Wong Wei Kang Noah, Tan Wen Po Jonathan, Phua Yue Min Crystal, Min Amelia Tan Gek, Naidu Kishan, Umapathysivam Kandiah, Smitham Peter Jonathan
Adelaide Medical School.
Adelaide Medical School; Department of Orthopedics and Trauma, Royal Adelaide Hospital & Discipline of Orthopedics & Trauma, The University of Adelaide.
Orthop Rev (Pavia). 2021 Jul 10;13(2):25546. doi: 10.52965/001c.25546. eCollection 2021.
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 16 century, with a dramatic increase in novel designs in recent years aiming to further improve intramedullary fixation techniques.
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.
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.
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.
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.
髓内钉是目前治疗长骨干骺端和部分干骺端骨折的金标准。自16世纪发明以来，髓内钉的设计经历了多次修订，近年来新型设计急剧增加，旨在进一步改进髓内固定技术。
梳理骨科手术中髓内钉的演变历程，探讨当前髓内钉的局限性和并发症，并确定可能影响未来设计创新的新型髓内钉。
我们通过在谷歌学术上使用以下关键词进行检索，对骨科髓内钉的现状进行了范围综述。最初由五名独立评审员根据标题和摘要对检索到的出版物和专利进行评估。共检索到52篇论文进行全文审查，并从这些论文中检查参考文献。研究小组内部讨论了结果，并就新型髓内钉达成了共识。
新型髓内钉设计包括分别针对骨折愈合和围手术期感染风险的生长因子和/或抗菌涂层；避免使用锁定螺钉的微创可扩张髓内钉；以及具有理论上更优生物力学性能且在CT和MRI成像上无伪影的新型材料，如碳纤维。
近年来提出的新型髓内钉总体目标是通过减少手术时间和辐射暴露、促进骨折愈合或监测骨癌进展来改进髓内固定技术。然而，要解决这些复杂问题还需要更多的研究和开发。
