This year marks the 75th anniversary of the introduction to modern surgery of the revolutionary nail developed by Prof G. Kuntscher. His intuitions and studies as well as his techniques of closed intramedullary (IM) nailing of long bone fractures, continue to remain a pivotal cornerstone in orthopedic culture and practice.
In Italy in the early 80s, the widespread use of IM nailing for mid-shaft femur or tibia fractures was relegated to major academic hospitals. The Rizzoli Institute in Bologna that I attended as an orthopedic resident was one of them, where innovative surgeons such as L. Gui and M. Campanacci were practicing.
Bob D’ Ambrosia from New Orleans was always fascinated and interested with new techniques or implants. In the mid 80s he took me to Strasbourg, France to observe firsthand the results of the modified Kuntscher nail that Arsene Grosse had developed, the G-K nail.
Subsequently, I exchanged Ilizarov’s know-how with nailing technique pearls in Memphis with Charlie Taylor, of the closed-section Russell-Taylor nail.
Then I had the opportunity to learn the tip and tricks of IM nailing directly from the TIO Editor-in-Chief, Bruce Browner, in Houston, in the late 80s, working at Hermann Hospital. Dr Browner was introduced to the system by “Sig” Hansen from Seattle and subsequently mastered his experience at Shock Trauma in Baltimore with colleagues such as Brumback, Burgess, and Poka. Thus, not only I learned from the masters, but I have been a first-line spectator of historical changes in intramedullary stabilization of long bone fracture with reamed nails.
Intramedullary nailing, truly one of my passions in orthopedic traumatology, remains a challenging art, an act of surgery that is performed daily on thousands of individuals all over the globe and where no single fracture is identical to the other. Major successions of changes and improvements have been made in nail design, metallurgy, and radiographic imaging. Still, preoperative planning, positioning of the patient and selection of treatment options continue to remain of paramount importance. This issue of Techniques in Orthopaedics contains the first of two parts dedicated to “Updates on Intramedullary Nailing.” I have selected some of the most comprehensive new aspects of intramedullary nailing, in traumatology as well as in reconstructive surgery. An international faculty shares it expertise, presenting new management approaches to help understanding and solving old problems, from limb lengthening to stabilization of femur, tibia, and femoral neck fractures. Articles that discuss up-to-date clinical evidence of compartment syndrome as well as original improved contemporary technical optional approach for tibia fractures are included. Contributions from Europe in the field of antibiotic-coated implants as well as the latest on lengthening over a nail are presented.
A major thank you goes to Bruce Browner, who never ceases to impress me with his extraordinary, contagious enthusiasm about new projects. I hope that I have been able to pass it myself to some other young orthopedic trauma surgeon.
This two-part TIO series is dedicated to all those whom I have lost and in particular to Mrs Florence L. Nathan: without her I would have not been where I am and a lot might have not been achieved.