Impact of Intramedullary Nailing in the Treatment of Femur Fractures An Evolutionary Perspective.

Today intramedullary nails (IMN) are the gold standard in the treatment of femur fractures. Since its inception, improved design and understanding of the surrounding anatomy has exponentially increased successful patient treatment and outcomes by promoting early mobilization and reliable union. In this review, we provide an in-depth look into the evolutionary process that has led IMN to becoming today's gold standard in femur fractures.

The Evolution of Remote-Controlled Intramedullary Lengthening and Compression Nails.

The operative elongation of limbs has long been a goal of orthopaedic surgeons. Indeed, the very first external skeletal fixators, although designed for stabilization of displaced fractures, were also used to overcome the posttrauma shortening that so commonly accompanies fracture deformities.

Give me a break: Gerhard Küntscher and his nail.

The treatment of broken bones has long adhered to principles of tight juxtaposition of fracture ends and of strict rest. Splinting and casting with plaster of Paris helped considerably. Attempts at internal splinting with pegs, bolts, or stabilizing contraptions usually failed. Foreign materials were either not biocompatible or broke easily, and the insertion of these prostheses directly into the fracture created additional risks from infections. All this changed when Gerhard Küntscher (1900-1972) stabilized broken long bones by intramedullary insertion of stainless steel nails through a small incision, distant from the fracture. Küntscher employed his method from the late 1930s on, initially as a surgeon at the Kiel University in Germany. His early and encouraging results were rejected when presented in 1940, and he remained ostracized thenceforth. During WWII he was stationed in Finland, where he treated wounded soldiers from both sides of the front. POWs returning home propagated the new method by revealing these rods in roentgenograms of their legs; had he not been so successful in treating POWs, he might have had to stand trial at the Nuremberg Doctors' Trial (1947). He documented his experiments and experiences in more than 200 articles and three monographs. Today, his method is employed universally.

Evolución histórica de las ideas en el tratamiento de fracturas trocantéricas / Historical development of trochanteric fracture treatment ideas

Se realiza una revisión de los distintos conceptos, estrategias de tratamiento y dispositivos de osteosíntesis, desde que se comienza a conocer en los primeros tratados las fracturas del fémur en el siglo XVI hasta nuestros días. Mal conocida al principio, es confundida con luxaciones de cadera hasta incluso avanzado el siglo XVIII. En el siguiente siglo los cirujanos ponen su empeño en tipifi car los distintos trazos de fractura y relacionarlas con su pronóstico. Los tratamientos ortopédicos que defi enden las diversas escuelas, a veces incluso encontrados, y que abarcan hasta principios del siglo XX, provocan una alta incidencia de secuelas y un porcentaje muy preocupante de mortalidad sobre todo ligado al prolongado encamamiento. En el siglo XX y fruto de la mejora en técnicas asépticas y anestésicas se comienza a propugnar la cirugía, pero no es hasta la década de los 60 cuando nace la propuesta de que el tratamiento quirúrgico y de urgencia de estas fracturas, debe ser la regla. Se desarrollan diversos tipos de osteosíntesis pudiéndose establecer cuatro diferentes etapas: Sus inicios, el clavo-placa monobloque, las osteosíntesis dinámicas y por último los clavos trocantéricos. Todo progreso en el desarrollo de nuevas osteosíntesis, aunque sea mínimo es de gran utilidad y de importancia considerable, dada la gran repercusión de las fracturas de cadera en nuestro medio (AU)

A review was performed of the various concepts, treatment strategies and osteosynthesis devices, since the fi rst treaties about femoral fractures were published in the 16th Century, until today. Initially, it was poorly known and often confused with hip dislocations even until well into the 18th Century. In the following century surgeons strove into typifying the different fracture lines, thus relating these with their prognoses. The orthopedic treatment that the various schools defend, sometimes contradictory, and that was carried out until the onset of the 20th Century, caused a high incidence of secondary effects, and a very worrying percentage of mortality due to prolonged bed rest. In the 20th Century and thanks to improved aseptic and anesthetic techniques, surgical intervention was more widespread; nevertheless, it was not until the 1960s when surgical and emergency treatment of such fractures became the gold standard. Diverse types of osteosynthesis were developed, with four different stages being established: its beginnings, the monoblock nail-panel, dynamic osteosynthesis and lastly trochanteric nails. Progress in the development of new osteosynthesis—even minimum—is of great use and considerable importance, given the important repercussion of hip fractures (AU)

Intramedullary nailing in fracture treatment: history, science and Küntscher's revolutionary influence in Vienna, Austria.

Although the first intermedullary fixation technique was already reported in 1886, successfully inter-medullary nailing did not start until November 1939 when Küntscher's revolutionary technique was applied for the first time. Whereas Küntscher initially stated that his "marrow nail" was suitable for almost every fracture type as well as for other procedures including fixation of osteotomies, joint arthrodesis and pseudarthro-sis treatment he tried to develop an own nail for every possible fracture type through the years. Undoubtedly, Küntscher has to be considered one of the most influential surgeons. Nevertheless, he was never offered a university position and a lot of people did not acknowledge his brilliancy until his death in 1972. Only in Vienna the willingness to seize Küntscher's ideas was high. Therefore, in addition to a historic overview and to fundamental knowledge referring to reamed and unreamed respectively to static and dynamic nailing Küntscher's influence on Viennese researchers is presented in our paper.

[Gerhard Küntscher and intramedullary fixation].

Gerhard Küntscher, a German surgeon, was born in Zwickau in 1900. He graduated from the School of Medicine in Jena in 1926. He is renowned for the development of intramedullary fixation as a solution for fixation of fractures in the long bones. He worked in the Freiburg and Hamburg hospitals, but gained most experience during the Second World War, when he was on the Eastern front. In the period 1943-1944, he was the chief surgeon in the German military hospital in Kemio (Finland). After the war, he worked in hospitals is Schleswig and Hamburg until his retirement in 1965. He introduced the method of percutaneous intramedullary nailing in the femur fractures, as well as the interlocking nail, nail fixation of the pertrochanteric fractures and nails for intramedullary osteotomy. He published over 200 papers and 4 books. In his papers, he was often ahead of his time, and today is considered one of the founders of the concept of intramedullary fixation in fractures.

Historia del enclavado endomedular / History of the intramedullary nailing

Se hace una historia de los distintos pasos por los que ha viajado el enclavado endomedular con sus distintos hitos históricos