Understanding Your Intramedullary Nail

At Home, Where Do I Go from Here?

Prior to being discharged, be sure to ask for an at-home recovery plan. Should you have questions later, contact your surgeon directly. The information that follows can help you make a smooth transition home while your fracture heals.

How do I care for the healing incision sites?
You may find it helpful to enlist the support of a friend or family member while you adjust to caring for yourself at home. You will need clean gauze pads or a clean cloth, plain soap, clean water, clean towels and a shower or hand sprayer to clean and protect your incision sites while they heal. Most patients prefer using the shower in the bathroom, but you will use a location where you feel the most secure and have access to a faucet sprayer or spray bottle.

This is what your doctor will typically advise:

1. Spread all of your supplies on a clean towel for easy access.
2. Either sit on a stool in the shower or use the spray faucet or spray bottle in the sink.
3. Wash your hands.
4. Remove the bandages from the incision sites.
5. Gently wipe away any dried blood with a saline-moistened gauze pad.
6. Inspect the sites for signs of infection such as redness, excessive or prolonged drainage, or pus. It’s normal to see some clear and/or blood-tinged drainage in the first few days after surgery while the incision is closing.
7. Place a fresh, dry dressing on the site and secure it.
8. Once the incision has closed and all drainage stops, the bandages do not have to be replaced and the incision site can remain open to the air.
9. Wet the incision sites with clean lukewarm water.
10. Clean the sites with soap and water using a gauze pad or clean cloth.
11. Remove any “crusty” material from the wound.
12. Wash everything again.
13. Dry the skin with a clean towel or gauze.
14. Let any remaining secretions dry.
15. If the site is still draining, place a clean, dry gauze pad over the site and secure it.

What precautions should I take?
Although your bone is not fully healed and you should keep your surgeon’s precautions in mind — like avoiding activities that could cause a fall — your doctor will likely advise you to engage in as much normal movement as possible. Your physician will advise you based on your injury and recovery. Remember the instructions from your orthopaedic surgeon with regard to mobilization, weightbearing and physical therapy.

Further Precautions Your Surgeon Will Likely Give:

• Be careful with stairs, rugs and loose shoelaces.
• Avoid contact with animals.
• Avoid contact with dust and dirt.
• Avoid unnecessary handling of your incision sites.

What if I suspect a skin infection?
Even if you follow all the precautions, the skin around the incision sites may become infected. Symptoms of infection include local reddening and/or swelling of the skin, pain and fever. If these symptoms progress, contact your physician. You may require oral antibiotics to control the infection.

Will your nail be removed?
In general, after a year the soft tissues improve and the fracture heals enough that your orthopaedic surgeon may remove the intramedullary nail.When your doctor decides the time is right, the nail may be removed in either an outpatient or day surgery center. Following removal of your intramedullary nail, you’ll need to care for the incision sites
just as you did when the nail was implanted.

For more information, contact your physician.

Reference:

1. Thomas Mueckley, Oliver Gonschorek, and Volker Buehren, “Compression Nailing of Long Bones,” European Journal of Trauma, 2003;
29:113-28.