Insertion-related pain with intramedullary nailing

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering

Background:

• Intramedullary nails are increasingly used for long bone fracture treatment.
• They offer biomechanical benefits over plates and less direct fracture exposure.
• However, insertion-related pain is a common complication impacting long-term outcomes.

Purpose of the Study:

• To explore the unclear etiologies of insertion-related pain following intramedullary nail fixation.
• To identify factors contributing to this complication and suggest methods for mitigation.

Main Methods:

• Review of proposed theories and supporting evidence for insertion-related pain.
• Analysis of iatrogenic factors and their impact on surgical outcomes.

Main Results:

• Potential causes include hardware prominence, poor nail entry points, heterotopic ossification, and implant instability.
• These factors can lead to soft tissue irritation, structural compromise, and micromotion.
• Insertional strain is also implicated as a poorly defined contributor.

Conclusions:

• Insertion-related pain after intramedullary nail use has multifactorial etiologies.
• Many contributing factors are iatrogenic and can be mitigated.
• Refined surgical techniques and attention to detail are crucial for optimizing outcomes and reducing pain.