Inter Muscular Nailing Removal
Discussion
Has anyone had a IM nailing then had it removed? I had one from knee to ankle put in last July had an X ray yesterday and the surgeon now wants to remove it in six months time. I asked if I would be able to walk straight away he said yes just be sore for a good few weeks. Has anyone had this done? Could you walk straight away? I can post a picture of the x ray if you don't understand what needs removing.
Edited by myvision on Thursday 25th April 09:55
Slink said:
wouldnt mind the xray 
but if your having an op on your leg, you might be able to walk, but it would be pretty damn sore if your walking on it the same day as the op
Here's the x ray i can't see how I could be walking on it the same day after having it removed.but if your having an op on your leg, you might be able to walk, but it would be pretty damn sore if your walking on it the same day as the op
Surely pulling that out must cause damage but the surgeon reckons not much!!!
myvision said:
Has anyone had a IM nailing then had it removed? I had one from knee to ankle put in last July had an X ray yesterday and the surgeon now wants to remove it in six months time. I asked if I would be able to walk straight away he said yes just be sore for a good few weeks. Has anyone had this done? Could you walk straight away? I can post a picture of the x ray if you don't understand what needs removing.
So, removing the nail is done for various reasons: irritation of overlying structures, infection, bone not healing, high chance of refracture (you are Evil Knievel). I don't know why you are having it out.Edited by myvision on Thursday 25th April 09:55
Taking it out usually takes about 30 mins, leaving holes where the locking (side-to-side) bolts are. The middle of the bone is non structural anyhow.
I would let people walk on it if the fracture had healed. I don't let them do any sports or heavy impacts for 6 weeks minimum, if the fracture has healed. I would recommend 10 days off work for everyone, just pottering around the house. This is for uncomplicated nail removal in a healed fracture.
See the pt at 6 weeks and maybe Xray, then move on with mobility.
Can't comment on you, but here's some guides. Complications of surgery are not discussed here.
The_Doc said:
So, removing the nail is done for various reasons: irritation of overlying structures, infection, bone not healing, high chance of refracture (you are Evil Knievel). I don't know why you are having it out.
Taking it out usually takes about 30 mins, leaving holes where the locking (side-to-side) bolts are. The middle of the bone is non structural anyhow.
I would let people walk on it if the fracture had healed. I don't let them do any sports or heavy impacts for 6 weeks minimum, if the fracture has healed. I would recommend 10 days off work for everyone, just pottering around the house. This is for uncomplicated nail removal in a healed fracture.
See the pt at 6 weeks and maybe Xray, then move on with mobility.
Can't comment on you, but here's some guides. Complications of surgery are not discussed here.
Thanks the surgeon said he would look like to remove it incase I did it again I bloody hope not. So basically a couple of weeks off then I can cope with that I was expecting alot worse.Taking it out usually takes about 30 mins, leaving holes where the locking (side-to-side) bolts are. The middle of the bone is non structural anyhow.
I would let people walk on it if the fracture had healed. I don't let them do any sports or heavy impacts for 6 weeks minimum, if the fracture has healed. I would recommend 10 days off work for everyone, just pottering around the house. This is for uncomplicated nail removal in a healed fracture.
See the pt at 6 weeks and maybe Xray, then move on with mobility.
Can't comment on you, but here's some guides. Complications of surgery are not discussed here.
As the Doc says, the intramedullary unit is in the marrow of the bone, which is not solid. So no major dramas to remove.
My team-mate had one similar in his femur, and once healed, it was removed because he still intended to go racing. Hence, a further trauma to the limb with a pin still inside could result in an injury that would be far worse. An impact that stresses the internal fixation may result in the bone shattering magnificently.
He told me that the procedure to remove was not difficult or hugely uncomfortable for him, and he was relatively pain-free and walking reasonably well within the week.
He was back racing around 6 weeks later, and as far as I know has had no further complications or long-term issues.
HTH
My team-mate had one similar in his femur, and once healed, it was removed because he still intended to go racing. Hence, a further trauma to the limb with a pin still inside could result in an injury that would be far worse. An impact that stresses the internal fixation may result in the bone shattering magnificently.
He told me that the procedure to remove was not difficult or hugely uncomfortable for him, and he was relatively pain-free and walking reasonably well within the week.
He was back racing around 6 weeks later, and as far as I know has had no further complications or long-term issues.
HTH
Ray Luxury-Yacht said:
My team-mate had one similar in his femur, and once healed, it was removed because he still intended to go racing. Hence, a further trauma to the limb with a pin still inside could result in an injury that would be far worse. An impact that stresses the internal fixation may result in the bone shattering magnificently.
