Intramedullary rod

Intramedullary nailing is a surgical procedure for the treatment of fractures of the long bones.

History

1887 reported Bircher and king of the first intramedullary fixation of broken bones. Ernest William Hey Groves 1916 used ivory and cattle bones. 1925 presented Marius Nygaard Smith - Petersen nail for femoral neck fractures the three blades. 39 Kiel cases were published in 1939 by Gerhard Küntscher.

In March 1940, Küntscher at the 68th Meeting of the German Society for Surgery in Berlin before his intramedullary nail. The indignation of the conference participants was large because the bone marrow an irreplaceable importance for the vitality of the bone and the healing was attributed after bone fractures. The bone marrow should therefore not be touched by the then idea. The clinical success and the benefits of Marknagelosteosynthese convinced but gradually the initial skeptics. The rapid loading of the injured limb, the shortened hospital stay and rapid recovery of the ability to work were the convincing arguments for this osteosynthesis. The costs associated with the time prevailing therapy long wait times and immobilisation often caused considerable complications, such as eingesteifte joints, pneumonia, thrombosis, and pulmonary embolism. This sometimes life- threatening complications were much less common thanks Küntschers method.

Küntscher first one and unreamed unlocked intramedullary nail was introduced with V- shaped cross section. This means that the internal splinting a steel pipe in the medullary cavity " wedged " was. The nail was stuck elastic from the inside By the later cloverleaf-shaped cross-section. The next step was the reaming of the medullary cavity, in order to achieve a better jamming and thus to obtain even more stable osteosynthesis. By drilling the cross section was enlarged and a thicker intramedullary nail could be implanted. 1942 Richard began Maatz drill out the marrow space. He wanted to include the positive engagement in the bone produce. Therefore, he used tapered intramedullary nails. Shortly after, Küntscher took over the technique of reaming. First, he used rigid drill until Ernst Pohl 1955, a flexible, motorized reamer available.

In the following years, the reamed intramedullary nailing developed a standard procedure for tibial shaft fractures with minimal soft tissue damage. In 1972 the clamping Schellmann Nail and shortly after the Strasbourg or Grosse- Kempf nail introduced, in addition the possibility of static or dynamic locking offered. A further development of the compression intramedullary nail that allows to select for the compression of the fracture area, and thus improve the apposition of the fracture ends significantly. This was around 1966 the model after Kaessmann even with an attached clamping apparatus of the pioneer.

Presence

The present state of the art intramedullary nails of largely inert titanium alloys. These implants offer the possibility of static or dynamic locking and compression to the fracture. Be powered closed and simply open fractures of large bones (thigh (femur), shinbone ( tibia), humerus (humerus ) ). Other supplies provide outsiders applications in special cases dar. for periarticular fractures of the bone above there are a number of specialized implants with special properties such as the Gamma nail, proximal humeral or distal femoral nail. The implants are anatomically shaped to the target bone and available in different thicknesses and lengths.

Basically, these implants can be left in a metal removal is not medically necessary. Nevertheless, the foreign material is often removed after healing of the fracture after one year. On one hand, so that the way of any subsequent joint prostheses paved, on the other hand can apply the locking screws and intramedullary nails interfere. Rule of thumb is: The older the patient, the more likely the implant is left in place. About the Marknagelosteosynthese per se is no longer disputed today. Scientific controversies are still today the reamed nail versus unreamed nail ( reamed versus unreamed ) and the optimal time for the care of severely injured patients with appropriate osteosynthesis.