Medullary Nailing of Fractures After Fifty Years

Watson-Jones, Reginald; Adams, John Crawford; Bonnin, J. G.; Burrows, H. Jackson; King, Thomas; Nicoll, E. A.; Palmer, I; Saal, Frederick vom; Smith, Hugh M.; Trevor, David; Vaughan-Jackson, O. J.; Vay, A. David Le

doi:10.1302/0301-620x.32b4.694

Cited by 58 publications

(16 citation statements)

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“…The fast body absorption of ivory-based materials and, in some cases, the inability of the implant to achieve the appropriate length made these fixators incapable of providing the stability required for fractures healing. 23 Hence, at the start of the 20th century, a search for finding suitable materials with different mechanical properties began. Records show that, in 1911, Lilienthal implanted an aluminium intramedullary splint in a femur shaft fracture.…”

Section: The First Pioneers In Intramedullary Nailingmentioning

confidence: 99%

Intramedullary nailing biomechanics: Evolution and challenges

Rosa

Marta

Vaz

et al. 2019

Proc Inst Mech Eng H

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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.

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Section: The First Pioneers In Intramedullary Nailingmentioning

confidence: 99%

Intramedullary nailing biomechanics: Evolution and challenges

Rosa

Marta

Vaz

et al. 2019

Proc Inst Mech Eng H

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“…There is little consensus with regard to who pioneered the use of radiographic techniques for positioning of intramedullary implants. Watson-Jones et al (1950) credit Delbet (1919) with having "practised the internal fixation of fractures of the femoral neck by screws introduced under X-ray control" [6,56]. Mears cites Martin and King as being the first surgeons (in 1922) to have used radiographs to position nails through the greater trochanter into the femoral head and neck [39].…”

Section: Routinization Of Surgical Treatment For Fracturesmentioning

confidence: 99%

“…Often, these implants lacked the necessary length to provide a stable fixation. Furthermore, the natural resorption of bone and ivory implants often occurred too fast for stable fracture healing [56]. Regardless of the materials used, the nailing technique was virtually the same, i. e., insertion of the implant directly into the intramedullary space after exposing the fracture; today, this would be referred to as the open technique.…”

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confidence: 99%

300 Years of Intramedullary Fixation – from Aztec Practice to Standard Treatment Modality

2000

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This work is designed to synthesize the literature and to give an overview of the historical development of intramedullary fixation. The intellectual seed for intramedullary fixation was planted in Mexico in the 16th century; 4 centuries of implant and technique development ensued. Intramedullary fixation in its nascency was an empiric craft defined by the organic-based implants (e. g. wood, ivory and bone) used at the time (16th century -1890). The advent of antiseptics and anesthesia (mid -1800s) transformed surgery into a scientific discipline and allowed for the routinization of surgical treatment for fractures. Technical advances including the use of radiography for positioning of implants and the development of biologically inert materials (early 1900s) paved the way for the first clinical series of intramedullary fixations and refinement of the method (1930 to 1940). Intramedullary fixation "traveled abroad" from Germany to North America during World War II, when American soldiers returned home with metallic implants in their medullary canals. Refinements in the method since that time include introduction of the reaming technique (1942), development of modern interlocking nails (1953), and measures to mitigate problems associated with fat emboli during reaming of the intramedullary canal. Breakthroughs in the area of bioresorbable materials may pave the way for further developments in the 21th century.

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“…As clinical evidence accumulated, some difficulties and limitations of this method became apparent (3). It is our purpose to demonstrate a new perforated cruciate type of intramedullary nail which allows wider application, possesses several obvious advantages and has fewer limitations.…”

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confidence: 99%