Postoperative treatment of a multifragmentary fracture treated with nailing
Following stable fixation, postoperative treatment is usually functional.
Since soft-tissue swelling and edema are associated with these high-energy fractures, temporary immobilization with a well-padded, bulky splint for 10-14 days is advised to allow adequate soft-tissue healing. During this period, elevation, gentle finger motion, active and passive, together with elbow flexion/extension and shoulder motion, can be started, if a stable fixation and/or static locking has been achieved.
If the stability of the fixation is questionable, splinting should continue for 4-6 weeks.
Lifting and resisted exercises are restricted until radiographic signs of healing appear. More intensive exercises, such as progressive resisted exercises and return to sports should be delayed until at least 3-6 months after surgery.
Close postoperative follow-up is required in these fractures that have been treated by means of relative stability. Secondary bone healing with callus formation is anticipated and early signs of delayed union should alert the surgeon to consider secondary interventions, such as bone grafting.
Follow-up x-rays should be obtained according to local protocol. X-rays to assess fracture position are usually taken at 1, 2, and 4 weeks after operation. Subsequent x-rays are usually taken to assess bony healing at appropriate intervals from 6-8 weeks, depending on the fracture configuration and potential for healing.
Unlike plating, the risk for refracture after nail removal is low. However, routine removal of these implants is unnecessary unless the hardware is symptomatic.