| dc.description.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
Splint used in the first world war (2).
Advances in asepsis in 1856 by Pasteur, and
introduction of X-rays in 1895 further improved
management of these fractures. The first allowed clean
surgery while the latter allowed closed reduction of
fractures. The discovery of Penicillin by Alexander
Fleming in 1928 further contributed to a decrease in
fracture infections, morbidity and mortality (2).
The history of intramedullary (IM) nailing for
the treatment of long bones fractures and non unions
is old and interesting. The earliest recorded examples
are from Mexico in the 16th Century (3). Since then,
there has been great changes in design, materials and
basic science principles which have led to well accepted
and successful methods of intramedullary nailing of
diaphyseal fractures.
Throughout the history of IM nailing, these
advances in methods, principles and design appear
to go hand in hand with advances in radiological and
aseptic techniques thereby allowing easy operative care
of fractures and thereby get acceptable outcomes.
Intramedullary nailing is now the gold standard
of the treatment of most diaphyseal fractures of the
lower limbs and is gaining hold on humerus and
forearm fractures.
Introduction of the technique was met with
skepticism and hostility in Europe and America during
the early twentieth century but later has become
accepted as the main therapeutic method of choice
and has greatly improved the patient outcome.
The beginning of intramedullary nailing: In the
beginning, a 16th century anthropologist named
Benadino de Sahaqun traveled to Mexico and witnessed
and recorded the first account of intramedullary device.
He saw Aztech surgeons placing wooden sticks into
the medullary cavity of patients with long bone non
unions (3).
In 1887 Bircher (4) and Konig (5) both recorded
the first intramedullary fixations followed by Gluck
in 1890 (6) who recorded the first description of
interlocked intramedullary device. It consisted of an
ivory intramedullary nail that contained holes at the end
through which ivory interlocking pins were passed.
In 1897 Nicolaysen of Norway described the
biomechanical principles of intramedullary devices
in the treatment of proximal femoral fractures (7 | en_US |
