- by Dr. Robert C. Martin
Every year in the United States thousands of people fracture their femur (thigh bone) or tibia (leg bone). In most cases these fractures are stabilized with rods placed down the center or medullary canal of the bone to act as a stent or internal brace. This operative treatment termed intramedullary (IM) rodding is minimally invasive, obviates the need for a cast or bed rest with traction and dramatically reduces the complications associated with these injuries such as stiffness, muscle loss, pneumonia, fat or blood clots to the lung and death. These patients are benefiting from one of the most significant scientific and technological developments this century in orthopedic trauma treatment and this year marks the 100th anniversary of the birth of Gerhard Kuntscher who pioneered the use of IM rodding.
Gerhard Kuntscher was born in Zwickau, Germany and began his academic career focused on engineering. He soon shifted his attention to medicine and in particular the process of fracture healing. Kuntscher’s interest led him to animal experiments in the early 1930's in which he inserted wires and other objects into the intramedullary (IM) canal (which is the soft marrow center) of bones. He observed new bone formation around these wires. Kuntscher’s experiments then evolved to using intramedullary pins to stabilize fractures in animals that he observed would heal rapidly. This validated his theory IM stabilization would work.
This theory was counter to other accepted methods of fracture stabilization of that time. The most common method of the time was bed rest with traction but the Swiss calling for rigid fixation of the bone with metal plates and screws was rapidly growing popular.
In November 1939, Kuntscher performed his first IM rodding on a patient at the University of Kiel's Department of Surgery. The first IM rod recipient was a 35-year-old shipbuilding engineer who fell onto a dock and fractured his femur. He was reported to be able walk on his leg a few days after surgery.
Shortly thereafter, Kuntscher published and presented his work at the Annual Congress of the German Surgical Society. His revolutionary ideas caught the interest as well as the ire of the group, with many calling for him to be forbidden from performing future rodding procedures. There was great skepticism a steel rod inside the bone would not allow it to heal properly.
The outbreak of World War II saw Kuntscher serving as medical officer in the German army from 1941 to 1945. He served on the eastern front where he saw an abundance of femur fractures. Despite the fact that the German military disapproved of his concepts he treated thousands of patients with IM rodding.
Because of his isolation during the war Kuntscher’s concepts of fracture treatment did not spread to the rest of the world until repatriated prisoners of war returned to their home carrying Kuntscher's legacy in the form of steel rods in their legs. Surgeons in the US and France were first shocked then intrigued by these huge rods seen on patient x-rays along with the patient stories of rapid healing. This intrigue led many to seek out information on this revolutionary form of treatment. Despite this interest it took another 20 years before improvements in the design of the rod and advancements in x-ray machines used in the operating room allowed the use of IM rodding to gain wide acceptance.
Today many options are available for treatment of femur and tibia fractures but still none is used more commonly and with greater success than the IM rod. Hopefully you will never have to take advantage of Dr. Kuntscher's breakthrough technology but in case you do now you know whom to thank.