Physiotherapy Role in Intramedullary Nailing Surgery

Original Editors - Oluwafikunayomi Wole-Bankole, Okunoye Mercy Awelewa Oluwatayo, as part of the Redeemer's University Physioculture Journal Project

Top Contributors - Oluwafikunayomi Wole-Bankole and Tolulope Adeniji

INTRODUCTION

Intramedullary nailing is a world wide method for fracture stabilization for long bones it is a metal rod placed across the fracture and into the medullary cavity of a bone to give the fractured bone a strong support. The "gold standard" for treating femoral shaft fractures is intramedullary nailing. It is a prefered method for the fixing of femoral shaft fractures

The goals of intramedullary nailing are to maintain the anatomical integrity of fracture sites and to offer a suitable environment for fracture healing. In turn, this ought to enhance functionality and lessen long-term effects like arthritis pain. Additionally, nailing helps to preserve the blood flow during surgery, limiting injury to the soft tissues close to the bone and promoting fracture healing and satisfactory functional recovery. It is also used to align the fractured bones and provide optimal healing support; the orthopaedic surgeon makes a small incision through the skin and tissue closest to one end of the broken bones. The surgeon then inserts a small rod-like nail device into the hollow center of the bone, called the medullary cavity. The intramedullary nail forms a self-contained internal splint to stabilize the fracture. This is often done for fractures of the tibia, femur (thigh), and humerus (shoulder). There are several team that involves in intramedullary nailing surgery, pre and post-surgical. These team include surgical team, nurses and the physiotherapists. Post surgically, the pain management in terms of medication include using steroids, glucocorticoids and nerve blocking.

Pre-operatively, therapeutic nerve blocking is one procedure that occurs during the intramedullary nailing surgical procedure. The anaesthetic agent impact on the sensory and the motor system of the nerve supply of the extremity where the intramedullary nail occurs. Thus therapeutic nerve blocking and the intramedullary nailing surgery procedure leave patients with sensory and motor residual deficit/impairment. Therefore, physiotherapy intervention is essential to improve the symptoms such as the temporary loss in the sensory and motor functions.

Physiotherapy Role

Physiotherapists play an important role in the post-operative management for Intramedullary Nailing Surgery. Following an Intramedullary nailing, the aim of physiotherapy treatment is to improve function and prevent disability in patients who have undergone intramedullary nailing surgery. Physiotherapists also educate patients on proper postures and positions to attain in order to increase comfort and reduce to risk of development of bed sores or pressure ulcers. The summary of physiotherapy role the post-operative are:

1. Prevention of complications: The complications from intramedularry nailing includes pressure ulcers, compartment syndrome, disorders of the arterial and venous system such as thromboembolism, neurological deficits like muscle weakness and fat embolism.
2. Early mobilization post surgery reduces the risk of post surgical complications, brings about faster recovery and reverses the physiological effects of surgery on the body Examples of early mobilization exercises include passive and active range of motion active side-to-side turning, postural changes, passive movements and bed exercises.
3. Weight bearing Exercises: this should begin at the early stages of management.
4. Strengthening exercises to prevent hypotrophy of thigh muscles.
5. Pain Management: Patients who have the intramedullary nailing of the tibia usually have complaints about anterior nerve pain.
6. The use of Cryotherapy will be effective in the early stages of management.
7. Range of Motion exercises to prevent stiffness.
8. Transfer Training
9. Walking Re-education to avoid gait disturbances.

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