Intramedullary nailing biomechanics: Evolution and challenges

Abstract

This article aims to review the biomechanical evolution of intramedullary nailing and describe the breakthrough concepts which allowed for nail improvement and its current success. The understanding of this field establishes an adequate background for forthcoming research and allows to infer on the path for future developments on intramedullary nailing. It was not until the 1940s, with the revolutionary Küntscher intramedullary nailing design, that this method was recognized as a widespread medical procedure. Such achievement was established based on the foundations created from intuitionbased experiments and the first biomechanical ideologies. The nail evolved from allowing alignment and stability through press-fit fixation with nail-cortical wall friction to the nowadays nail stability achieved through interlocking screws mechanical linkage between nail and bone. Important landmarks during nail evolution comprise the introduction of flexible reaming, the progress from slotted to non-slotted nails design, the introduction of nail 'dynamization' and the use of titanium alloys as a new nail material. Current biomechanical improvement efforts aim to enhance the boneintramedullary nail system stability. We suggested that benefit would be attained from a better understanding of the ideal mechano-biological environment at the fracture site, and future improvements will emerge from combining mechanics and biological tools.

Using antibiotic cement nail with multiple screws fixation as a single-stage salvage procedure for patient with infected tibiotalocalcaneal arthrodesis: A case report

“…1,2 In comparison to plate-and-screw constructs, the retrograde nail is a load-sharing device with improved bending stiffness and rotational stability that allows for early ambulation. 3 The inherent biomechanical advantages make it a good choice for TTC arthrodesis, and the reported outcomes were satisfactory. According to the previous literature, the union rate ranges from 76% to 96%, and the satisfaction rate could be up to 92%.…”

Intramedullary nail: the past, present and the future – a review exploring where the future may lead us

“…The slot allowed for elastic radial compression of the IMN to maximize bone-nail contact for rotational and axial stability. 16 The slot also allows the nail to adapt to the unique infrastructure of the medullary canal, thus avoiding undesirable mechanical stress during implantation. 16 In the 1960s, Huckstep introduced titanium metal for…”

Numerical and Experimental Assessment of a Novel Anchored for Intramedullary Telescopic Nails Used in Osteogenesis Imperfecta Fractures

“…Another way is using external blocks, although they lack aesthetics and efficiency by remaining for long periods outside the stabilized limb [12]. Thus, reference [13] points out that, until 1999, intramedullary fixation evolution has been lack. The main design parameters have been the cross-transversal section and the locking method to the bone.…”