300 years of intramedullary fixation - From Aztec practice to standard treatment modality

Abstract

This work is designed to synthesize the literature and to give an overview of the historical development of intramedullary fixation. The intellectual seed for intramedullary fixation was planted in Mexico in the 16th century; 4 centuries of implant and technique development ensued. Intramedullary fixation in its nascency was an empiric craft defined by the organic-based implants (e. g. wood, ivory and bone) used at the time (16th century-1890). The advent of antiseptics and anesthesia (mid-1800s) transformed surgery into a scientific discipline and allowed for the routinization of surgical treatment for fractures. Technical advances including the use of radiography for positioning of implants and the development of biologically inert materials (early 1900s) paved the way for the first clinical series of intramedullary fixations and refinement of the method (1930 to 1940). Intramedullary fixation 'traveled abroad' from Germany to North America during World War II, when American soldiers returned home with metallic implants in their medullary canals. Refinements in the method since that time include introduction of the reaming technique (1942), development of modern interlocking nails (1953), and measures to mitigate problems associated with fat emboli during reaming of the intramedullary canal. Breakthroughs in the area of bioresorbable materials may pave the way for further developments in the 21th century.