The most difficult and frightening question for orthopedic patients is: Will the nail break during the surgery? Should the nail be removed or not? When should they be removed? Will the nail rust and rot inside if it is not removed?
Will your nail break in the bone? If it does, what should I do?
Q: What are the surgical procedures in joint surgery that require nailing?
A: Common procedures include periacetabular osteotomy, femoral osteotomy, surgical dislocation of the hip, knee osteotomy orthopedic surgery, and joint fusion, all of which require nailing.
Q: Why is nailing necessary?
A: In orthopedic surgery, nails and other internal fixation materials are needed to connect the disconnected bones so that the bones can grow and heal.
Q: How are these nails made?
A: The method of nailing is different for each surgery. In the case of periacetabular osteotomy, in order to put the crooked hat on the femoral head, we need to completely cut the acetabulum off the pelvis and rotate it (hence the name periacetabular osteotomy) to the normal position where the hat is put on. The position of the cap is normal. Therefore, the fixation is very much a “candy cane”, which requires the use of 4 nails crossed to reposition the acetabulum to the pelvis in the correct position for wearing the cap.
Q: Do I need to remove the nails that have been pinned into the bone?
A: Nail into the bone should be removed for young adults before the age of 50. For those who are older, they should be removed as well. Unless the patient is in poor physical condition and cannot withstand the shock of another surgery to remove the nail, or an elderly person with a high incidence of various chronic diseases, it is safer for his or her health not to remove the nail on balance.
The reason why a nail must be removed from the bone is that the nail is, after all, a metal foreign body that is nailed to the bone and is a double-edged sword. On the one hand, it can play a role in the internal fixation of the support of solid; on the other hand, it will deprive the bone of its own “pin” of the fixed force, so that the support and strength of the bone because of the unexpected intervention of the nail and become fragile.
Another important reason why nails must be removed from bones is that if the patient’s nail is not removed, it may seriously affect other surgeries that may be needed later. For example, a patient with a periacetabular osteotomy may face an artificial hip replacement decades later. If the nail is not removed, it may affect the total hip replacement by grinding the acetabulum, and the nail in the acetabulum will not be able to grind or thwart, just like the steel in the concrete wall, so the operation will encounter obstacles and cannot be done further. At this point, the only way to proceed is to remove the nail first and then do a total hip replacement.
The nail has been rooted in the bone for so many years, do you think it is good to remove it?
We in joint surgery have really encountered such a nail that has not been removed for years. In total hip replacement, the nail to be removed has been buried deep in the bone, and the nail cap, which was exposed outside the bone to facilitate the removal of the nail, has disappeared (it has been “encapsulated” by years of bone growth).
The most difficult part of removing this nail, which had lain dormant in the bone for decades, was not that it could not be found (it could be found under x-ray fluoroscopy), but that it was difficult to find a matching nail removal tool. Such a procedure is sometimes more difficult and complicated than the most painful and difficult revision surgery. It often takes several hours just to remove the nail.
The most painful part for us doctors is that we have to dig a big hole in the bone, just like we dig the roots of an old tree, picking and prying little by little.
If there is a nail in the concrete wall, the butt of the nail is gone, the nail is invisible, and no tools are given to you, but you have to gouge it out. This feeling is the feeling of pulling nails that have been dormant in the bones for decades.
Q: When exactly is the nail removed?
A: At 3 months, 6 months and 12 months after surgery, we ask patients to come to the hospital for a review and decide when to remove the nail according to the different recovery status of each patient.
The general principle of nail removal is that as long as the doctor judges that the bone has grown solidly, it can be removed. For example, for patients with 4 nails in periacetabular osteotomy, nails can be removed under local anesthesia as soon as one year after surgery. For patients with femoral osteotomy, the fixed plate of the thigh bone usually takes 1.5 to 2 years to be taken out, which requires hospitalization under lumbar or general anesthesia.