Comprehensive global evolution of intramedullary nailing of diaphyseal fractures

Abstract

The treatment of midshaft fractures of the long bones has significantly evolved in the last 150 years. This paper will trace the timeline and evaluate the treatment of these fractures which has evolved through from the sixteenth century. The first and second world wars had amputation as the surgery of choice until the development of the Kuntsher Nail (1939) for femoral shaft fractures. Then followed interlocking nails, Ender nails, the telescoping nail and lastly the elastic intramedullary nails used in childhood and adolescents (1). It will also touch on the development of interlocking nails for other long bones; the humerus, tibia and the forearm bones and most recently intramedullary nails for small bones of the hand and feet. This paper touches on the historical reasons for the different techniques and how they have improved patient outcome. To the early surgeons, stabilization of diaphyseal fractures was difficult more so in open fractures and dilemma was which way to go – Amputation by the radical surgeons or conservative treatment to save the limbs. At that time the surgeons had only the above two options. During the American Civil War, Smith’s anterior splint was used but led to ulcerations and malunion and was not popular. It was clumsy with the leg suspended from the ceiling and traction obtained by moving the bed forwards/backwards. The next was Hodgers Cradle splint which was a wire splint suspension device to ensure complete extension of the limb and prevent contractures. Then followed the famous Thomas