Intramedullary Nail Dynamisation

⚙️What This Procedure Involves

Under X-ray guidance, the locking screw(s) at one end of the intramedullary nail are identified through a small skin incision. The screws are removed with a screwdriver, converting the nail from a 'statically locked' configuration (no motion at the fracture) to a 'dynamically locked' configuration (allowing axial compression). This permits the fracture ends to compress together with weight-bearing, stimulating healing. The procedure takes 15–30 minutes under local or general anaesthesia.

💡Why It May Be Recommended

Dynamisation is considered for fractures that are showing delayed union — typically at three to six months post-nailing, when callus formation is inadequate on X-ray. By allowing axial compression, it increases the mechanical stimulus for healing.

⚖️Non-Operative Alternatives

Continued observation and weight-bearing (some fractures will eventually heal without intervention), bone stimulator (electromagnetic or ultrasound), and exchange nailing (replacing the nail with a larger one) for more established non-unions.

📋Preparing for Surgery

X-rays confirming delayed union with gap at the fracture site. Review of the original nail configuration. Day-case or outpatient procedure.

✅Expected Benefits

Healing following dynamisation in approximately 50–70% of cases with delayed union. It is a simple, low-risk intervention that avoids the morbidity of exchange nailing.

⚠️Common Risks

• ShorteningCommon

  Removal of locking screws allows the fracture to shorten by a few millimetres. Usually clinically insignificant.

• No benefitCommon

  Dynamisation may not stimulate healing if the fracture biology is the primary problem.

🔴Less Common but Serious Risks

• Excessive shorteningUncommon

  If significant fracture comminution is present, shortening may be more than expected.

• Rotational malunionUncommon

  Loss of rotational control.

• Nail migrationRare

  The nail may back out without distal locking.

• Need for exchange nailingCommon

  If dynamisation fails, exchange nailing is the next step.

💉Anaesthetic Considerations

Local anaesthesia with sedation, or brief general anaesthesia.

🏃Recovery and Rehabilitation

Immediate full weight-bearing to maximise axial compression. Follow-up X-rays at six weeks and three months to assess healing response.

📅Follow-Up

X-rays at six weeks and three months post-dynamisation.

❓Frequently Asked Questions