An intramedullary rod, also known as an intramedullary nail (IM nail) or inter-locking nail or Küntscher nail (without proximal or distal fixation), is a metal rod forced into the medullary cavity of a bone. IM nails have long been used to treat fractures of long bones of the body. Gerhard Küntscher is credited with the first use of this device in 1939,[1][2] during World War II, for soldiers with fractures of the femur. Prior to that, treatment of such fractures was limited to traction or plaster, both of which required long periods of inactivity. IM nails resulted in earlier return to activity for the soldiers, sometimes even within a span of a few weeks, since they share the load with the bone, rather than entirely supporting the bone.[3]
X-ray showing the proximal portion of a fractured tibia with an intramedullary nailProximal femur nail with locking and stabilisation screws for treatment of femur fractures of left thighAn intramedullary nail found in the left knee of a mummified Egyptian man
The oldest intramedullary nail was found in the left knee of a mummy named Usermontu, the remains of an Egyptian man from more than 3,500 years ago. Researchers believe the pin was inserted after the man's death, but before his burial.[4]
The earliest IM nails were triangular or V-shaped in cross-section. Later they were modified to their present and more rotationally stable clover-leaf shape.[2] Several modifications and shapes were introduced subsequently for various bones such as V-nails for tibia, radius[5] and ulna nails, Rusch nails etc.
Although stainless steel was used for older IM nails, titanium has several advantages, including lower mechanical failure rates and improved biocompatibility.[6] A more significant problem with earlier designs was their failure to prevent collapse or rotation in inherently unstable fractures. This was addressed by the introduction of the concept of 'locking' the nails, where bolts on each end of the nail fix it to the bony cortex, preventing rotation among the fragments. This led to the emergence of locked IM nailing, which is the standard today.[3]
The extension mechanism of intramedullary can be of two types: ratcheting, such as in the Bliskunov, Albizzia, and the Internal Skeletal Kinetic Distractor (ISKD, removed from market in 2015) nails; and rotating spindle, as in the Fitbone, Phenix, PRECICE, and PRECICE 2 nails.[7]
Complicationsedit
At a median 14 years after tibial nailing of isolated tibial fractures, patients' function is comparable to population norms, but objective and subjective evaluation shows persistent sequelae which are not insignificant.[8]
One potential complication of intramedullary nailing after a fracture is bone malrotation, where the broken bone is fixated out of alignment and heals incorrectly, causing a rotated limb.
Lower screws holding intramedullary rods can sometimes cause limited dorsiflexion as a result of damage and subsequent healing and fibrotic developments around that area. If the bone breaks more medially, there is scope to position the nails further from the ankle joint which would prevent/reduce this dorsiflexion loss.
^(PDF). AO Foundation. p. 42. Archived from the original (PDF) on 2015-01-21. Retrieved 2013-03-12.
^ abBong, Matthew R.; Koval, Kenneth J.; Egol, Kenneth A. (2006). (PDF). Bulletin of the NYU Hospital for Joint Diseases. 64 (3/4). NYU Hospital for Joint Diseases: 94–97. PMID 17155917. Archived from the original (PDF) on 2015-01-21. Retrieved 2013-03-12.
^ ab"Wheeless' Textbook of Orthopaedics - Intramedullary Nailing of Femoral Shaft Frx". Duke Orthopaedics. Retrieved 2011-08-04.
^Snow, Karen (June 1996). "BYU professor finds evidence of advanced surgery in ancient mummy". BYU Magazine. Brigham Young University. Retrieved May 27, 2015.
^Jordan, R. W.; Saithna, A. (October 2015). "Defining the role of intramedullary nailing for fractures of the distal radius: a systematic review". The Bone & Joint Journal. 97-B (10): 1370–1376. doi:10.1302/0301-620X.97B10.35297. ISSN 2049-4394.
^Leung, Kwok-Sui; Kempf, Ivan; Alt, Volker; Taglang, Gilbert; Haarman, H. J. Th. M.; Seidel, Hartmut; Schnettler, Reinhard (15 February 2006). Practice of intramedullary locked nails: new developments in techniques and applications. Birkhäuser. p. 100. ISBN978-3-540-25349-5. Retrieved 20 December 2011.
^Green, Stuart A.; Dahl, Mark T. (2017). Intramedullary Limb Lengthening: Principles and Practice. Springer. p. 180. ISBN9783319602974.
^Lefaivre, K. A.; Guy, P.; Chan, H.; Blachut, P. A. (2008). "Long-Term Follow-up of Tibial Shaft Fractures Treated with Intramedullary Nailing". Journal of Orthopaedic Trauma. 22 (8): 525–529. doi:10.1097/BOT.0b013e318180e646. PMID 18758282.
External linksedit
Cluett, Jonathan (M.D.). . About.com. Archived from the original on 2009-01-26. Retrieved 2008-12-19.
