link
Bookmarks
Intramedullary Rod/Nail
Cheryl A. Petersilge, MD, MBA
To access 4,300 diagnoses written by the world's leading experts in radiology, please log in or subscribe.Log inSubscribe
0
6
19
0

KEY FACTS

  • Terminology

    • Imaging

      • Clinical Issues

        TERMINOLOGY

        • Definitions

          • Orthopedic hardware is ever evolving field with constant introduction of new technology
            • Vendor-specific names are often erroneously used to describe hardware types
            • It is impossible to know all names and types
            • Best to understand concepts
          • Rods: Solid, usually rigid structures
          • Nails: Hollow rigid structures that can be locked
          • Antegrade placement: Placed from proximal end of bone to distal end of bone; most common direction of insertion
          • Retrograde placement
            • Placed in distal aspect of bone and directed proximally; for example, in femur placed through intercondylar notch and directed proximally
            • Indications for retrograde insertion in femur
              • Obese patients where entry point in proximal femur will be difficult to reach
              • Polytrauma patients to minimize surgical time
              • Distal femoral fractures to achieve better control/reduction
        • Concepts of Rod/Nail Placement and Use

          • Used to treat long bone fractures
          • Share load, allowing for early weight-bearing
            • Unlocked and dynamic locking allow micromotion, which stimulates healing
          • Insertion with minimal soft tissue dissection
            • Antegrade vs. retrograde determined by site of fracture, ease of access to desired entry site
          • Removed after healing achieved in children/young adults
          • Dynamic locking
            • Interlocking screw, locked at 1 end only
            • To dynamize means to remove 1 set of screws of static (proximal and distal) locked rod
              • Dynamizing allows compression across fracture
              • Used for transverse or shallow oblique fractures with minimal comminution
          • Static locking
            • Rod locked at proximal end and distal end
            • Provides axial and rotational stability
            • Allows immediate weight-bearing
            • Risk is overdistraction, which can lead to delayed healing
            • Used for unstable fractures
            • Prevents collapse at fracture, which could lead to leg-length discrepancy
          • Reaming: To remove intramedullary contents and widen canal by removing endosteal bone
            • Disrupts internal blood supply, ↑ infection risk
            • Reamed nails usually larger, provide greater stability
            • May increase risk of fat embolism
          • Flexible rods: Ender, Lottes, Rush
            • Less rigid, may require additional stabilization, such as splint/cast
            • Usually place multiple rods via multiple entry sites in metaphysis
            • Used in immature skeleton to avoid growth plate
          • Cephalomedullary nails a.k.a. reconstruction or recon nails or proximal femoral nails
            • Placed antegrade in femur for treatment of proximal fractures; has proximal hole to allow insertion of pin/screw into femoral neck
            • Used for fractures where dynamic hip screw instrumentation not sufficient
          • Gamma nails: Combination of intramedullary rod and sliding screw used for extracapsular proximal femoral fractures

        IMAGING

        • General Features

          • Radiographic Findings

            • CT Findings

              • MR Findings

                CLINICAL ISSUES

                • Presentation

                  Selected References

                  1. Georgiannos D et al: Subtrochanteric femoral fractures treated with the long Gamma3 nail: a historical control case study versus long trochanteric Gamma nail. Orthop Traumatol Surg Res. ePub, 2015
                  2. Queally JM et al: Intramedullary nails for extracapsular hip fractures in adults. Cochrane Database Syst Rev. 9:CD004961, 2014
                  3. Study to Prospectively Evaluate Reamed Intramedullary Nails in Patients with Tibial Fractures Investigators et al: Randomized trial of reamed and unreamed intramedullary nailing of tibial shaft fractures. J Bone Joint Surg Am. 90(12):2567-78, 2008
                  4. Gadegone WM et al: Proximal femoral nail - an analysis of 100 cases of proximal femoral fractures with an average follow up of 1 year. Int Orthop. 31(3):403-8, 2007
                  5. Wood GW 2nd: Intramedullary nailing of femoral and tibial shaft fractures. J Orthop Sci. 11(6):657-69, 2006
                  Related Anatomy
                  Loading...
                  Related Differential Diagnoses
                  Loading...
                  References
                  Tables

