Introduction: Biology and New Technical Trends in Intramedullary Nailing of the Femur

Abstract

In the early part of the new millennium, technique and implant improvements in orthopaedic traumatology have focused on minimally invasive surgical techniques and fixedangle or locked plating. Meanwhile, during this period, improvements in both implants and surgical techniques for intramedullary nailing have also been recognized. The focus of this Journal of Orthopaedic Trauma supplement is to highlight the advances in implants, surgical techniques, and basic science research for intramedullary nailing of the femur. The slotted cloverleaf nails of Kuntscher (Fig. 1) and the intramedullary implants of today share little more than outward appearance. Certainly, the development of interlocking screws has been a major step. Changes in implant design and instrumentation allow for easier insertion. New alternatives for proximal and distal interlocking screws provide additional stability for juxtaarticular fractures. Interlocking screws that are angle stable or attach to the nail optimize stability in unstable and/or osteoporotic fractures. Internal nail compression instrumentation and techniques allow for better adaptation of displaced fractures. Moreover, a more thorough understanding of the posttraumatic, hypoxemic, and immunologic changes has provided the ability to better plan the best timing for intramedullary fracture fixation. Also, an increasing body of research on the technical aspects of intramedullary nailing has provided new animal models for the study of fracture healing. Additionally, research directed toward maximizing functional recovery in terms of rehabilitation has improved patient outcomes. It is hoped that the advancements addressed in this supplement will contribute positively to the art and science of intramedullary nailing of femoral shaft fractures. The authors would like to thank the Editor of the Journal of Orthopaedic Trauma for the opportunity to summarize the recent developments. FIGURE 1. Gerhard Kuntscher, 1900–1972.