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J Am Acad Orthop Surg, Vol 15, No 2, February 2007, 97-106.
© 2007 the American Academy of Orthopaedic Surgeons
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Intramedullary Nailing of the Lower Extremity: Biomechanics and Biology

Matthew R. Bong, MD, Frederick J. Kummer, PhD, Kenneth J. Koval, MD and Kenneth A. Egol, MD

Dr. Bong is Trauma Fellow, Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, NC. Dr. Kummer is Associate Director, Musculoskeletal Research Center, Department of Orthopaedic Surgery, NYU–Hospital for Joint Diseases, New York, NY. Dr. Koval is Vice Chairman, Department of Orthopaedic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH. Dr. Egol is Chief of Fracture Service, Department of Orthopaedic Surgery, NYU–Hospital for Joint Diseases.

None of the following authors or the departments with which they are affiliated has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Bong, Dr. Kummer, Dr. Koval, and Dr. Egol.

Reprint requests: Dr. Egol, NYU–Hospital for Joint Diseases, 14th Floor, 301 East 17th Street, New York, NY 10003.

The intramedullary nail or rod is commonly used for long-bone fracture fixation and has become the standard treatment of most long-bone diaphyseal and selected metaphyseal fractures. To best understand use of the intramedullary nail, a general knowledge of nail biomechanics and biology is helpful. These implants are introduced into the bone remote to the fracture site and share compressive, bending, and torsional loads with the surrounding osseous structures. Intramedullary nails function as internal splints that allow for secondary fracture healing. Like other metallic fracture fixation implants, a nail is subject to fatigue and can eventually break if bone healing does not occur. Intrinsic characteristics that affect nail biomechanics include its material properties, cross-sectional shape, anterior bow, and diameter. Extrinsic factors, such as reaming of the medullary canal, fracture stability (comminution), and the use and location of locking bolts also affect fixation biomechanics. Although reaming and the insertion of intramedullary nails can have early deleterious effects on endosteal and cortical blood flow, canal reaming appears to have several positive effects on the fracture site, such as increasing extraosseous circulation, which is important for bone healing.






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Copyright © 2007 by the American Academy of Orthopaedic Surgeons.