Tibial Nails

What are Tibial Nails?

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

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

Indications for Tibial Nails

Your surgeon may recommend tibial nails for various types of tibial fractures such as:

Distal, proximal, and metaphyseal shaft fractures
Comminuted fractures
Segmental fractures
Fractures with bone loss
Periprosthetic fractures
Pathological fractures
Intraarticular fractures
Simple and compound shaft fractures

Preparation for Tibial Nailing

In general, preoperative preparation for tibial 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.
X-rays of the injured tibia are taken and evaluated for canal size, length, and implant suitability. X-rays of the uninjured tibia may also be taken for preoperative evaluation of the characteristics of the pre-injured tibia.
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 Tibial Nailing

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

You will lie on your back on the operating table under general or spinal anesthesia.
The injured leg is flexed at a 90-degree position and a C-arm image intensifier is positioned appropriately around the tibia for visualization and capturing of intraoperative images of the tibia in various angles.
It is crucial to achieve anatomic reduction of the fracture prior to tibial nail insertion. Your surgeon will 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. This is called traction.
A 3 to 5 cm long, deep incision is made along the patella in line with the central axis of the intramedullary canal to expose the knee joint.
Suitable nails of specific diameter and length are chosen and inserted through the suprapatellar pouch and top of the tibia into the intramedullary canal or center of the fractured tibial bone.
Holes are drilled in the ends of the bone for screw fixation and interlocking screws are placed through the bone into the tibial nail to stabilize the bone and secure the implant.
X-ray is taken to confirm the correct placement of the implant and fracture reduction.
The overlying soft tissue and skin around the incision area are closed with sutures and sterile bandages are applied.

Postoperative Care and Recovery

In general, postoperative care instructions and recovery after tibial 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 lower limb 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 leg muscles and optimize leg 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

Tibial 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