History of Intramedullary Nailing

Recent developments on intramedullary nailing: a biomechanical perspective

“…Medullary reaming was a remarkable strategy because it allowed the use of lengthier and larger diameter nails. The increase of the nail diameter enhanced overall bone–implant system stability by increasing the contact area between the nail and the medullary wall throughout the entire length of the long bone …”

“…The implant stabilization improvement succeeded through the introduction of mechanical linkage between nail and bone with interlocking screws. Although the first steps were taken by Küntscher, it was Klaus Klemm and Wolf‐Dieter Schellmann who, in 1972, materialized the concept . Intramedullary nail static locking by employing screws both proximally and distally to the fracture sites prevents rotation or sliding movements between the bone extremities and maintains length and physiological alignment of the system .…”

“…Such effect was perceived as a potential problem and was assumed to cause delayed recovery and nonunion cases . In an attempt to reduce the stress‐shielding effect and promote healing, Grosse and Kempf emphasized nail dynamization , where a fixed end is responsible for ensuring fracture rotational stability, while the opposite extremity is free to slide slightly inside the bone . In the materials field, a strong novelty was also introduced in the 1990s with the adoption of titanium, a new material competing with the until then commonly used AISI 136 LVM ASTM F138 stainless steel (generally known as medical‐grade stainless steel) .…”

“…The earliest records of human attempts to deal with fracture come from the 16th century Aztec population, where resinous wood sticks were placed in the medullary canal for stabilization. [3][4][5][6][7] However, only decades later, during the 19th century, an increased interest in the potentialities of "intramedullary doi: 10.1111/nyas.13524 fixation" emerged. It started with ivory peg developments in patients with nonunions and not bone fractures.…”

“…10 It was not until World War II that Gerhard Küntscher-a German physician known as the founder of modern intramedullary nailingpresented a pioneer concept, through the V-shaped and the clover-leaf stainless steel intramedullary nails. 4,5,11 Küntcher's nails featured a slotted configuration ( Fig. 1), which allowed fracture stabilization through a nail compressed to fit in the medullary canal.…”