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The understanding of this field establishes an adequate background for forthcoming research and allows to infer on the path for future developments on intramedullary nailing. It was not until the 1940s, with the revolutionary K\u00fcntscher intramedullary nailing design, that this method was recognized as a widespread medical procedure. Such achievement was established based on the foundations created from intuition-based experiments and the first biomechanical ideologies. The nail evolved from allowing alignment and stability through press-fit fixation with nail-cortical wall friction to the nowadays nail stability achieved through interlocking screws mechanical linkage between nail and bone. Important landmarks during nail evolution comprise the introduction of flexible reaming, the progress from slotted to non-slotted nails design, the introduction of nail \u2018dynamization\u2019 and the use of titanium alloys as a new nail material. Current biomechanical improvement efforts aim to enhance the bone\u2013intramedullary nail system stability. We suggested that benefit would be attained from a better understanding of the ideal mechano-biological environment at the fracture site, and future improvements will emerge from combining mechanics and biological tools.<\/jats:p>","DOI":"10.1177\/0954411919827044","type":"journal-article","created":{"date-parts":[[2019,3,19]],"date-time":"2019-03-19T08:20:44Z","timestamp":1552983644000},"page":"295-308","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":53,"title":["Intramedullary nailing biomechanics: Evolution and challenges"],"prefix":"10.1177","volume":"233","author":[{"given":"Natacha","family":"Rosa","sequence":"first","affiliation":[{"name":"Department of Mechanical Engineering, Faculty of Engineering, University of Porto, Porto, Portugal"}]},{"given":"Miguel","family":"Marta","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Centro Hospitalar de S\u00e3o Jo\u00e3o, Porto, Portugal"}]},{"given":"M\u00e1rio","family":"Vaz","sequence":"additional","affiliation":[{"name":"Department of Mechanical Engineering, Faculty of Engineering, University of Porto, Porto, Portugal"},{"name":"INEGI, Faculty of Engineering, University of Porto, Porto, Portugal"}]},{"given":"Sergio M O","family":"Tavares","sequence":"additional","affiliation":[{"name":"INEGI, Faculty of Engineering, University of Porto, Porto, Portugal"}]},{"given":"Ricardo","family":"Simoes","sequence":"additional","affiliation":[{"name":"Polytechnic Institute of C\u00e1vado and Ave, Barcelos, Portugal"},{"name":"Institute for Polymers and Composites IPC\/I3N, University of Minho, Guimar\u00e3es, Portugal"}]},{"given":"Fern\u00e3o D","family":"Magalh\u00e3es","sequence":"additional","affiliation":[{"name":"LEPABE\u2013Faculdade de Engenharia, Universidade do Porto, Rua Dr. Roberto Frias, Portugal"}]},{"given":"Antonio Torres","family":"Marques","sequence":"additional","affiliation":[{"name":"Department of Mechanical Engineering, Faculty of Engineering, University of Porto, Porto, Portugal"}]}],"member":"179","published-online":{"date-parts":[[2019,3,19]]},"reference":[{"key":"bibr1-0954411919827044","doi-asserted-by":"publisher","DOI":"10.1007\/s00402-009-0819-7"},{"key":"bibr2-0954411919827044","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2009.01.117"},{"key":"bibr3-0954411919827044","doi-asserted-by":"publisher","DOI":"10.1016\/j.jajs.2014.06.007"},{"key":"bibr4-0954411919827044","first-page":"1","volume-title":"Practice of intramedullary locked nails: scientific basis and standard techniques recommended by AIOD","author":"Kempf I","year":"2002","edition":"2"},{"key":"bibr5-0954411919827044","doi-asserted-by":"publisher","DOI":"10.1007\/978-1-4471-6612-2_1"},{"key":"bibr6-0954411919827044","first-page":"94","volume":"64","author":"Bong MR","year":"2006","journal-title":"Bull NYU Hosp Jt Dis"},{"key":"bibr7-0954411919827044","doi-asserted-by":"publisher","DOI":"10.1007\/PL00002445"},{"key":"bibr8-0954411919827044","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-195234030-00002"},{"key":"bibr9-0954411919827044","volume-title":"Biomechanics of musculoskeletal injury","author":"Whiting WC","year":"2008","edition":"2"},{"key":"bibr10-0954411919827044","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1890.02410140021002d"},{"key":"bibr11-0954411919827044","doi-asserted-by":"publisher","DOI":"10.1177\/095952876404700113"},{"key":"bibr12-0954411919827044","first-page":"243","volume":"24","author":"Hoglund EJ","year":"1917","journal-title":"Surg Gynecol Obstet"},{"key":"bibr13-0954411919827044","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-189601000-00059"},{"key":"bibr14-0954411919827044","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.305.6868.1534"},{"key":"bibr15-0954411919827044","doi-asserted-by":"publisher","DOI":"10.1007\/s00402-010-1082-7"},{"key":"bibr16-0954411919827044","first-page":"410","volume":"34","author":"Bircher H","year":"1886","journal-title":"Arch Klin Chir"},{"key":"bibr17-0954411919827044","doi-asserted-by":"publisher","DOI":"10.3109\/17453674.2014.937924"},{"key":"bibr18-0954411919827044","volume-title":"Internal fixation in osteoporotic bone","author":"An YH","year":"2011"},{"key":"bibr19-0954411919827044","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-189307000-00019"},{"key":"bibr20-0954411919827044","first-page":"1","volume":"8","author":"Nicolaysen J","year":"1897","journal-title":"Nord Med Ark"},{"key":"bibr21-0954411919827044","volume-title":"A manual of orthopaedic terminology","author":"Nelson FRT","year":"2015","edition":"8"},{"key":"bibr22-0954411919827044","first-page":"421","volume":"19","author":"Gluck T","year":"1881","journal-title":"Implantation von fremdkorpern. 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