And there you are. Never a truer word said, thanks Ray L-Y.From your profile, Ray: Previously Owned: Kawasaki KX250, Suzuki GT250, Yamaha TZR125, Suzuki GSX400F, Kawasaki GPZ900R, Suzuki GSXR1000 K4, Yamaha R1, Yamaha YZF 1000 750 with 1000 pistons etc, Yamaha YZF 750
This is the sort of person I would remove the nail from
As far as I'm aware, a Zickel Nail is for proximal femoral trauma - i.e. the bit with the ball on top wot goes into your pelvis...hence wouldn't interfere with a knee replacement?
Although I'm not sure how far down the bone it goes, so could be wrong. Hopefully the Doc will be along shortly...
Although I'm not sure how far down the bone it goes, so could be wrong. Hopefully the Doc will be along shortly...
Oh yeah, I see...ouch! 
Well then yes, if you have metal in the condyles, then obviously it would be right in the way of some arthroplasty prostheses, depending upon what is being replaced. There are different types of replacement knee joints, some complete, some in part.
I'm at the limit of my medical knowledge now to be honest, hence I've no idea if they would want to remove the intramedullary fixations before an arthroplasty, or do it all at the same time.
Any operation carries risk, hence two separate procedures carries double the risk kinda thing...however, I don't know how they'll make the call between the safest way - two procedures, or one big one, that carries more risk of complications during surgery.
Looking at your X ray, your internal fixations are way more complicated than the simple nail the OP is discussing. So just to remove your metalwork looks a reasonably complex procedure.
From what I've seen so far (and I am just a medical student with a little knowledge, and hence absolutely lethally dangerous ) my money is on two separate procedures.
HTH
Well then yes, if you have metal in the condyles, then obviously it would be right in the way of some arthroplasty prostheses, depending upon what is being replaced. There are different types of replacement knee joints, some complete, some in part.
I'm at the limit of my medical knowledge now to be honest, hence I've no idea if they would want to remove the intramedullary fixations before an arthroplasty, or do it all at the same time.
Any operation carries risk, hence two separate procedures carries double the risk kinda thing...however, I don't know how they'll make the call between the safest way - two procedures, or one big one, that carries more risk of complications during surgery.
Looking at your X ray, your internal fixations are way more complicated than the simple nail the OP is discussing. So just to remove your metalwork looks a reasonably complex procedure.
From what I've seen so far (and I am just a medical student with a little knowledge, and hence absolutely lethally dangerous
) my money is on two separate procedures.HTH
One of 'em has been out for years as it was giving me jip, the one on the outside is still there along with a screw that is in the wear surface so is probably best left alone I'm told.There's a big fused mess in there apparently, I suspect replacement for me will be quite complex anyway.
Seems to work well enough still though, I can cycle up to about sixty miles when I'm fully fit so can't complain really
Crikey - well quit your whining then b
h - I have no damage or metalwork in either of my legs, but could not cycle 60 miles anytime soon these days
In all seriousness though - I do carry a knee injury that was caused by a twisting trauma about 20 years ago. It tore my medial and anterior cruciate ligaments badly. I got the joint reasonably stable after some physio and gym work, and back then I was very fit and active, and I ended up regularly running on the joint, to marathon distances with no problems.
Until 2007, when pain and joint locking reared it's ugly head. Long story short, but I had an arthroscopy procedure which sorted it out for about 2 years, until it went south again, so I had a second procedure.
After that, the joint is once again stable and relatively pain-free...but the lateral movement inherent in the joint coupled with millions of miles of running meant that my articular cartilage (the hard surface on the condyles) had worn badly, and is now so thin, that the consultant told me, post-op, to never run again, unless I wanted to be back for a knee replacement within 5 years (I was 37 at the time
)
So I went home, sulked, and stopped running. Now I'm monstrously fat and completely unfit...but anyway, I at least understand your discussion of knee replacements!
Heheh - well as said, obviously Internet medics like me are not to be trusted, so clearly a visit to a Consultant will yield the answers and advice you need. Do you mind me asking what happened to cause your huge femoral trauma? And why you are thinking that you might need a knee replacement soon?
h - I have no damage or metalwork in either of my legs, but could not cycle 60 miles anytime soon these days In all seriousness though - I do carry a knee injury that was caused by a twisting trauma about 20 years ago. It tore my medial and anterior cruciate ligaments badly. I got the joint reasonably stable after some physio and gym work, and back then I was very fit and active, and I ended up regularly running on the joint, to marathon distances with no problems.
