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will larger nail actually heal my tibia enough ?

hello , last april I suffered a type iiib open fracture of my left tibia which i underwent a muscle flap and IM nail. nearly 18 months later I found out that i now need a bigger exchange nail to fully heal the bone as CT scans show that although the bone has healed there is still a clear fracture line and no bone growth in the centre of the bone. I was really hoping I wouldnt need this operation as to date I have had 5 operations and now have to go though the whole thing again. My questions are firstly would I benefit from a bone simulator ? and also how long will I not be able to work after having this operation. Doctors tell me I should only be in hostipal for 1/2 days but how long am i likely to be on cruthces for. I really worried about this operation. Will having this larger nail actually heal my tibia enough for the nail to be removed in the future and make a good recovery.

Tom Oakley
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replied August 21st, 2012
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TOMOAKLEY,

Sorry to hear of your accident and that the bone has not completely healed yet.

Sometimes a bone stimulator will help. It is a noninvasive therapy and many surgeons will give it a try (especially if there is going to be a wait till the nail exchange can be done). But, the scientific research sort of goes both ways; you can find research that says that the stimulators will help in nonunion cases, but you can find just as much the other way, saying that it does not help at all. So, some surgeons do not believe in the stimulators. But, it might be worth a try; if you are willing to wait on the time it takes for the stimulator to work (can be several weeks/months).


While no surgery can be fully guaranteed, it is known that a nail exchange can stimulate the bone to heal fully. While it is not really the putting in of a larger nail that does the trick, it is the reaming of the intramedullary canal. The reaming will clean out the fibrous tissue that has formed. It will clean the bone back to nice bleeding bone. Because of the reaming, a large size nail will have to be placed. So, again, it is not just the larger size of the nail, but the cleaning of the bone that is the stimulating factor.

Sounds like they are not going to do an open bone grafting of the fracture site (since the outside of the bone has healed), so your recovery should be a lot quicker. The bone is not unstable as before, and you do not have the soft tissue injuries to worry about now.


So, in the overall treatment of your injuries, a nail exchange is not all that big of a deal. Yes, it is a major orthopedic surgery, with all of the usual risks, but it sounds like it is what is needed.


Speak to your surgeon about the stimulator. At this point, it may not be of too much benefit. But, you can always ask about it.


Good luck. Hope your leg finally heals up.
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