International Orthopaedics (SICOT) DOI 10.1007/s00264-014-2320-3
ORTHOPAEDIC HERITAGE
The history of internal fixation of proximal femur fractures Ernst Pohl—the genius behind Jan Bartoníček & Stefan Rammelt
Received: 5 March 2014 / Accepted: 6 March 2014 # Springer-Verlag Berlin Heidelberg 2014
Abstract The most frequently used implants for internal fixation of proximal femoral fractures are currently the dynamic hip screw and the intramedullary hip nail. However, little has been written about one of the pioneers in this field, a German genius, the designer Ernst Pohl (1876–1962). Without his involvement the concepts of intramedullary nailing coined by Gerhard Küntscher, Richard Maatz and other surgeons could hardly have been implemented. Through his achievements Pohl has rightly merited his pre-eminent position in the history of bone surgery. This article outlines the extraordinary contribution of Ernst Pohl to the development of skeletal surgery and radiology, as well as other medical disciplines. Keywords History of internal fixation . Ernst Pohl . Dynamic hip screw . Y-Nagel . Proximal femoral nail The most frequently used implants for internal fixation of proximal femoral fractures are currently the dynamic hip screw (DHS) and the intramedullary hip nail (IMHN). However, little has been written about one of the pioneers in this field, a German genius, the designer Ernst Pohl (Fig. 1).
Ernst Pohl 1876–1962 Ernst Pohl was born on 12 December 1876 in Stralsund (North Germany), the third of eight children. In 1891, he J. Bartoníček (*) Department of Orthopaedic Trauma, First Faculty of Medicine, Central Military Hospital, Charles University, U Vojenské nemocnice 1200, 169 02 Prague 6, Czech Republic e-mail: [email protected] S. Rammelt UniversitätsCentrum für Orthopädie & Unfallchirurgie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany e-mail: [email protected]
started work as a merchant, but his career changed after his hand-made insoles attracted the attention of Professor Heinrich Helferich (1851–1945) in Greifswald (North Germany). Helferich recognized Pohl’s talent and, after inviting him to work at the Christian-Albrechts-University in 1899, he took Pohl with him to Kiel (North Germany). In Kiel, Helferich charged Pohl with the management of MedicoMechanicum, actually an orthopaedic gym. In 1902, Pohl and Jungnickel founded a company manufacturing surgical instruments. From 1904, the official title of the company was the Ernst Pohl, Kiel Company. At that time, Pohl, brilliant and self-taught, was intrigued by radiological devices, perhaps inspired by Heinrich Helferich, who was one of the first to publish, in 1897, radiographs of fractures, in the 3rd edition of his Atlas of Fractures [1]. Another significant impulse came when Pohl started to cooperate with Ernst Meyer, who later became the first Associate Professor for Radiology in Germany. One of the goals of Pohl’s efforts was the reduction of both patients’ and the operating staff’s X-ray exposure. In the 1920s, he invented the Omniscope that could be rotated around the patient. This brought him worldwide fame. Over the years, Pohl registered more than 150 patents related to radiological devices and surgical instruments. Some of them he sold to other companies, e.g. Siemens, who subsequently profited from them. In addition, he worked on the development of a pump for blood transfusion and the principle invented by Pohl has been used in dialysis machines to this day. In 1947, Pohl was, for his merits, awarded an honorary doctorate of the Faculty of Medicine (Dr.med.h.c.) of the Christian-Albrechts-University and was also appointed a Corresponding Member of the German Radiological Society (Deutsche Röntgengesellschaft). In the 1930s, Pohl began to collaborate with Gerhard Küntscher (1900–1972), then subsequently with Richard
International Orthopaedics (SICOT)
as a material for internal fixation implants. In 1972, restructuring of Austenal resulted in the establishment of Howmedica, a subsequently prominent world manufacturer of orthopaedic implants and instruments. In 1998, Howmedica was acquired by Stryker.