Until 2007, when pain and joint locking reared it's ugly head. Long story short, but I had an arthroscopy procedure which sorted it out for about 2 years, until it went south again, so I had a second procedure.
After that, the joint is once again stable and relatively pain-free...but the lateral movement inherent in the joint coupled with millions of miles of running meant that my articular cartilage (the hard surface on the condyles) had worn badly, and is now so thin, that the consultant told me, post-op, to never run again, unless I wanted to be back for a knee replacement within 5 years (I was 37 at the time
)So I went home, sulked, and stopped running. Now I'm monstrously fat and completely unfit...but anyway, I at least understand your discussion of knee replacements!
Heheh - well as said, obviously Internet medics like me are not to be trusted, so clearly a visit to a Consultant will yield the answers and advice you need. Do you mind me asking what happened to cause your huge femoral trauma? And why you are thinking that you might need a knee replacement soon?
Motorbike crash, knee first into a car, the femur did a Humpty Dumpty 4" up my femur. Split patella, part of my quad gone, couple of ligaments replaced with something else I believe and cartilage gone. There's still 2" of shortening...
It's unstable, clunks and creaks like a good un and just feels a bit more worn. I've not run since the accident but I swim and cycle these days to keep it moving. I was told at the time it would need fusing in five to ten years but it refuses to give up, probably because I try and keep what muscle is left in good condition.
My healing rate is crap compared to when I was nineteen, I was just wondering if there was any benefit in getting it removed so I can have a decade or so of bone growth to give any replacement surgery a better chance of success.
ETA although the xray is crap you can probably make out some missing bone, that's well over a year after the accident...
It's unstable, clunks and creaks like a good un and just feels a bit more worn. I've not run since the accident but I swim and cycle these days to keep it moving. I was told at the time it would need fusing in five to ten years but it refuses to give up, probably because I try and keep what muscle is left in good condition.
My healing rate is crap compared to when I was nineteen, I was just wondering if there was any benefit in getting it removed so I can have a decade or so of bone growth to give any replacement surgery a better chance of success.
ETA although the xray is crap you can probably make out some missing bone, that's well over a year after the accident...
Blimey - and 'ouch' again
I served an apprenticeship of around 15 years riding on the road (like a mentalist), followed by 5 years of racing - and although I've copped a few injuries (like the one I mentioned) I think I count my lucky stars that, somehow, I got away without suffering a major trauma like yours. I was just lucky.
All my injuries have been tissue and ligament mainly - and apart from my dodgy knee, the rest of the big ones (spinal vertebrae, facet joints, ligaments to both ankles, muscle tears, and a grade 3 acromio-clavicular separation) don't give me any real gyp day-to-day.
Bikes eh? They're silly and dangerous!
You seem to have the right idea though - exercise, movement and usage are the name of the game. Every time I was discharged from hospital, with the advice 'rest and elevate the joint for weeks on end'...what I actually did was rest the joint for a period involving days, not weeks, until it felt bearably less painful, and then headed straight to the gym, to work it gently and sensibly back into use. For example, with the shoulder separation, the hospital told me to rest it for 6 weeks. But within 7 days, I was moving it in the gym on the bench, using just the bar by itself without any weights on it.
6 weeks rest? I was actually back racing in week 4! But then again, I was fit and only 30, which helps.
Anyway, yeah, as you say - it's good that you're thinking about your limb, and it's future. As I said, get yourself to your GP, talk to him/her about your thoughts and concerns, and don't be afraid to be pushy - after all, it's your body that you have to live with - and if you think medical intervention will be beneficial, then don't be palmed off.
It seems like you know what you're doing
With my previous injuries, and my medical training so far - I can honestly say that no-one knows their own body like the patient does - and often, as long as the patient is reasonably intelligent and well-informed, then they probably know what's best for themselves.
Keep me informed, ok? It's interesting!
I served an apprenticeship of around 15 years riding on the road (like a mentalist), followed by 5 years of racing - and although I've copped a few injuries (like the one I mentioned) I think I count my lucky stars that, somehow, I got away without suffering a major trauma like yours. I was just lucky.
All my injuries have been tissue and ligament mainly - and apart from my dodgy knee, the rest of the big ones (spinal vertebrae, facet joints, ligaments to both ankles, muscle tears, and a grade 3 acromio-clavicular separation) don't give me any real gyp day-to-day.
Bikes eh? They're silly and dangerous!
