Current concepts in intramedullary nailing.

The past decade has seen a dramatic increase in the use of intramedullary nailing for fracture manage- ment. Increased availability of new techniques and instrumentation have contributed to the continuing expansion of applications for intramedullary nailing. The introduction and availability of image intensi- fiers into American hospitals has also led to the popularization of closed intramedullary nailing techniques, and locking nails have expanded the indications of closed intramedullary nailing to unstable long bone frac- tures of the femur, tibia, and humerus. New classes of nails such as the second generation Reconstruction Nail have expanded the use of intramedullary nailing for more proximal femoral fractures. In addition, advances in biomechanical and locking designs have recently led to the use of intramedullary nailing in distal femur fractures and forearm fractures. There is continuing evolution of specialized nails including a self-guiding nail, nails for use in femoral lengthening, and nails used in conjunction with intramedullary osteotomies.