• Cindy

The Silver Shin Club - My Love and Hate Relationship with IM Nails

The 'Silver Shin' club is very exclusive. Money alone cannot buy entrance. Rather entrance must be earned by suffering a fracture of the tibia so severe manual manipulation and casting will not guarantee healing. Instead a silver titanium rod, called an intramedullary nail (IM) must be drilled into the tibia to fixate the fracture.

Each of the women in the above photographs have started the process of joining the 'Silver Shin' Club

The use of intramedullary nails to fractures of the tibia actually dates back to the 16th century. There is a evidence that Aztec physicians in Mexico used wooden sticks inserted in the medullary canal of fractured tibias.

Over the years, technology improved as did success rates. Today, IM Nails are used to treat a variety of bone fracture including fracture to the tibia, femur, and humerous.

Once the act of breaking a tibia is completed, the next steps in joining the Silver Shin Club are relatively quick. The story of Tami, an Idaho resident, is fairly typical of the club admission process.

Tami, who an TV personality and author, was skiing with her family a few years ago.

In her own words. "I was on the second ski run of the day. And it was on the bunny hill of all things! My daughter fell behind me and I look back and tried to stop. While trying to stop my shin went “snap, crackle, crackle, crackle, pop!”

I screamed in pain. I have never felt such horrible pain. I have shattered my shoulder, been bit by a brown recluse spider, been through child birth twice, and experienced shingles. Nothing in my lifetime had ever hurt as bad as this.

"In that moment of pain, I silently said “Why?” And then words came into my head at that moment; an answer that is still so clear: “This will be good for you.” The pain being so intense I just cried. I couldn’t even help myself."

"I ended up on an ambulance headed to the Driggs hospital, and still the pain never stopped. X-rays, CAT scans, and moving my leg around hurt even with the hospital drugs. I kept thinking, “How is this going to be good for me?” The pain just would not stop."

After a young resident attempted to set the leg manually, Tami was placed in a splint and sent home to wait for surgery.

"I was home and on intense drugs with my family and friends surrounding me as I waited for surgery, still clinging to the belief that I could take care of myself (even as I relied on others for everything). Then I tried to stand on my own – with the brace and drugs – and still nearly passed out from pain."

"I couldn’t get myself food. If I didn’t have the remote I had to watch whatever was stuck on the TV. I couldn’t care for my basic needs. The pain forced me to stay down. I felt like a toddler; with my life and needs subject to others’ schedules and lives. Asking for help made me feel demanding and needy. It’s true I couldn’t do it on my own, and there was no way around that, but still I felt bad asking for help."

Finally, surgery day rolled around and Tami officially became a member of the Silver Shin Club.

Tami's surgeon used a manual drill to insert the titanium rod through Tami's knee and down the tibia. This a violent procedure that often involves hammering the nail into place. Once inserted, the rod is secured with the insertion of screws at the upper and lower ends of the tibia.

From the patient's viewpoint, the advantage of IM nailing is the ability of the patient to begin weight bearing almost immediately and avoid confinement in a cast. Of course, this is bad news for the cast community.

Three years after breaking her leg, Tami suffers from arthritis in her knee and ankle. She limps on occasion, and thinks daily about the pain she experienced that day on the mountain.

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