You seem to have the right idea though - exercise, movement and usage are the name of the game. Every time I was discharged from hospital, with the advice 'rest and elevate the joint for weeks on end'...what I actually did was rest the joint for a period involving days, not weeks, until it felt bearably less painful, and then headed straight to the gym, to work it gently and sensibly back into use. For example, with the shoulder separation, the hospital told me to rest it for 6 weeks. But within 7 days, I was moving it in the gym on the bench, using just the bar by itself without any weights on it.
6 weeks rest? I was actually back racing in week 4!
But then again, I was fit and only 30, which helps.Anyway, yeah, as you say - it's good that you're thinking about your limb, and it's future. As I said, get yourself to your GP, talk to him/her about your thoughts and concerns, and don't be afraid to be pushy - after all, it's your body that you have to live with - and if you think medical intervention will be beneficial, then don't be palmed off.
It seems like you know what you're doing
With my previous injuries, and my medical training so far - I can honestly say that no-one knows their own body like the patient does - and often, as long as the patient is reasonably intelligent and well-informed, then they probably know what's best for themselves.
Keep me informed, ok? It's interesting!
Lol - well I have, kinda.
When I was racing, I did running to keep my stamina up and my weight down, and mountain biking to exercise the musculature used for racing fitness.
Hence, there were many, many weekends spent in the saddle cycling - which was fun and beneficial at first...but actually after a while became a little tedious and boring. Once you've cycled the numerous local routes on numerous occasions, I dunno, to me...it became a little dull. Even chucking the bike in the boot of the car and going somewhere new kinda lost it's appeal after a while.
A couple of years ago, to try and re-ignite the passion, I bought a lovely new road bike. In the first couple of months, it was great fun (despite millions of car drivers doing their best to kill me) and I couldn't believe how fast a dedicated road bike was on tarmac, compared to my heavy, lumpy ATB.
But that excitement soon waned - especially because ALL the scenery I passed riding on any local-ish road, was scenery I have seen many times before from inside my cars or on my motorbikes. So, despite trying to do something different like attain fitness on a road bike, and all the Olympics and Bradley Wiggins factor and all that - it still just felt like I was tediously touring round a load of local roads that are not exciting and I know well. That's the trouble with having lived in the same place for the last 30 years I guess...
When I was racing and mountain-biking for fitness, as a young, fearless fit kid - the interest cycling off-road mostly came from the mental, fast, downhill bits - with the bike trying to spit me off over lumps, bumps and tree-roots, and getting air off any crests and humps.
Trouble is, these days, now I'm a battered 40 year-old, with injuries and a mid-life crisis, I just feel vulnerable, danger-avoiding and hugely aware of my own mortality and injury averse...which I had no idea of 10 years ago, Hence, even on a previously exciting downhill section, all I do these days is keep the brakes on and go down in a thoroughly pedestrian and safe fashion, terrified of hurting myself
Life is basically NO FUN once you get old and wise...
When I was racing, I did running to keep my stamina up and my weight down, and mountain biking to exercise the musculature used for racing fitness.
Hence, there were many, many weekends spent in the saddle cycling - which was fun and beneficial at first...but actually after a while became a little tedious and boring. Once you've cycled the numerous local routes on numerous occasions, I dunno, to me...it became a little dull. Even chucking the bike in the boot of the car and going somewhere new kinda lost it's appeal after a while.
A couple of years ago, to try and re-ignite the passion, I bought a lovely new road bike. In the first couple of months, it was great fun (despite millions of car drivers doing their best to kill me) and I couldn't believe how fast a dedicated road bike was on tarmac, compared to my heavy, lumpy ATB.
But that excitement soon waned - especially because ALL the scenery I passed riding on any local-ish road, was scenery I have seen many times before from inside my cars or on my motorbikes. So, despite trying to do something different like attain fitness on a road bike, and all the Olympics and Bradley Wiggins factor and all that - it still just felt like I was tediously touring round a load of local roads that are not exciting and I know well. That's the trouble with having lived in the same place for the last 30 years I guess...
When I was racing and mountain-biking for fitness, as a young, fearless fit kid - the interest cycling off-road mostly came from the mental, fast, downhill bits - with the bike trying to spit me off over lumps, bumps and tree-roots, and getting air off any crests and humps.
Trouble is, these days, now I'm a battered 40 year-old, with injuries and a mid-life crisis, I just feel vulnerable, danger-avoiding and hugely aware of my own mortality and injury averse...which I had no idea of 10 years ago, Hence, even on a previously exciting downhill section, all I do these days is keep the brakes on and go down in a thoroughly pedestrian and safe fashion, terrified of hurting myself
Life is basically NO FUN once you get old and wise...
Gassing Station | Health Matters | Top of Page | What's New | My Stuff