Intramedullary Nailing of Tibial Diaphyseal Fracture

What is Intramedullary Nailing of Tibial Diaphyseal Fracture

Intramedullary (IM) nailing of tibial diaphyseal fracture is a procedure in which a metal rod or wire (nail) is placed inside a bone in the lower leg (tibia). The nail holds the broken (fractured) bone in place while it heals.

After this procedure, you will not need a cast, and you may be able to put some weight on your leg right away (partial weight-bearing). The bone may take up to 4–6 months to heal.

This procedure is usually done when a large force, such as from a car or sports accident, has fractured the tibia. Often, the other bone in the lower leg (fibula) is also fractured at the same time as the tibia.

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 surgeries you have had.
  • Any medical conditions you have.
  • Whether you are pregnant or may be pregnant.

What are the risks?

  • Infection.
  • Allergic reaction to medicines.
  • Damage to other structures or organs, such as nerves or blood vessels.
  • Blood clot.
  • Scarring.
  • Failure of the bone to heal properly (nonunion).
  • Needing another procedure to remove the IM nail if it causes pain.
  • Severe swelling and pain in the injured leg (compartment syndrome).

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.

General instructions

  • You may have a physical exam. It is important for you to tell your healthcare provider how your injury occurred and if you think you may have other injuries as a result.
  • You may have imaging tests, such as:
    • X-rays.
    • CT scan.
  • You may be asked to shower with a germ-killing soap.
  • Ask your health care provider how your surgical site will be marked or identified.
  • Plan to have someone take you home from the hospital or clinic.
  • Plan to have a responsible adult care for you for at least 24 hours after you leave the hospital or clinic. This is important.
  • 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.

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 area.
  • An IV will be inserted into one of your veins.
  • You may be given one or both of the following:
    • A medicine to help you relax (sedative).
    • A medicine to make you fall asleep (general anesthetic).
  • An incision will be made below your knee on the front side of your leg.
  • Skin and tissue will be moved out of the way with a surgical device.
  • A metal rod may be placed in the front of your knee and down into your tibia to keep the fractured section of bone in place.
  • An X-ray or a series of X-rays may be done to make sure that the rod is in the correct place.
  • The IM nail will be screwed into place on either side of the fracture to allow the bone to heal.
  • An X-ray will be done to make sure that the IM nail is in the correct place.
  • Tendons and other tissue will be closed with stitches (sutures) that do not need to be removed.
  • Your incision will be closed with sutures.
  • A bandage (dressing) may be placed over your incision.
  • A removable splint may be placed over the dressing.

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 leg pain. You will be given medicines as needed.
  • You will be encouraged to do deep breathing exercises.
  • Do not drive until your health care provider approves.

Summary

  • Intramedullary (IM) nailing of tibial diaphyseal fracture is a procedure in which a metal rod or wire (nail) is placed inside a bone in the lower leg (tibia). The bone may take up to 4–6 months to heal.
  • After this procedure, you will not need a cast, and you may be able to put some weight on your leg right away (partial weight-bearing).
  • You should not use any products that contain nicotine or tobacco for as long as directed before your procedure.

Intramedullary Nailing of Tibial Diaphyseal Fracture, Care After

This sheet gives you 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 the procedure, it is common to have:

  • Pain and swelling in your lower leg.

Follow these instructions at home:

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

If you have a splint:

  • Wear the splint as told by your health care provider. Remove it only as told by your health care provider.
  • Loosen the splint if your toes tingle, become numb, or turn cold and blue.
  • Keep the splint clean.
  • If the splint is not waterproof:
    • Do not let it get wet.
    • Cover it with a watertight covering when you take a shower.

Bathing

  • Do not take baths, swim, or use a hot tub until your health care provider approves. You may only be allowed to take sponge baths for bathing for the first few days.
  • Ask your health care provider if you can take showers.
  • 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:
    • More redness, swelling, or pain.
    • More fluid or blood.
    • Warmth.
    • Pus or a bad smell.

Managing pain, stiffness, and swelling

  • Raise (elevate) the injured area above the level of your heart while you are sitting or lying down.
  • Move your toes often to avoid stiffness and to lessen 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.

Activity

  • Do not use the injured limb to support your body weight. You may be able to put some weight on your leg (partial weight-bearing). Use crutches or a walker. Follow directions as told by your healthcare provider.
  • Avoid sitting or lying for a long time without moving. You will be encouraged to walk with assistance as soon as you can. This will help prevent blood clots.
  • If physical therapy was prescribed, do exercises as directed. It is important to do physical therapy to regain muscle strength and range of motion in your leg.
  • Rest and avoid activities that require a lot of effort or put you at risk for a fall or another leg injury. Ask your health care provider what activities are safe for you and when you can begin leg motion after surgery.

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.
  • Take steps to prevent falls at home, such as removing throw rugs and tripping hazards.
  • Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

  • You have more redness, swelling, or pain around your incision.
  • You have more 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:

  • Your incision breaks open.
  • You have red, painful, or swollen areas in one or both legs.
  • You have severe pain that does not get better with medicine.

Summary

  • After your procedure, it is common to have pain and swelling in your lower leg.
  • Check your incision area every day for signs of infection, such as more redness or swelling.
  • Do not use the injured limb to support your body weight. You may be able to put some weight on your leg (partial weight-bearing). Use crutches or a walker. Follow directions as told by your healthcare provider.
  • Ask your health care provider what activities are safe for you while you recover. It is important to do physical therapy as instructed to regain strength and range of motion in your leg.
  • Keep all follow-up visits as told by your health care provider. This is important.
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