                  Tables

                  KEY FACTS

                  • Terminology

                    • Imaging

                      • Clinical Issues

                        TERMINOLOGY

                        • Definitions

                          • Orthopedic hardware is ever evolving field with constant introduction of new technology
                            • Vendor-specific names are often erroneously used to describe hardware types
                            • It is impossible to know all names and types
                            • Best to understand concepts
                          • Rods: Solid, usually rigid structures
                          • Nails: Hollow rigid structures that can be locked
                          • Antegrade placement: Placed from proximal end of bone to distal end of bone; most common direction of insertion
                          • Retrograde placement
                            • Placed in distal aspect of bone and directed proximally; for example, in femur placed through intercondylar notch and directed proximally
                            • Indications for retrograde insertion in femur
                              • Obese patients where entry point in proximal femur will be difficult to reach
                              • Polytrauma patients to minimize surgical time
                              • Distal femoral fractures to achieve better control/reduction
                        • Concepts of Rod/Nail Placement and Use

                          • Used to treat long bone fractures
                          • Share load, allowing for early weight-bearing
                            • Unlocked and dynamic locking allow micromotion, which stimulates healing
                          • Insertion with minimal soft tissue dissection
                            • Antegrade vs. retrograde determined by site of fracture, ease of access to desired entry site
                          • Removed after healing achieved in children/young adults
                          • Dynamic locking
                            • Interlocking screw, locked at 1 end only
                            • To dynamize means to remove 1 set of screws of static (proximal and distal) locked rod
                              • Dynamizing allows compression across fracture
                              • Used for transverse or shallow oblique fractures with minimal comminution
                          • Static locking
                            • Rod locked at proximal end and distal end
                            • Provides axial and rotational stability
                            • Allows immediate weight-bearing
                            • Risk is overdistraction, which can lead to delayed healing
                            • Used for unstable fractures
                            • Prevents collapse at fracture, which could lead to leg-length discrepancy
                          • Reaming: To remove intramedullary contents and widen canal by removing endosteal bone
                            • Disrupts internal blood supply, ↑ infection risk
                            • Reamed nails usually larger, provide greater stability
                            • May increase risk of fat embolism
                          • Flexible rods: Ender, Lottes, Rush
                            • Less rigid, may require additional stabilization, such as splint/cast
                            • Usually place multiple rods via multiple entry sites in metaphysis
                            • Used in immature skeleton to avoid growth plate
                          • Cephalomedullary nails a.k.a. reconstruction or recon nails or proximal femoral nails
                            • Placed antegrade in femur for treatment of proximal fractures; has proximal hole to allow insertion of pin/screw into femoral neck
                            • Used for fractures where dynamic hip screw instrumentation not sufficient
                          • Gamma nails: Combination of intramedullary rod and sliding screw used for extracapsular proximal femoral fractures

                        IMAGING

                        • General Features

                          • Radiographic Findings

                            • CT Findings

                              • MR Findings

                                CLINICAL ISSUES

                                • Presentation

                                  Selected References

                                  1. Georgiannos D et al: Subtrochanteric femoral fractures treated with the long Gamma3 nail: a historical control case study versus long trochanteric Gamma nail. Orthop Traumatol Surg Res. ePub, 2015
                                  2. Queally JM et al: Intramedullary nails for extracapsular hip fractures in adults. Cochrane Database Syst Rev. 9:CD004961, 2014
                                  3. Study to Prospectively Evaluate Reamed Intramedullary Nails in Patients with Tibial Fractures Investigators et al: Randomized trial of reamed and unreamed intramedullary nailing of tibial shaft fractures. J Bone Joint Surg Am. 90(12):2567-78, 2008
                                  4. Gadegone WM et al: Proximal femoral nail - an analysis of 100 cases of proximal femoral fractures with an average follow up of 1 year. Int Orthop. 31(3):403-8, 2007
                                  5. Wood GW 2nd: Intramedullary nailing of femoral and tibial shaft fractures. J Orthop Sci. 11(6):657-69, 2006