Intramedullary nails: should it be removed after fracture healing?
Keywords:Tibial nails, Fracture, Implant, Removal, Refracture
Background:Intramedullary Nailing of long bone fracture is a common surgery done in orthopaedics. It offers early weight bearing and less chances of malunion than cast and other conservative treatment. Removal of intramedullary nail after the bone has united is a matter of debate, we reviewed 48 cases in terms of improve in symptoms ,functional status and complications associated with hardware removal.
Methods: Retrospective study was conducted in tertiary care centre.48 patients were enrolled in the study who were admitted for Tibia nail removal or exchange nailing. The mean age was 37.9 years ranging from 20-69 years. There were 28 males and 20 females in our study. On follow up visits x-rays were taken at 3 weeks and patients were assessed for improvement in symptoms, pain status, functional outcome and complications of nail removal.
Results:Out of 48 patients operated, 43 (89.58%) tibial intramedullary nail were removed over a period of 5 years. Out of 23 patient insisting nail removals due to anterior knee pain only 21 nails were removed and 19 patients who requested nail removal only 16 nails could be removed. Complications were seen in 13% of nail removals. Overall, 72.09% (31/43) of patients were satisfied with their IMN removal. The mean VAS score was 2 after nail removal.
Conclusions:We conclude that removal of tibia nail should be done if patient complaints of pain. Radiographs must be assessed for fracture union and patient must be warned about the complications associated with the hardware removal.