Tibial intramedullary nailing is an operation to stabilise a fracture of the shinbone (tibia) by inserting a metal rod down the centre of the bone. It is the standard treatment for most displaced tibial shaft fractures.
An incision is made just below the knee. Under X-ray guidance, a metal rod (nail) is inserted into the hollow centre of the tibia and passed across the fracture to hold the bone in alignment. The nail is secured at the top and bottom with locking screws. The fracture does not need to be opened directly. The operation typically takes one to two hours.
Intramedullary nailing is the standard treatment for displaced tibial shaft fractures. It provides strong fixation, allows early weight-bearing, and has high healing rates. It is also used for open fractures after initial wound management.
Some tibial fractures can be managed with a plaster cast or functional brace, but this requires prolonged immobilisation, close monitoring, and carries higher rates of malunion. Non-operative treatment may be appropriate for undisplaced or minimally displaced fractures.
Surgery may be performed urgently or within days of the injury. Standard pre-assessment and fasting are required.
The aim is to restore alignment, promote healing, and allow early mobilisation. Union rates with tibial nailing are approximately 95%. Most patients can begin weight-bearing within days of surgery, depending on the fracture pattern.
Pain at the front of the knee near the nail entry point is the most common long-term complaint, affecting 30–50% of patients.
Expected around the leg for several weeks.
Tibial fractures can be slow to heal, particularly in the lower third.
Failure to heal requiring further surgery such as bone grafting or exchange nailing. Approximately 5–10%.
Healing in a rotated or angulated position.
A serious emergency where pressure builds in the leg muscles. Requires urgent surgery.
Particularly with open fractures. Deep infection may require nail removal.
DVT or pulmonary embolism despite preventive measures.
General or spinal anaesthesia. The patient is positioned supine on a specialised fracture table.
Weight-bearing status depends on the fracture pattern — many patients can weight-bear immediately. Physiotherapy focuses on knee movement, ankle exercises, and progressive loading. Return to desk work at two to four weeks, manual work at three to six months. The nail is usually left in permanently but can be removed if it causes symptoms, typically after 18–24 months.
Regular X-rays at six weeks, three months, and six months to monitor healing. Physiotherapy throughout.
Not routinely. Removal is considered if the nail causes anterior knee pain or other symptoms after the fracture has healed.
Many patients begin weight-bearing within days of surgery, but this depends on the fracture pattern. Your surgeon will advise.
The tibia has a relatively limited blood supply compared to other bones, particularly in the lower third. This can lead to delayed healing.