Let me start by telling you a story. This patient, a woman in her seventies, slipped hard on a windy night when a thin layer of ice formed on the snow.
Unfortunately, she suffered a comminuted fracture of the right hip between the ramus. An emergency vehicle soon came and a closed reduction internal fixation was done at the hospital.
But, even more unfortunately, just after leaving the operating room and moving from the flatbed to the bed in the ward, she let out an “oops” and her nail came out of her skin.
She was suffering from very serious osteoporosis, and the nail was like a nail in an already weathered wall with many holes, so of course it couldn’t be nailed.
This is a typical nail “accident”.
Also, nails can really break in the bone.
Q: Do your nails break in the bones?
A: Will the nail break in the bone or not? First of all, this is related to the nail material is strong, but also with the nail and the bone to grow strong or not.
Generally speaking, nails made of stainless steel are stronger than nails made of titanium. There is no doubt that the stronger the nail, the less likely it is to break. Especially with the long screws we use for periacetabular osteotomies, the titanium nails are more likely to break. The inventor of the periacetabular osteotomy, Prof. Ganz from Switzerland, told us that steel nails are cheap and strong, and that rigid nails must be used for osteotomies. In the spirit of responsibility to patients, the internal fixation screws used in osteotomy are all steel nails.
Steel nails are usually silvery white, while titanium nails are available in a variety of colors
In addition, titanium nails are more likely to grow stronger with the bone than stainless steel nails. As a result, we have to use more force to screw out the titanium nail, and in the process, the titanium nail is more likely to break.
The titanium nail can’t be screwed in, and the hand is worn out with blisters after surgery
Will the nail break off in the bone or not? It also has to do with the patient’s own physical condition and weight. Some patients have a strong affinity for the bone, and the nail grows fast and strong; others have a weakness for the nail, and it grows slowly and hollow. If the patient is a big fat person, the nail must be subjected to greater gravity, will easily affect the mechanical structure of the nail and the bone, the nail due to prolonged excessive weight, will produce fatigue fracture.
Will the nail break off in the bone or not? It is also related to the patient’s premature weight-bearing on the ground. If the bone is weighted before it grows, the bone cannot share the force of the nail, and all the force is concentrated on the nail, which is prone to fatigue fracture.
Will the nail break off in the bone or not? Of course, it also has to do with the skillfulness and rigor of the surgeon.
When we talk about the issue of whether the nail will break in the bone during the preoperative nail removal, we also emphasize the “slippage” (the screwdriver screwing the end of the nail out of place) during the nail removal. This is a common risk and accident in nail removal. It also has to do with the material of the nail and the tightness of the bond between the nail and the bone. Overall, titanium nails are more likely to slip than steel nails (about 5 – 10% slip rate for titanium nails).
Slipped and broken screws
Q: What if the nail breaks? If not taken will rust and rot inside?
A: This is one of the biggest headaches for the surgeon when taking the internal fixation. Whether the nail is broken before surgery, or broken during surgery, the principles and methods of handling are the same.
If the location of the broken nail will not affect the future surgery, the broken nail can be left out. This way the surgeon has less trouble and the patient suffers less. Moreover, all nails (regardless of steel or titanium) are safe to leave in the body and will not rust or rot if not removed. It is also safe to have an MRI with the nail (except for some steel nails). It is just that a broken nail left in the body does not look good on the film and is uncomfortable for the doctor and the patient. Therefore, we doctors are especially reluctant to encounter a broken nail.
However, if the broken nail may affect future surgeries, the broken nail should and must be removed in a timely manner. The removal of this nail is an absolute test for our joint surgeons. Holes have to be drilled and even parts of the bone have to be split. It is a “long march” in surgery. The highest record for a broken nail surgery is 7 hours. After the nail is removed, the patient is at risk of re-fracture.
Think about how difficult it is to remove a broken nail, not to mention that the body bleeds.