Y-Nail (Y-Nagel) and its successors (IMHN)
Fig. 1 Ernst Pohl (1876–1962)
Maatz (1905–1989). Küntscher, who later entered the anthology of skeletal surgery as the father of modern intramedullary nailing, would never have been able to implement his ideas without the technical foundations provided to him by Pohl. This fact was clearly documented in the Küntscher’s and Maatz’s book of 1945 [2]. A wide range of shapes of nails, and instruments for their insertion, including sophisticated targeting devices, were the achievements of Ernst Pohl. In 1957, Pohl designed a flexible intramedullary electric drill— the Lentodrill. Pohl’s contribution to the development of intramedullary fixation was repeatedly acknowledged by both Küntscher [3] and Maatz [4] in their various publications. Ernst Pohl died in Kiel on 2 November 1962, shortly before his 86th birthday. His company was sold in 1964 to Austenal, an enterprise belonging to the Pfizer empire. Austenal was known particularly for development of Vitallium alloy in 1929. Venable and Stuck [5] tested it successfully, in 1935,
Fig. 2 Schema of Y-nail (Y-Nagel) (adapted after [2])
The first prototype of an intramedullary implant for osteosynthesis of trochanteric fractures, known as the “YNagel” was designed by Pohl in the early 1940s (Fig. 2), probably inspired by the principle of two crossed screws described by Lambotte [6] in 1913 (Fig. 3). Küntscher [7] published the first experience in the use of Y-Nail, including a radiograph, in 1940 (Fig. 4). A detailed description of the implant and the necessary instrumentation may be found in the publication of 1945 (Fig. 5). At the end of the 1950s, the design of the nail was changed (Fig. 6) [3]. The Y-Nail was used in Germany until the 1970s, but never found popularity in other countries [8–11]. In 1967 in the Unites States, Zickel [12] introduced a nail similar to the original Küntscher’s Y-nail for treatment of high subtrochanteric fractures (Fig. 7). Its use, however, remained limited. A change came as late as in 1986 in France when Grosse, Tanglang and Kempf, in cooperation with Howmedica, developed the successor to the original Ernst Pohl’s company, the so-called Gamma nail [13, 14]. The Gamma nail became the most widely-used IMHN for trochanteric fractures worldwide. Many authors travelled their learning curves with such an implant, which was sadly attended with a relatively high incidence of complications. Some of these complications were addressed by an upgraded design of the proximal femoral nail (PFN) of Synthes. These implants were followed by a number of other IMHNs with various design modifications.
International Orthopaedics (SICOT)
Fig. 3 Lambotte’s method for the treatment of trochanteric fractures [7]
History of dynamic hip screw Robert Danis, in 1934, was the first to design a dynamic implant for stabilization of femoral neck fractures, although he never put it into practice [15]. The first clinically successful sliding hip screw was patented by Ernst Pohl in Germany in 1951 [16] (Fig. 8). The driver for the development of an implant, later called “Pohlsche Lasche” (“Pohl’s buttstrap”), was probably the fact that, in 1944, Pohl’s mother died from complications of a nonoperatively treated fracture of the proximal femur. Pohl’s aim was “to construct an implant which could allow stable fracture fixation, early mobilization and the best condition for
Fig. 4 Radiograph of Küntscher’s first case treated with Y-nail [7]
Fig. 5 Instruments for the insertion of the Y-nail (adapted after [2])
fracture healing” [17]. This implant comprised a two-holed side-plate with a plate/barrel angle of 135°. The patent was registered in the United States in 1952. Schumpelick and Jansen published their first experience with the use of this implant in German in 1953 [18] and then in 1955 in the English literature [19]. In 1955, Schumpelick [20] described a new implant, the so-called “verbundene Doppelschraube”, developed by Pohl for medial fractures of the femoral neck. This system was patented in the United States in 1956 (Fig. 9).
Fig. 6 Modification of the Y-nail (adapted after [3])
International Orthopaedics (SICOT)
Fig. 7 Zickel-nail (adapted after [12])
Fig. 8 Pohl’s patent of the “Pohlsche Lasche” in Germany
In the same period, i.e., in 1955, Willis L. Pugh [21] developed a similar 120° angled implant with a tri-flanged nail instead of the lag screw. In 1957, John Charnley et al. [22] introduced a 120° dynamic sliding screw of a highly sophisticated construction for intracapsular femoral neck fractures. In the United States, Pohl’s implant inspired the Richards Company, at the end of the 1950s, to develop a dynamic implant, later known as the Richards classic hip screw, with plate/barrel angles of both 135 and 150°. Kay Clawson, a pioneer in its use, began to implant it in 1959, and in 1964 he published the first results [23]. However, AO/ASIF, founded in 1958, preferred fixed angled blade-plates for the treatment of proximal femur fractures, which held back further development of dynamic implants in Europe until the 1970s [24]. At the end of the 1960s, surgical treatment of trochanteric fractures underwent a crisis. It became evident that the existing implants, such as the Jewett nail, or the AO 130° angled blade-plate, were associated with high incidences of biomechanical failure [25–27]. As an alternative, nonanatomical reconstruction of a different type was proposed, based on the principle of resection of the comminuted zone, medial translation of the femoral shaft and valgus reduction of the proximal fragment [25–27].
