Intramedullary Nail Removal After Femoral Fracture

Q: Intramedullary Nail Removal After Femoral Fracture

Hello, here are the responses to your questions： 1. Although the bone has healed, it is still recommended to wait a year and a half before removing the screws. 2. There should be no major issues. 3. Generally, crutches can be discontinued after suture removal;

Issues related to the removal of intramedullary nails for femoral fractures?

Hello, Doctor.
A year ago today, I was involved in a car accident that resulted in a closed fracture of the femoral shaft.
I have been continuously monitored over the past year, and the bone has healed.
Today, during my follow-up appointment, I asked the doctor whether I could have the steel nail removed, as I experience a rubbing sound in my hip when walking and moving, and it feels sore when I roll over.
The doctor allowed me to decide whether to proceed with the removal.
I would like to ask:
1.
I have read that the removal of intramedullary nails for femoral fractures should be done at least 1.5 to 2 years post-surgery.
Since I have just completed one year, would it be too soon for me to have the nail removed?
2.
I underwent two arthroscopic knee surgeries last month, one for adhesions and the other for debridement due to a bacterial infection.
Given the close timing of these surgeries, are there any concerns about undergoing another surgery for nail removal?
3.
After the removal of the steel nail, how long will I need to use crutches? Will I be able to play badminton a month later?
4.
Can I take the removed steel nail home as a keepsake?
Thank you, Doctor, for your answers!

Niming, 20~29 year old female. Ask Date: 2018/07/26

Dr. Li Yongheng reply Orthopedics

Hello, here are the responses to your questions: 1.
Although the bone has healed, it is still recommended to wait a year and a half before removing the screws.
2.
There should be no major issues.
3.
Generally, crutches can be discontinued after suture removal; however, there may still be some pain after a month, so playing badminton is not advisable.
4.
The removed screws should not be taken home.
Thank you for your inquiry.

Reply Date: 2018/07/26

More Info

When considering the removal of an intramedullary nail after a femoral fracture, there are several important factors to take into account. Based on your situation, here are detailed answers to your questions:
1. Timing for Nail Removal: Generally, the recommendation for intramedullary nail removal is around 12 to 24 months post-surgery, depending on the individual’s healing process and the presence of any complications. Since you mentioned that your fracture has healed and you are experiencing discomfort, it may be reasonable to consider removal after just one year. However, the decision should be made in consultation with your orthopedic surgeon, who can assess the healing of the bone and any potential risks associated with early removal.

2. Previous Surgeries: You mentioned undergoing two arthroscopic knee surgeries in the past month. Having multiple surgeries in close succession can increase the risk of complications such as infection or delayed healing. It’s essential to discuss with your surgeon how these previous procedures may affect your recovery and the timing of the nail removal. They will evaluate your overall health, the condition of your knee, and any signs of infection or complications before proceeding.

3. Use of Crutches Post-Removal: After the removal of the intramedullary nail, the need for crutches will depend on your pain levels, stability, and the surgeon’s recommendations. Typically, patients may require crutches for a few days to a few weeks post-surgery, depending on how well they can bear weight on the leg. Engaging in activities like playing badminton may be possible within a month, but this is contingent on your recovery progress and the advice of your healthcare provider. It’s crucial to follow a rehabilitation program to strengthen the muscles around the knee and hip to support your return to sports.

4. Keeping the Removed Nail: Many patients ask if they can keep the removed intramedullary nail as a keepsake. This is usually permissible, but it’s best to confirm with your surgeon or the surgical team. They may have specific protocols regarding the disposal or return of surgical hardware.

In addition to these answers, it’s important to consider the following:
- Post-Operative Care: After the removal of the nail, you may experience swelling, bruising, or discomfort. Following your surgeon’s post-operative care instructions is crucial for a smooth recovery. This may include rest, ice application, and gradual weight-bearing exercises.

- Physical Therapy: Engaging in physical therapy post-removal can significantly aid in regaining strength and mobility. A physical therapist can provide tailored exercises to help you recover effectively and return to your desired activities safely.

- Monitoring for Complications: After surgery, be vigilant for signs of complications such as increased pain, swelling, or signs of infection (redness, warmth, fever). If you experience any concerning symptoms, contact your healthcare provider promptly.

In conclusion, while it may be possible to remove the intramedullary nail after one year, the decision should be made with careful consideration of your overall health, previous surgeries, and the advice of your orthopedic surgeon. Following the removal, adhere to post-operative care and rehabilitation to ensure a successful recovery and return to your normal activities.

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