Current intramedullary nail insertion and removal practice in the UK

Locked intramedullary (IM) nailing is accepted as the standard method of stabilising closed diaphyseal long-bone fractures in the lower limb. The treatment of open long-bone fractures and the role of medullary canal reaming during intramedullary (IM) nail insertion for closed long-bone fractures are contentious issues. Concerns remain regarding the length of operations, pulmonary effects and rates of re-operation, non-union and infection. The decision to remove IM nails following uncomplicated fracture healing remains a matter of personal choice based upon a variety of reasons and potential risks supporting either routine removal or retention. Postal questionnaires were sent to fellows of the British Orthopaedic Association (BOA) to establish current IM nail insertion and removal practice. Fellows were asked about their current involvement in the use of IM nails, nail of choice for closed long-bone fractures, whether they routinely reamed and fixation method of choice for open long-bone diaphyseal fractures. Additional questions established indications and contraindications for IM nail removal and listing practice as day case or overnight stay. This study revealed a variation in the treatment of both closed and open long-bone fractures and IM nail removal. This probably reflects the paucity of convincing large, randomised trials comparing different techniques of stabilisation and the lack of any large long-term follow-up studies or nationally approved guidelines for nail removal.