Gerhard Küntscher, the father of intramedullary nailing, introduced his nails to his German colleagues in 1939. He was roundly ridiculed for operating on a fracture. Traction in a hospital bed for 6 weeks was the standard of care at the time. Operating on fractures had been attempted many times before this and almost always met with failure. The perceived pitfalls of operating on a fracture and introducing a metal rod in the medullary canal were:
- Nerve and/or blood vessel injury
- Introduction of germs (infection)
- Malreduction/malalignment
- Nonunion
- Hardware failure
Küntscher was born in Zwickau, Germany in 1900. He studied medicine at the University of Leipzig and the University of Kiel. After graduation, he worked as a general surgeon. In 1939, he performed the first intramedullary nail procedure at the University of Hamburg’s Department of Surgery. In the early days of World War II, while in the German military, he was stationed in Finland where his “Küntscher Technique” was gaining traction (no pun intended!) within the orthopedic community.
He referred to his first nail as his Marrow Nail. It was stainless steel with a clover leaf cross section that allowed the nail to compress as it was inserted and expand in the canal. It held the bone fragments in alignment and resisted rotation.
The war raged on, and as a military surgeon, he was treating German pilots with fractured femurs and eventually allied prisoners of war (POW’s). When the POWs returned home the speculation was that they had been tortured until the former patients of Dr Küntscher related stories of being out of bed and walking just a few days post operation.
Remember, a femur fracture on the battlefield most likely was fatal. If you did make it to a hospital alive you spent six weeks in traction. According to a U.S. Naval Bulletin after the war, the use of these nails reduced patient recovery time by more than a year (1).
The Nuremberg Doctors’ Trial of 1947 was a military tribunal that prosecuted 23 German doctors and scientists who were accused of crimes against humanity. Dr Küntscher was captured and held in an allied POW camp until 1947. If he had not been so successful in treating the POWs he might have been charged. He was not. The fact that his name comes up in the literature of those times is amazing.
Today, the procedure that was known as the Küntscher Technique is the standard of care around the world. It may have taken a while in the United States though, since traction was still being used to treat femur fractures in the late 1970’s.
Dr Küntscher was ostracized by his colleagues and not widely recognized for his groundbreaking fracture treatment until after his death in 1972.
This is a Youtube video of a procedure dated 1942!
The video is titled “G.Kuntscher 1942”
(1) Habler C. “Experience with the marrow nail operation according to the principles of Keuntscher.” US Nav Med Bull. 1949;49:423. Google Scholar