International Orthopaedics (SICOT) Fig. 9 Pohl’s patent of the “conjoined double screws” in the United States
At the end of the 1970s, Ender’s condylo-cephalic nailing became popular throughout the world [28, 29]. At the end of the 1980s, however, it became obvious that Ender’s nailing was also burdened by a high incidence of complications and the method was gradually abandoned. At that time, the dynamic hip screw (DHS) began to gain ground and, at the end of the 1980s, it became a standard implant for the treatment of
trochanteric fractures [30, 31]. The approach of AO/ASIF to the DHS was highly reserved for a long time as the principle of its design did not correspond to AO/ASIF principles [24]. Only under the market pressure were the benefits of the DHS finally recognized and AO/ASIF introduced their own construction of this implant, including the trochanteric support plate [32].
International Orthopaedics (SICOT)
Significance of Ernst Pohl The above-mentioned facts outline the extraordinary contribution of Ernst Pohl to the development of skeletal surgery and radiology, as well as other medical disciplines. Without his involvement the concepts of Gerhard Küntscher, Richard Maatz and other surgeons could hardly have been implemented. The two basic implant designs used today for the treatment of trochanteric fractures were originally developed by Pohl. Through his achievements Pohl has rightly merited his preeminent position in the history of bone surgery.
References 1. Helferich H (1897) Atlas und Grundriss der traumatischen Frakturen und Luxationen, 3rd edn. Lehmann, München 2. Küntscher G, Maatz R (1945) Technik der Marknagelung. Thieme, Leipzig 3. Küntscher G (1962) Praxis der Marknagelung. Schattauer, Stuttgart 4. Maatz R, Lentz W, Arens W, Beck H (eds) (1986) Intramedullary nailing and other intramedullary osteosyntheses. Saunders/ Schattauer, Philadelphia 5. Venable CS, Stuck WG (1947) The internal fixation of fractures. Thomas, Springfield 6. Lambotte A (1913) Chirurgie opératoire des fractures. Masson, Paris 7. Küntscher G (1940) Die Marknagelung von Knochenbrüchen. Arch Klin Chir 200:443–455 8. Standenat E, Schauer H, Prinsti K (1970) Indikation und Technik des Y-Nagels nach Küntscher. H Unfallheilkunde 106:56-5752-54 9. Fischer S (1970) Erfahrung mit der Y-Nagelung nach Küntscher. H Unfallheilkunde 106:54–56 10. Giebel MG (1970) Erfahurngen mit dem Trochanternagel nach Küntscher. H Unfallheilk 106:56–57 11. Bartoníček J, Douša P, Jehlička D (2001) History of intramedullary nailing of proximal femur fractures. Acta Chir Orthop Tramatol Čech 68:59–62 12. Zickel RE (1967) A new fixation device for subtrochanteric fractures of the femur. A preliminary report. Clin Orthop Rel Res 54:115–123 13. Kempf I, Grosse A, Taglang G, Favreul E (1993) Le clou gamma dans le traitment á foyer fermé des fractures trochantériennes. Resultats et indications á propos d’une série de 121 cas. Rev Chir Orthop 79:29–40
14. Kempf I, Taglang G (2005) The gamma nail – historical background. Osteo Trauma Care 13:2–6 15. Danis R (1949) Théorie et practique de l’ostéosynthése. Masson, Paris 16. Pohl E (1951) Verbindungsvorrichtung für gelenkanahe Knochenbrüche. German Patent Nr. 918531, 7 December 1951 17. Dittel KK, Rapp M (eds) (2008) The double dynamic Martin screw (DMS). Steinkopf Verlag, Stuttgart 18. Schumpelick W, Jantzen PM (1953) Die Versorgung der Frakturen im Trochanterbereich mit einer nichtsperrenden Laschenschraube. Chirurg 24:506–509 19. Schumpelick W, Jantzen PM (1955) A new principle in the operative treatment of trochanteric fractures of the femur. J Bone Joint Surg Am 37-A:693–698 20. Schumpelick W (1955) Die stabile Osteosynthese des medialen Schenkelhalsbruches mit der verbundenen Doppelschraube. Chirurg 26:131–135 21. Pugh WL (1955) A self-adjusting nail-plate for fractures about the hip joint. J Bone Joint Surg Am 37-A:1085–1093 22. Charnley J, Blockley NJ, Purser DW (1957) The treatment of displaced fractures of the neck of the femur by compression. J Bone Joint Surg (Br) 39-B:45–65 23. Clawson DK (1964) Trochanteric fractures treated by the sliding screw plate fixation method. J Trauma 4:737–752 24. Schlich T (2002) Surgery, science and industry. Palgrave Macmillan, Houndmills 25. Dimon JH, Hughston JC (1967) Unstable intertrochanteric fractures of the hip. J Bone Joint Surg Am 49-A:440–450 26. Debrunner A, Čech O (1969) Biomechanik der Osteosynthese pertrochanter Frakturen. Z