Femoral Nails

What are Femoral Nails?

Femoral nails are metal rods used to align and stabilize fractured fragments of the femur or thigh bone. The rods are passed through the bone marrow at the center of the femur, across the fracture site. The rod is inserted through a small incision at either end of the bone and fixed at both ends with screws. Femoral nails are also called intramedullary (IM) devices, as they go inside of the bone.

Femoral fractures are usually treated by externally aligning the broken bones and immobilizing with a cast. In some cases where fracture fragments are unstable and cannot be aligned, femoral nails are employed. Femoral nails act as internal splints holding the fragments together, allowing early mobilization. High success rates are noted with femoral nails as it is associated with reduced chances of infection and faster healing. 

Indications for Femoral Nails

Your surgeon may recommend femoral nailing for various types of femoral fractures such as:

• Intertrochanteric fractures
• Subtrochanteric fractures
• Comminuted fractures
• Segmental fractures
• Nonunions
• Fractures with bone loss
• Distal and proximal fractures

Preparation for Femoral Nailing

In general, preoperative preparation for femoral nailing will involve the following steps:

• A thorough examination is performed by your doctor to check for any medical issues that need to be addressed prior to surgery.
• Depending on your medical history, social history, and age, you may need to undergo tests such as bloodwork and imaging to screen for any abnormalities that could threaten the safety of the procedure.
• You will be asked if you have allergies to medications, anesthesia, or latex.
• You should inform your doctor of any medications, vitamins, or supplements that you are taking.
• You should refrain from supplements or medications such as blood thinners, aspirin, or anti-inflammatory medicines for 1 to 2 weeks prior to surgery.
• You should refrain from alcohol or tobacco at least a week before surgery.
• You should not consume solids or liquids at least 8 hours prior to surgery.
• Arrange for someone to drive you home after surgery.
• A written consent will be obtained from you after the surgical procedure has been explained in detail.

Procedure for Femoral Nailing

In general, the femoral nailing procedure for femoral factures will involve the following steps:

• You will lie on your back on the operating table under general or spinal anesthesia.
• A 3 to 5 cm long incision is made along the tip of the greater trochanter.
• Suitable nails of specific diameter and length are chosen and inserted through the tip of the femur passing through the central or medullary canal of the fractured femoral bone.
• The nails are bent and inserted through an incision near either end of the femur bone.
• If possible, your surgeon may perform closed reduction of the fracture under image intensifier control where the bone pieces will be aligned in the correct position by pushing or pulling the bone.
• Holes are drilled in the ends of the bone for screw fixation and interlocking screws are placed through the bone into the nail to stabilize the femoral nails and the bone.
• X-ray is taken to confirm correct placement of the femoral nail and fracture reduction.
• The overlying soft tissue and skin around the incision area is closed with sutures and sterile bandages are applied.

Postoperative Care and Recovery

In general, postoperative care instructions and recovery after femoral nailing will involve the following:

• You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anesthetic reactions and monitor your vital signs as you recover.
• You may need to stay in the hospital for 2 to 3 days before discharge to home.
• You may notice some pain, swelling, and discomfort in the femoral area. Pain and anti-inflammatory medications are provided as needed.
• You will be placed on assistive devices such as crutches with instructions on restricted weight-bearing for a specified period of time. You are encouraged to walk with assistance as frequently as possible to prevent blood clots.
• Keep the surgical site clean and dry. Instructions on surgical site care and bathing will be provided.
• Refrain from smoking and alcohol for a specified period of time as it can hinder the healing process.
• Eating a healthy diet rich in vitamin D is strongly advised to promote healing and a faster recovery.
• Refrain from strenuous activities for the first few months and lifting heavy weights for at least 6 months. Gradual increase in activities over a period of time is recommended.
• An individualized physical therapy protocol will be designed to help strengthen thigh muscles and optimize thigh function.
• You will be able to resume your normal activities in 3 to 4 weeks after surgery; however, return to sports may take at least 6 months or longer.
• Refrain from driving until you are fully fit and receive your doctor’s consent.
• A periodic follow-up appointment will be scheduled to monitor your progress.

Risks and Complications

Femoral nailing is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:  

• Infection
• Bleeding
• Blood clots
• Implant malposition
• Hardware failure
• Fracture malunion
• Fracture non-union
• Leg length discrepancy
• Soft tissue irritation
• Periprosthetic fracture