  • Any allergies you have.
  • All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
  • Any problems you or family members have had with anesthetic medicines.
  • Any blood disorders you have.
  • Any medical conditions you have.
  • Any surgeries you have had.
  • Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

  • Infection.
  • Bleeding.
  • Fracture of other parts of bone while fixing the injured bone.
  • Allergic reaction to medicines.
  • Blood clot.
  • Scarring.
  • Shoulder pain.
  • Failure of the bone to heal (nonunion).
  • Injury to a nerve in the arm (radial nerve).
  • Loosening of the nail.

What happens before the procedure?

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

  • Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

  • 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
  • 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
  • 6 hours before the procedure – stop drinking milk or drinks that contain milk.
  • 2 hours before the procedure – stop drinking clear liquids.

Medicines

  • Ask your health care provider about:
    • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
    • Taking over-the-counter medicines, vitamins, herbs, and supplements.
    • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines unless your health care provider tells you to take them.
  • You may be given antibiotic medicine to help prevent infection.
  • You may be given medicine to help relieve pain.

General instructions

  • You may have a physical exam and assessment.
  • You may have imaging tests, such as:
    • X-rays.
    • CT scan.
  • You may be given ice to help relieve pain.
  • Do not use any products that contain nicotine or tobacco for as long as directed before your procedure. This includes cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
  • Plan to have someone take you home from the hospital or clinic.
  • Ask your health care provider how your surgical site will be marked or identified.
  • You may be asked to shower with a germ-killing soap.

What happens during the procedure?

  • To lower your risk of infection:
    • Your health care team will wash or sanitize their hands.
    • Your skin will be washed with soap.
    • Hair may be removed from the surgical site.
  • An IV tube will be inserted into one of your veins.
  • You will be given one or more of the following:
    • A medicine to help you relax (sedative).
    • A medicine to make you fall asleep (general anesthetic).
  • A small incision will be made in your upper arm, near your shoulder.
  • Muscles and tendons may be moved out of the way.
  • A nail will be placed into your humerus so that it joins the bone pieces together.
  • The nail will be screwed into place on either side of the fracture.
  • You may have imaging tests during surgery, such as a series of X-rays, to ensure proper placement of the nail.
  • Your wound will be thoroughly washed and cleaned.
  • Your incision will be closed with stitches (sutures).
  • A tube and collection device (drain) may be placed near your wound to drain fluid from the surgical area.
  • A bandage (dressing) may be placed over your incision.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

  • Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
  • You may continue to receive fluids and medicines through an IV tube.
  • You will have some arm pain. You will be given medicines as needed.
  • You will be encouraged to do deep breathing exercises.
  • To prevent blood clots:
    • Avoid sitting or lying for a long time without moving your legs. You will be encouraged to walk as soon as you can.
    • You may have to wear compression stockings.
  • You will be given instructions on when to start physical therapy. You will need to complete physical therapy as instructed to regain motion and strength in your arm.
  • Do not drive until your health care provider approves.

Summary

  • During this procedure, a metal rod or wire (nail) is placed inside the bone between your shoulder and your elbow (humerus) to help heal the fractured bone.
  • You should not use any products that contain nicotine or tobacco for as long as directed before your procedure.
  • After the procedure, do not drive until your health care provider approves.
  • You will need to complete physical therapy as instructed in order to regain motion and strength in your arm.

Care After Intramedullary Nailing of Humeral Shaft Fracture

Here is the information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After your procedure, it is common to have:

  • Pain and swelling in your upper arm.

Follow these instructions at home:

If you have a sling:

  • Wear the sling as told by your health care provider. You may wear it for up to 12 weeks after surgery. Remove it only as told by your health care provider.
  • Loosen the sling if your fingers tingle, become numb, or turn cold and blue.
  • Keep the sling clean.
  • If the sling is not waterproof:
    • Do not let it get wet.
    • Cover it with a watertight covering when you take a bath or shower.

Bathing

  • Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you can take showers. You may only be allowed to take sponge baths for bathing.
  • Keep your bandage (dressing) dry until your health care provider says it can be removed.

Incision care

  • Follow instructions from your health care provider about how to take care of your incision. Make sure you:
    • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
    • Change your dressing as told by your health care provider.
    • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
  • Check your incision area every day for signs of infection. Check for:
    • Redness, swelling, or pain.
    • Fluid or blood.
    • Warmth.
    • Pus or a bad smell.

Managing pain, stiffness, and swelling

  • If directed, put ice on the injured area.
    • Put ice in a plastic bag.
    • Place a towel between your skin and the bag.
    • Leave the ice on for 20 minutes, 2–3 times a day.
  • Move your fingers often to avoid stiffness and to lessen swelling.
  • Raise (elevate) the injured area above the level of your heart while you are sitting or lying down.

Driving

  • Do not drive or use heavy machinery while taking prescription pain medicine or until your health care provider approves.

Activity

  • Rest and avoid activities that require a lot of effort. Ask your health care provider what activities are safe for you.
  • Follow instructions from your health care provider about:
    • Whether you may gently use your hand and elbow immediately after surgery.
    • When to start doing gentle range of motion movements with your shoulder and elbow. It is important to do these movements to prevent loss of motion.
    • How much weight you can put on your arm.
    • Avoiding lifting, pulling, and pushing. You may need to avoid these actions for up to 12 weeks.
  • Avoid rotating motions with your arm.
  • If physical therapy was prescribed, do exercises as directed.

Medicines

  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • If you were prescribed an antibiotic medicine, take it as told by your health care provider. Do not stop taking the antibiotic even if you start to feel better.

General instructions

  • To prevent or treat constipation while you are taking prescription pain medicine, your health care provider may recommend that you:
    • Drink enough fluid to keep your urine clear or pale yellow.
    • Take over-the-counter or prescription medicines.
    • Eat foods that are high in fiber, such as fresh fruits and vegetables, whole grains, and beans.
    • Limit foods that are high in fat and processed sugars, such as fried and sweet foods.
  • Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. These can delay bone healing. If you need help quitting, ask your health care provider.
  • Wear compression stockings as told by your health care provider. These stockings help to prevent blood clots and reduce swelling in your legs.
  • Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

  • You have redness, swelling, or pain around your incision.
  • You have fluid or blood coming from your incision.
  • Your incision feels warm to the touch.
  • You have pus or a bad smell coming from your incision.
  • You have a fever.

Get help right away if:

  • You have severe pain.
  • Your incision breaks open.
  • You fall.

Summary

  • Ask your health care provider what activities are safe for you while you recover.
  • Check your incision area every day for signs of infection, such as redness or swelling.
  • If physical therapy was prescribed, do exercises as directed.
  • Keep all follow-up visits as told by your health care provider. This is important.
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