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Review
. 2021 Jul 10;13(2):25546.
doi: 10.52965/001c.25546. eCollection 2021.

Intramedullary nail: the past, present and the future - a review exploring where the future may lead us

Noah Wong Wei Kang  1 , Wen Po Jonathan Tan  1 , Yue Min Crystal Phua  1 , Amelia Tan Gek Min  1 , Kishan Naidu  1 , Kandiah Umapathysivam  1 , Peter Jonathan Smitham  2
Affiliations
Review

Intramedullary nail: the past, present and the future - a review exploring where the future may lead us

Noah Wong Wei Kang et al. Orthop Rev (Pavia). .

Abstract

Background: Intramedullary nails (IMNs) are the current gold standard treatment for long bone diaphyseal and selected metaphyseal fractures. The design of IMNs has undergone many revisions since its invention in the 16th century, with a dramatic increase in novel designs in recent years aiming to further improve intramedullary fixation techniques.

Aims: To map the evolution of IMNs in orthopedic surgery, discuss the limitations and complications of current IMNs and identify novel IMNs that may influence future design innovations.

Methods: We undertook a scoping review on the status of orthopedic IMNs by reviewing Google Scholar with the following keywords. Publications and patents selected for retrieval were initially assessed on the title and abstract by five independent reviewers. 52 papers were retrieved for complete text examination, and secondary references were checked from these papers. The results were discussed within the research group and consensus was obtained describing novel IMNs.

Results: Novel IMN designs include growth factor and/or antimicrobial coatings targeting fracture healing and perioperative infection risk, respectively; minimally invasive expandable IMNs to avoid the need for interlocking screws; and novel materials such as carbon fiber for their theoretically superior biomechanical properties and avoidance of artifact on CT and MRI imaging.

Conclusion: The novel IMNs proposed in recent years collectively aim to improve intramedullary fixation techniques by reducing operative time and radiation exposure, improving fracture healing or monitoring bone cancer progression. However, more research and development are necessary to solve these complex problems.

Keywords: carbon fiber nails; coated nails; expandable nails; intramedullary nails; orthopedic.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

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Figure 1. Timeline of the evolution of IMNs
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Figure 2. Illustration of Fixion IMN – a cross-section of a long bone pre-and post-expansion
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Figure 3. Illustration of US Patent Expandable Orthopeedic Device
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Figure 4. Illustration of Screwless Blade Expandable Nail
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Figure 5. Illustration of the Novel Expandable Nail Model
See this image and copyright information in PMC

References

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