Femoral intramedullary nailing is an operation to stabilise a fracture of the thighbone (femur) by inserting a metal rod into the centre of the bone. It is the standard treatment for femoral shaft fractures.
An incision is made near the hip or the top of the thighbone. Under X-ray guidance, a long metal rod is inserted down the hollow canal of the femur, crossing the fracture. Locking screws are placed at each end to prevent rotation. The fracture site itself is usually not opened. The operation typically takes one to two hours.
Femoral shaft fractures in adults are almost always treated with intramedullary nailing. The femur is the strongest bone in the body and requires robust fixation to maintain alignment and allow healing. Nailing provides excellent stability and allows early mobilisation.
Non-operative treatment (traction) is rarely used in adults due to the prolonged immobilisation required and inferior outcomes. It may be considered in exceptional circumstances where surgery is not possible.
Femoral shaft fractures are typically treated as an urgent or emergency procedure within 24–48 hours. Blood loss from the fracture may require transfusion. Standard pre-assessment is performed.
High union rates exceeding 95%. Most patients can begin partial weight-bearing within days and progress to full weight-bearing over six to twelve weeks. The nail provides strong, reliable fixation.
Discomfort in the thigh, particularly at the proximal locking screw site, is common.
Femoral fractures and their fixation involve more blood loss than smaller bone fractures. Transfusion may be needed.
Significant thigh swelling is expected.
Failure to heal requiring further surgery. Approximately 5%.
Rotational malalignment can occur and may affect gait.
Release of fat particles into the bloodstream during nailing. Rare but potentially serious.
Deep infection requiring further surgery.
Pudendal nerve injury from the traction post during surgery, causing numbness in the genital area. Usually temporary.
DVT or pulmonary embolism.
General or spinal anaesthesia. The patient is positioned on a fracture table with traction applied to align the bone.
Weight-bearing depends on the fracture pattern — most patients begin partial weight-bearing within a few days. Crutches or a frame are used for four to eight weeks. Physiotherapy focuses on hip, knee, and thigh muscle rehabilitation. Return to desk work at four to six weeks, manual work at three to six months. Full recovery takes six to twelve months.
Regular X-rays at six weeks, three months, and six months. The nail is usually left in permanently.
Femoral shaft fractures cause significant blood loss and pain. Early fixation reduces complications and allows faster recovery.
Usually at eight to twelve weeks, once you can comfortably control the pedals and perform an emergency stop.
Not usually. Removal is only considered if the nail causes symptoms after the fracture has healed.