This narrative review traces the history of intramedullary nailing from 16th century Aztec practice through modern technique, examining how nail design, materials, and biomechanical principles evolved alongside advances in anesthesia, infection control, and intraoperative imaging to produce the current standard of care for diaphyseal lower extremity fractures.
When choosing between reamed and unreamed nailing or deciding on immediate weightbearing after femoral nailing, knowing the evidence base matters: reamed interlocked nails carry a 98% union rate in femoral shaft fractures, and larger-diameter high-fatigue-strength nails support immediate weightbearing even in comminuted patterns — principles established decades ago that still drive current protocols.
This narrative review traces the history of intramedullary nailing from 16th century Aztec practice through modern technique, examining how nail design, materials, and biomechanical principles evolved alongside advances in anesthesia, infection control, and intraoperative imaging to produce the current standard of care for diaphyseal lower extremity fractures.
When choosing between reamed and unreamed nailing or deciding on immediate weightbearing after femoral nailing, knowing the evidence base matters: reamed interlocked nails carry a 98% union rate in femoral shaft fractures, and larger-diameter high-fatigue-strength nails support immediate weightbearing even in comminuted patterns — principles established decades ago that still drive current protocols.