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Femoral nailing is a surgical technique used to treat a fractured or broken femur, or thighbone. The procedure involves inserting a metal rod called an intramedullary nail, or femoral nail, into the femur and positioning it so that it runs vertically along the length of the shaft. As the nail passes through the middle of the bone, it serves to hold the two broken sections together; screws may be placed at the top and bottom to fix it in position, preventing the bone from rotating around the rod. Compared with splints or casts, this method has the advantage that the femoral fracture is quickly made stable and patients become mobile sooner, avoiding the complications of long-term inactivity, such as blood clots in the legs.
There are two main types of femoral nailing procedure, described as antegrade and retrograde. The antegrade approach involves inserting the femoral nail from the top, or hip end of the femur while, in the retrograde approach, the nail goes in from the knee end. Antegrade femoral nailing is the method most commonly used to treat femoral shaft fractures, while the retrograde approach may sometimes be used for more complex fractures, in the obese, or in people who have multiple injuries.
The type of femoral fracture fixation surgery used in most instances is known as reamed femoral nailing. This involves introducing a guide wire along the shaft of the femur, across the fracture site and checking its position using X-rays. Next, a cutting instrument known as a reamer is used to hollow out a passage for the nail. Finally, the femoral nail is inserted into the bone and fixed into place.
Reaming carries a small risk of sending small pieces of fat into circulation, which could occasionally have fatal consequences due to blockage of blood vessels and injury to tissues. For this reason, some surgeons have preferred to use an unreamed femoral nailing technique. In spite of this, reamed femoral nailing is generally considered to have more advantages, as the unreamed method is associated with more cases of delayed bone healing and bones failing to heal.
Following femoral nailing surgery, patients normally stay in bed for only one or two days. Then, under supervision, a walking frame may be used for support until the person feels able to move around on crutches. A physiotherapist will recommend exercises which should be carried out to help the recovery process. As soon as people are able to move around independently and safely, it should be possible for them to return home, while a full recovery may take up to 12 weeks.