What are the five steps of intramedullary nailing in order?

• A. Reduction, Position, Insertion, Locking, Removal
• B. Position, Reduction, Locking, Insertion, Removal
• C. Position, Insertion, Reduction, Locking, Removal
• D. Position, Reduction, Insertion, Removal, Locking

Answer: (C)

The steps follow a logical flow from preparing the patient to securing the implant and finishing the procedure. You begin by positioning the limb properly to allow correct access and alignment. Then you insert the intramedullary nail into the medullary canal; advancing the nail helps to guide and achieve reduction of the fracture as it passes through the fracture site. Once the nail is in place and the fracture is aligned, you place the locking screws to lock the nail to the bone, preventing rotation and shortening. The final step is removal of temporary instrumentation or completing the procedure, which is listed as removal in this sequence.

This order makes sense because reduction is achieved during or after the nail is inserted and advanced, not before insertion, and locking cannot occur before the nail is in place.