Kuntscher Nail: A Forgotten Entity Yet a Reliable Modality in Treatment of Winquist Type I and II Closed Femoral Shaft Fractures

Abstract

Background Interlocking intramedullary nail is used for almost all types of femoral shaft fractures worldwide because of its better mechanical stability. In countries like India with limited healthcare infrastructure, the use of Kuntscher nail (K-nail) in Winquist type I and type II isthmic fractures is still debated. Therefore, we conducted this study to compare the functional outcome, radiation exposure, and cost of the implant between closed reduction and internal fixation of Winquist type I and II fractures in the middle one-third shaft region by K-nail and intramedullary locked nails (IMILN), respectively. Methods This was a hospital-based non-blinded randomized trial which included 56 patients with closed Winquist type I and II femoral shaft fractures of the middle one-third femoral shaft (isthmic and paraisthmic zone). All the patients were either treated by K-nail or IMILN. The patients were followed up every three weeks for the initial six months and quarterly thereafter. Per operative duration of surgery and radiation exposure by C-arm was documented and assuming scattered radiation 20%, radiation exposure to the surgeon was calculated and patients were assessed clinically and radiologically for union. Results The patients were divided into two groups: group I (K-nail, n = 25) and group II (IMILN, n = 31). In groups I and II, the patients achieving radiological union were 88% (n = 22/25) and 84% (n = 27/31) at six months’ duration, respectively. The mean duration for the radiological union was 3.65 ± 0.55 months in group I (K-nail) and 3.76 ± 0.59 months in group II (IMILN), respectively. There was no statistically significant difference in the duration of the union (p = 0.4963). The average number of C- arm exposures was 16.36 ± 3.18 in group I as compared to 27.29 ± 4.01 in group II, and the mean scattered radiation was 5.0 ± 1.63 in group I and 6.61 ± 4.06 in group II. This difference was statistically significant. Conclusion Kuntscher intramedullary nailing can provide comparable rates of union as is achieved with interlocking intramedullary nailing with an advantage of less radiation exposure and duration of surgery, provided the patient selection is proper (isthmic and paraisthmic zone).

Effects of intramedullary nailing and internal fixation plates on postoperative wound infection and pain in patients with distal tibia fractures: A meta‐analysis

“…Based on previous studies, most scholars recommend intramedullary nailing (IMN) or internal fixation plates (IFP) for distal tibia fractures 5–7 . The IMN technique, which originated from Professor Kuntscher, has the advantages of minimal injury, easy removal of the nail after fracture healing and early weight bearing, and is suitable for most closed mid‐tibial fractures 8,9 . However, IMN placement is technically difficult and has a long learning curve, and some studies have demonstrated that IMN is associated with postoperative deformity healing and joint pain 10–12 .…”

“… 5 , 6 , 7 The IMN technique, which originated from Professor Kuntscher, has the advantages of minimal injury, easy removal of the nail after fracture healing and early weight bearing, and is suitable for most closed mid‐tibial fractures. 8 , 9 However, IMN placement is technically difficult and has a long learning curve, and some studies have demonstrated that IMN is associated with postoperative deformity healing and joint pain. 10 , 11 , 12 IFP requires less skill on the part of the surgeon, and the fracture is well aligned after treatment; however, the procedure is traumatic and often results in anterior tibial soft tissue problems.…”

“Turning The Tables”: A Technical Tip to Overcome Anatomic Constraints While Distal Locking During Femur Intramedullary Nailing

“…Most of these are fixed using intramedullary nails as a gold standard. 1 Proximal locking is breezily done with use of the proximal jigs in these nailing systems. In contrast, distal locking is still preferably done by a free hand using the perfect circle technique.…”

“…Increased life expectancy coupled with advanced industrialization has led to a multifold increase in both the geriatric hip fractures as well as diaphyseal femur fractures in the young. Most of these are fixed using intramedullary nails as a gold standard 1. Proximal locking is breezily done with use of the proximal jigs in these nailing systems.…”