Intramedullary Nail

A Comprehensive Guide to Intramedullary Fixation and Intramedullary Nails

Fractures are a common occurrence in our lives. Irrespective of age, anyone can get a fracture. However, the reasons vary depending on the age and overall health status. When a fracture occurs, particularly in long bones like the femur or tibia, stabilizing the broken pieces becomes crucial for proper healing. Although, it is important to bring back the limb in motion and relieve painful symptoms. This is where intramedullary nail comes in. These nails act as internal splints, offering stability and support for a fractured bone to mend. Whereas, the process of applying these IM nails surgically is known as intramedullary fixation. This blog will discuss the implant as well as the procedure. Let us start with a brief introduction to intramedullary fixation.

What is Intramedullary Fixation?

Intramedullary fixation is a surgical technique that utilizes an intramedullary nail to fix fractures in long bones like the femur and tibia. An IM nail is a long metal rod that is inserted into the hollow shaft (medullary cavity) of a fractured bone. The nail serves as an internal support system, aligning the bone fragments and promoting healing. Also known as intramedullary nailing, this surgical procedure can be carried out by both traditional and minimally invasive methods. However, the right technique depends on several factors. Only an experienced orthopedic surgeon can decide after thoroughly analyzing the fracture type and overall health of the patient. Well, the minimally invasive procedure offers several advantages over traditional methods including external fixation:

Improved Stability

IM nails provide superior stabilization compared to external methods. This allows for earlier mobilization and weight-bearing on the affected limb.

Reduced Pain

By minimizing bone movement at the fracture site, IM nails can significantly reduce pain and discomfort during recovery.

Faster Healing

Stable fixation promotes faster bone healing and hence, allows patients to regain function quickly.

Preserved Mobility

Compared to casts, IM nails allow for earlier movement of nearby joints by minimizing stiffness and promoting long-term function.

What Are the Different Types of Intramedullary Nails?

Intramedullary nails are made in different sizes and bends to accommodate different fracture patterns and severities. Different types of nails cater to specific fracture locations and bone characteristics. Here is a glimpse of the different types of nails used for intramedullary fixation:

Reamed and Unreamed Nails

Reamed nails

These require reaming the medullary canal to a specific diameter to accommodate the nail. This technique offers increased stability but may disrupt blood flow to the bone.

Unreamed nails

As the name suggests, these nails are inserted without reaming. They are typically smaller in diameter and more flexible. Thus, this makes them ideal for minimally invasive procedures and certain fracture types.

Femoral Nails

Proximal Femoral Nails

Designed for fractures around the hip joint (intertrochanteric fractures). These nails often have a curved design to navigate the complex anatomy of the hip.

Femoral Shaft Nails

Used for fractures in the main shaft of the femur. They come in various lengths and diameters depending on the specific fracture location and bone size.

Distal Femoral Nails

These nails are suitable for fractures near the knee joint (supracondylar fractures). These nails often have additional features for stabilizing the joint.

Tibial Nails

Tibial Shaft Nails

Similar to femoral shaft nails, these are used for fractures in the main shaft of the tibia. They come in both reamed and unreamed varieties and may have features for targeting specific fracture patterns.

Intramedullary Interlocking Nails (Interlocking Nails)

These advanced nails allow for the insertion of screws through the nail body while providing additional stability for complex fractures.

Humeral Nails

Humeral IM nails are for fractures in the shaft of the humerus. These nails are typically shorter compared to femoral or tibial nails due to the anatomy of the upper arm.

How to Choose the Right Intramedullary Nail?

The selection of the appropriate IM nail depends on several factors:

Fracture location and type

The location and type of fracture determine the specific nail design and features needed for optimal stabilization.

Bone quality

Factors like bone density and the presence of osteoporosis influence the choice between reamed and unreamed nails.

Patient factors

Age, health status, and activity level of the patients play a key role in choosing the most suitable nail type.

How Intramedullary Nails Are Applied?

Intramedullary fixation is an orthopedic surgical procedure which is typically performed under general anesthesia. The surgeon makes a small incision over the fracture site and aligns the bone fragments. Depending on the chosen nail type, the medullary canal may be reamed to accommodate the nail. The intramedullary nail is then inserted and secured with locking screws. The screws pass through the nail and into the surrounding bone. X-rays are used throughout the procedure to ensure proper alignment and nail positioning.

How Recovery and Rehabilitation Occurs After Intramedullary Fixation?

Following IM nail surgery, physical therapy is vital in regaining strength and mobility. The rehabilitation program typically focuses on:

Pain Management

Medications and physical therapy techniques help manage post-surgical pain.

Range of Motion Exercises

Gentle exercises gradually restore joint mobility around the fracture site.

Strengthening Exercises

As healing progresses, exercises are introduced to strengthen muscles and improve balance.


Intramedullary nails are a valuable tool in the orthopedic surgeon’s arsenal for treating fractures of long bones. They offer several benefits compared to traditional methods, promoting faster healing and a quicker return to function. Moreover, these nails have the ability to control the axial line of force at the fracture site. Moreover, these nails offer excellent resistance to fracture rotation. Hence, this eliminates the risk of implant failure. Based on the survey and studies, it is seen that IM nails need not be removed after fracture healing. They are known to cause discomfort in the majority of the cases. Even if the need for implant removal arises, only small incisions are required. However, the most important aspect of intramedullary nailing is selecting the right IM nail. For that, you need to choose the right orthopedic surgeon for the job.

About Siora Surgicals

Siora Surgicals Pvt. Ltd. is the name of trust in the orthopedic implant manufacturing and supplying industry. From PFNA intramedullary interlocking nails to hip prostheses, the company holds expertise in manufacturing hundreds of types of CE-certified trauma implants. It has an in-house production hub where all the implants are made using the latest machines sourced from renowned manufacturers. Moreover, every orthopedic device is tested to meet international standards.

Siora is also a global OEM/contract manufacturing service provider. It is also working to establish its presence as a leading Supplier for Orthopedic Implants in Turkiye by finding distributors in the country.