Complications of Intramedullary Nail Placement

Prevention and Management Strategies

• The American Academy of Orthopaedic Surgeons recommends thorough assessment of fracture pattern and location to determine optimal nail length and diameter, as well as evaluation for associated injuries, especially in high-energy trauma 1
• The American Academy of Orthopaedic Surgeons suggests consideration of temporary external fixation followed by delayed definitive nailing in patients with severe associated injuries, circulatory shock, or respiratory failure 1

Intraoperative Techniques to Minimize Complications

• The American Academy of Orthopaedic Surgeons advises thorough assessment of the entire femur before nail placement to avoid missing proximal lesions that could lead to implant failure 2, 3

Special Considerations

• The American Academy of Orthopaedic Surgeons notes that metastatic lesions do not appear to have a high frequency of new femoral neck lesions after intramedullary nailing, and therefore, there is no advantage to routine use of cephalomedullary nails for diaphyseal metastatic lesions 2, 3, 4

Pitfalls to Avoid

• The American Academy of Orthopaedic Surgeons warns that failure to diagnose femoral neck lesions before implanting an intramedullary nail increases risks of implant failure and need for additional surgery 3, 4
• The American Academy of Orthopaedic Surgeons emphasizes the importance of adequate preoperative imaging to avoid missed pathology and suboptimal implant selection 2, 3