Do I Need to Reinsert Intramedullary Nails for Bone Healing?

Does bone grafting require re-insertion of intramedullary nails?

Hello, doctor.
I was in a car accident last October, resulting in fractures of my left thigh and hip bone.
I had an intramedullary nail placed in my thigh and screws fixed in my hip bone, as well as above my knee.
After eight months, the bone healing has not progressed well, and it has been assessed that I need a bone graft.
The screws in my hip have slightly shifted but are not causing any issues, while one of the screws above my knee is bent but has not broken yet.

1.
My doctor suggested that I return for a follow-up in three months to evaluate whether a bone graft is necessary.
The recovery period after surgery is at least three months, but my wife is due in January, and I hope to be able to support her during her postpartum period.
Should I wait three months, or would it be better to have the surgery next month?
2.
The surgeon mentioned that during the bone graft procedure, all screws would be removed, and the intramedullary nail would need to be reinserted.
Is it necessary to reinsert it? If it is not reinserted, would the recovery period be shortened? If I do have to reinsert the intramedullary nail, will I need another surgery later to remove it?

A De, 30~39 year old female. Ask Date: 2021/06/12

Dr. Chen Bochen reply Orthopedics

1.
My doctor advised me to return for a follow-up in three months to assess whether I need a bone graft.
The recovery period after surgery is at least three months, but my wife is due in January, and I hope to be able to support her during her postpartum period.
Should I wait three months, or would it be better to have the surgery next month? >>> Waiting for the appropriate time is necessary to determine if a bone graft is needed.
However, getting an X-ray earlier wouldn’t cause any significant harm.
2.
The surgeon mentioned that the bone screws would be removed at that time, and the intramedullary nail would need to be reinserted.
Is it necessary to reinsert it? If it’s not reinserted, will the recovery period be shortened? If the intramedullary nail is reinserted, will I need another surgery to remove it later? >>> The surgeon who performs your operation has a better understanding of your condition and can make more accurate judgments.
Generally, whether the intramedullary nail needs to be reinserted, whether additional plates are needed, or if growth factors should be supplemented, will be determined by the doctor based on X-rays and the nature of the injury.
>>> The intramedullary nail does not necessarily need to be removed.
>>> Avoid smoking, as it can hinder bone healing.
>>> Increase calcium intake and get sunlight to aid in bone growth.

Reply Date: 2021/06/12

More Info

When it comes to the healing of bone fractures, particularly after significant trauma such as a car accident, the process can be complex and varies from person to person. In your case, you have experienced a fracture in your left femur and hip, with intramedullary nails and screws placed for stabilization. After eight months, you are facing challenges with bone healing, and your orthopedic surgeon has suggested a follow-up in three months to evaluate the need for bone grafting.

1. Should You Wait Three Months or Consider Surgery Sooner?
Your concern about the timing of potential surgery is understandable, especially with your wife's upcoming due date. It is crucial to allow enough time for proper assessment of the healing process. Bone healing can be influenced by various factors, including the type of fracture, the stability of the fixation, and your overall health.
Waiting for three months may provide your surgeon with a clearer picture of whether the bone is healing adequately or if intervention is necessary. However, if you are experiencing significant pain, instability, or other concerning symptoms, it may be worth discussing the possibility of an earlier intervention with your surgeon.
You could also consider getting a follow-up X-ray sooner than the suggested three months to see if there are any changes in the healing process. This could help you and your doctor make a more informed decision about the timing of any potential surgery.

2. The Need for Reinsertion of Intramedullary Nails
Regarding the need to reinsert the intramedullary nails, this decision should be based on the evaluation of your current healing status. If the current nails are stable and not causing any issues, it may not be necessary to remove and reinsert them. However, if there is significant displacement or if the nails are not providing adequate support for healing, your surgeon may recommend removal and reinsertion.

Reinserting the intramedullary nail could potentially extend your recovery time, as each surgical procedure typically requires a period of rehabilitation. However, if the current fixation is inadequate, it may be necessary to ensure proper healing.

Additional Considerations
- Bone Grafting: If your surgeon determines that the bone is not healing properly, they may recommend a bone graft. This procedure involves taking bone from another part of your body or using synthetic materials to promote healing. The decision to use bone grafting will depend on the extent of the non-union and the overall health of the surrounding bone.

- Smoking and Nutrition: It’s essential to avoid smoking, as it can significantly impede bone healing. Additionally, ensure you are getting adequate nutrition, particularly calcium and vitamin D, which are crucial for bone health. Sun exposure can also help with vitamin D synthesis.

- Post-Surgical Recovery: If surgery is performed, the recovery period will depend on the specific procedures undertaken. Generally, after surgery, you may need to follow a rehabilitation program to regain strength and mobility.

- Future Surgeries: If the intramedullary nails are removed, there may be a need for future surgeries, depending on how your bones heal and if any complications arise. Discussing this with your surgeon can provide clarity on what to expect.

In conclusion, while the decision to wait or proceed with surgery is ultimately yours, it is essential to have open communication with your orthopedic surgeon. They can provide personalized advice based on your specific situation, ensuring that you make the best decision for your health and your family’s needs.

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