Femoral and tibial fracture fixation: an OR 101 guide
Reviewed by Rodnie Oro, cath lab charge nurse · Last reviewed: October 2026 · Education only, not medical advice
Femur and tibia fixation in one minute
What it is: surgery to line up a broken thigh bone (femur) or shin bone (tibia) and hold it with a nail inside the bone or a plate and screws.
Who it is for: people with fractures of the femur or tibia, often after high-energy injuries or falls.
Main risks: bleeding, infection, the bone not healing, malalignment, fat embolism, compartment syndrome, blood clots.
Usually: under general anaesthetic, 1–3 hours, often several days in hospital.
On this page: What is femoral and tibial fracture fixation? · Who is it for? · When is it done? · Step by step · Recovery · Risks · Kit list · First time in theatre? · FAQ
What is femoral and tibial fracture fixation?
The femur (thigh bone) and tibia (shin bone) are long bones. Fractures of their shafts are usually fixed with an intramedullary nail: a metal rod passed down the hollow middle of the bone and locked with screws at each end.
- Nailing: small cuts at the hip or knee and for the locking screws; X-ray guides each step
- Plating: a plate and screws through a larger cut, often for fractures near a joint
- External fixation: a frame outside the leg, sometimes used first in severe or open injuries
Open fractures (with a wound) need urgent antibiotics and cleaning, as per national standards.
New to the acronyms? See the Cath Lab Abbreviations A–Z.
Who is it for?
It may be considered for people with:
- fractures of the femur or tibia shaft
- fractures near the knee or hip needing plate fixation
- open fractures (with urgent debridement)
The decision is made by your surgical team, who will talk through the reasons, the alternatives and the risks with you.
When is it done?
It is usually done urgently. Before it, you usually have:
- assessment, X-rays and often a CT scan
- pain relief, splinting and sometimes traction
- blood tests and crossmatch
- antibiotics for open fractures, as per centre protocol
- a chance to ask questions and give consent
Step by step
1. Getting ready
Team brief and WHO checklist first, including the implant check and confirming the site and side marking. The anaesthetic team and ODP give the anaesthetic (general, sometimes with a nerve block, as per centre protocol); antibiotics and blood-clot prevention are given as per centre protocol. The circulating practitioner checks positioning and pressure areas, the diathermy plate, warming, and radiation protection if X-ray is used. The scrub practitioner checks implant and instrument trays are complete and sterile, and does the first count. Theatre traffic is kept to a minimum, especially in laminar-flow theatres. Positioning on a traction table or radiolucent table is checked so X-ray images can be taken.
2. Access
For nailing, a small cut is made at the hip (femur) or knee (tibia) for the entry point, plus small cuts for locking screws. For plating, a cut is made over the fracture.
3. Fixing the bone
- A. Reduction. The fracture is lined up with traction and X-ray.
- B. Entry and reaming. A guide wire is passed down the bone, and the canal reamed if planned.
- C. Nail inserted. The nail is passed across the fracture, size per device and operator.
- D. Locked. Locking screws are placed at each end with X-ray guidance.
4. Finishing
Final X-ray images confirm alignment and length. The wounds are closed and dressed. Final counts are confirmed, implant details recorded, and the patient goes to recovery with a full handover, including limb checks (circulation and nerves), as per centre protocol.
Recovery and aftercare
- First days: pain relief, monitoring for leg swelling and compartment syndrome, as per centre protocol.
- Walking: physiotherapists help you walk, often the next day; weight-bearing as advised.
- Going home: varies, often several days.
- Clot prevention: as per centre protocol.
- Healing: bones take months to heal fully.
- Follow-up: X-rays and clinic review.
Call 999 if you have chest pain or sudden breathlessness. Contact your team if you have increasing pain, a cold, numb or very swollen limb, calf pain, fever, or a wound that becomes red, hot or leaky.
Risks and complications
Your team will explain the risks that apply to you. Possible problems include:
- bleeding needing transfusion
- wound infection or deep infection of the bone
- the bone not healing, or healing out of line
- fat embolism (rare)
- compartment syndrome (rare, urgent)
- knee or hip pain at the nail entry site
- blood clots in the legs or lungs
Theatre kit list (printable)
Example kit list
Every theatre has its own protocol, and sizes and doses vary.
- nail system instruments: guide wires, reamers and insertion handle
- nails and locking screws, sizes per device and operator
- plates and screws if plating, sizes per device and operator
- power drill and reamer
- traction table or radiolucent table
- image intensifier (C-arm) and radiation protection
- closure sutures and dressings
Procedural steps
- Team brief, WHO sign in; side marked; implant check; anaesthesia
- Traction or radiolucent table; prep and drape; count
- Reduction under X-ray
- Entry point; guide wire; reaming
- Nail insertion; proximal and distal locking
- Final images; closure; counts; implant log; sign out and handover
First time in theatre?
đź’ˇ First-time tip
- Implant check. Read back the implant type, side and size before opening, and record it in the implant log.
- Site and side. Check the marking at sign in and again before the cut.
- Counts matter. Swabs, needles, instruments and small implant parts are counted; speak up if one is missing.
- Radiation safety. Wear lead and a dosimeter when X-ray is used, and keep your distance.
- Image positions. Learn the C-arm positions the surgeon needs and keep cables clear.
FAQ
Will the nail be removed?
Usually not, unless it causes problems.
How long will healing take?
Often 3–6 months or more.
When can I put weight on my leg?
It depends on the fracture and fixation; your team will advise.
Related guides
Sources
All checked on 14 October 2026. Each page's own date is shown where it gives one.
- NICE. Fractures (complex): assessment and management (NG37). nice.org.uk/guidance/ng37
- British Orthopaedic Association. BOAST: Open fractures. boa.ac.uk
- StatPearls (NCBI Bookshelf), search: femur fracture. ncbi.nlm.nih.gov/books
- StatPearls (NCBI Bookshelf), search: tibial shaft fracture. ncbi.nlm.nih.gov/books
- World Health Organization. Surgical Safety Checklist. who.int
Disclaimer
Education only. This page is for general education for healthcare students, theatre staff and curious readers. It isn't medical advice and doesn't replace advice from your own doctor, surgical team or local unit protocols. Equipment and medicines are described generically. No product or manufacturer is recommended. If you think someone is having a medical emergency, call 999.
Disclosure: I work in the medical device industry. This page is independent education and isn't sponsored or reviewed by any company.
All diagrams on this page are original illustrations created for rodnieoro.com.
