Medullary Nailing of Femur and Tibia

Abstract

The biomechanical principles of intramedullary splinting were established by the intramedullary nailing technique introduced by Küntscher in 1940. Splinting provides only relative stability with no interfragmentary compression. In stable fractures, however, it permits early weight-bearing, which produces axial compression between the two main fracture fragments. The intramedullary nail is a load-sharing device which permits load-bearing across the fracture site. Active functional after-treatment is therefore possible in most cases. In the early 1950s, Küntscher also introduced intramedullary reaming. This permitted the use of nails which more accurately fit the diaphyseal portion of the medullary canal and has led to improved fixation. Küntscher’s concept of the “detensor” (1969) was the predecessor of the current concepts of interlocking, which considerably extend the indications for intramedullary nailing. At present we distinguish between the conventional and the interlocking techniques.