January 01, 1970
intramedullary, intramedullary, also, known, intramedullary, nail, nail, inter, locking, nail, küntscher, nail, without, proximal, distal, fixation, metal, forced, into, medullary, cavity, bone, nails, have, long, been, used, treat, fractures, long, bones, bod. An intramedullary rod also known as an intramedullary nail IM nail or inter locking nail or Kuntscher nail without proximal or distal fixation is a metal rod forced into the medullary cavity of a bone IM nails have long been used to treat fractures of long bones of the body Gerhard Kuntscher is credited with the first use of this device in 1939 1 2 during World War II for soldiers with fractures of the femur Prior to that treatment of such fractures was limited to traction or plaster both of which required long periods of inactivity IM nails resulted in earlier return to activity for the soldiers sometimes even within a span of a few weeks since they share the load with the bone rather than entirely supporting the bone 3 X ray showing the proximal portion of a fractured tibia with an intramedullary nail Proximal femur nail with locking and stabilisation screws for treatment of femur fractures of left thigh An intramedullary nail found in the left knee of a mummified Egyptian man The oldest intramedullary nail was found in the left knee of a mummy named Usermontu the remains of an Egyptian man from more than 3 500 years ago Researchers believe the pin was inserted after the man s death but before his burial 4 Contents 1 Design 2 Complications 3 See also 4 References 5 External linksDesign editThe earliest IM nails were triangular or V shaped in cross section Later they were modified to their present and more rotationally stable clover leaf shape 2 Several modifications and shapes were introduced subsequently for various bones such as V nails for tibia radius 5 and ulna nails Rusch nails etc Although stainless steel was used for older IM nails titanium has several advantages including lower mechanical failure rates and improved biocompatibility 6 A more significant problem with earlier designs was their failure to prevent collapse or rotation in inherently unstable fractures This was addressed by the introduction of the concept of locking the nails where bolts on each end of the nail fix it to the bony cortex preventing rotation among the fragments This led to the emergence of locked IM nailing which is the standard today 3 The extension mechanism of intramedullary can be of two types ratcheting such as in the Bliskunov Albizzia and the Internal Skeletal Kinetic Distractor ISKD removed from market in 2015 nails and rotating spindle as in the Fitbone Phenix PRECICE and PRECICE 2 nails 7 Complications editAt a median 14 years after tibial nailing of isolated tibial fractures patients function is comparable to population norms but objective and subjective evaluation shows persistent sequelae which are not insignificant 8 One potential complication of intramedullary nailing after a fracture is bone malrotation where the broken bone is fixated out of alignment and heals incorrectly causing a rotated limb Lower screws holding intramedullary rods can sometimes cause limited dorsiflexion as a result of damage and subsequent healing and fibrotic developments around that area If the bone breaks more medially there is scope to position the nails further from the ankle joint which would prevent reduce this dorsiflexion loss See also editDistraction osteogenesis Cannulated barReferences edit AO Dialogue 2206 The magazine of AO community PDF AO Foundation p 42 Archived from the original PDF on 2015 01 21 Retrieved 2013 03 12 a b Bong Matthew R Koval Kenneth J Egol Kenneth A 2006 The History of Intramedullary Nailing PDF Bulletin of the NYU Hospital for Joint Diseases 64 3 4 NYU Hospital for Joint Diseases 94 97 PMID 17155917 Archived from the original PDF on 2015 01 21 Retrieved 2013 03 12 a b Wheeless Textbook of Orthopaedics Intramedullary Nailing of Femoral Shaft Frx Duke Orthopaedics Retrieved 2011 08 04 Snow Karen June 1996 BYU professor finds evidence of advanced surgery in ancient mummy BYU Magazine Brigham Young University Retrieved May 27 2015 Jordan R W Saithna A October 2015 Defining the role of intramedullary nailing for fractures of the distal radius a systematic review The Bone amp Joint Journal 97 B 10 1370 1376 doi 10 1302 0301 620X 97B10 35297 ISSN 2049 4394 Leung Kwok Sui Kempf Ivan Alt Volker Taglang Gilbert Haarman H J Th M Seidel Hartmut Schnettler Reinhard 15 February 2006 Practice of intramedullary locked nails new developments in techniques and applications Birkhauser p 100 ISBN 978 3 540 25349 5 Retrieved 20 December 2011 Green Stuart A Dahl Mark T 2017 Intramedullary Limb Lengthening Principles and Practice Springer p 180 ISBN 9783319602974 Lefaivre K A Guy P Chan H Blachut P A 2008 Long Term Follow up of Tibial Shaft Fractures Treated with Intramedullary Nailing Journal of Orthopaedic Trauma 22 8 525 529 doi 10 1097 BOT 0b013e318180e646 PMID 18758282 External links editCluett Jonathan M D Intramedullary Rod About com Archived from the original on 2009 01 26 Retrieved 2008 12 19 Retrieved from https en wikipedia org w index php title Intramedullary rod amp oldid 1194388548, wikipedia, wiki, book, books, library,