Orthop 107:516–527 27. Sarmiento A, Williams EM (1970) Unstable intertrochanteric fracture: treatment with a valgus osteotomy and I-beam nail-plate: A preliminary report of one hundred cases. J Bone Joint Surg Am 52-A: 1309–1318 28. Simon-Weidner R (1969) Die Fixierung trochanterer Brüche mit multiplen elastischen Rundnägeln nach Simon-Weidner. H Unfallheilkunde 106:60–61 29. Ender J, Simon-Weidner R (1970) Die Fixierung trochanterer Brüche mit runden elastischen Condylennageln. Acta Chir Austriaca 1:40–42 30. Sahlstrand T (1974) The Richards compression and sliding hip screw system in the treatment of intertrochanteric fractures. Acta Orthop Scand 45:213–219 31. Ecker ML, Joyce JJ, Kohl J (1975) The treatment of trochanteric hip fractures using a compression screw. J Bone Joint Surg Am 57-A:23– 27 32. Regazzoni P, Rüedi T, Winquist R, Allgöwer M (1985) The dynamic hip screw implant system. Springer, Berlin
ORTHOPAEDIC HERITAGE
The history of internal fixation of proximal femur fractures Ernst Pohl—the genius behind Jan Bartoníček & Stefan Rammelt
Received: 5 March 2014 / Accepted: 6 March 2014 # Springer-Verlag Berlin Heidelberg 2014
Abstract The most frequently used implants for internal fixation of proximal femoral fractures are currently the dynamic hip screw and the intramedullary hip nail. However, little has been written about one of the pioneers in this field, a German genius, the designer Ernst Pohl (1876–1962). Without his involvement the concepts of intramedullary nailing coined by Gerhard Küntscher, Richard Maatz and other surgeons could hardly have been implemented. Through his achievements Pohl has rightly merited his pre-eminent position in the history of bone surgery. This article outlines the extraordinary contribution of Ernst Pohl to the development of skeletal surgery and radiology, as well as other medical disciplines. Keywords History of internal fixation . Ernst Pohl . Dynamic hip screw . Y-Nagel . Proximal femoral nail The most frequently used implants for internal fixation of proximal femoral fractures are currently the dynamic hip screw (DHS) and the intramedullary hip nail (IMHN). However, little has been written about one of the pioneers in this field, a German genius, the designer Ernst Pohl (Fig. 1).
Ernst Pohl 1876–1962 Ernst Pohl was born on 12 December 1876 in Stralsund (North Germany), the third of eight children. In 1891, he J. Bartoníček (*) Department of Orthopaedic Trauma, First Faculty of Medicine, Central Military Hospital, Charles University, U Vojenské nemocnice 1200, 169 02 Prague 6, Czech Republic e-mail: [email protected] S. Rammelt UniversitätsCentrum für Orthopädie & Unfallchirurgie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany e-mail: [email protected]
started work as a merchant, but his career changed after his hand-made insoles attracted the attention of Professor Heinrich Helferich (1851–1945) in Greifswald (North Germany). Helferich recognized Pohl’s talent and, after inviting him to work at the Christian-Albrechts-University in 1899, he took Pohl with him to Kiel (North Germany). In Kiel, Helferich charged Pohl with the management of MedicoMechanicum, actually an orthopaedic gym. In 1902, Pohl and Jungnickel founded a company manufacturing surgical instruments. From 1904, the official title of the company was the Ernst Pohl, Kiel Company. At that time, Pohl, brilliant and self-taught, was intrigued by radiological devices, perhaps inspired by Heinrich Helferich, who was one of the first to publish, in 1897, radiographs of fractures, in the 3rd edition of his Atlas of Fractures [1]. Another significant impulse came when Pohl started to cooperate with Ernst Meyer, who later became the first Associate Professor for Radiology in Germany. One of the goals of Pohl’s efforts was the reduction of both patients’ and the operating staff’s X-ray exposure. In the 1920s, he invented the Omniscope that could be rotated around the patient. This brought him worldwide fame. Over the years, Pohl registered more than 150 patents related to radiological devices and surgical instruments. Some of them he sold to other companies, e.g. Siemens, who subsequently profited from them. In addition, he worked on the development of a pump for blood transfusion and the principle invented by Pohl has been used in dialysis machines to this day. In 1947, Pohl was, for his merits, awarded an honorary doctorate of the Faculty of Medicine (Dr.med.h.c.) of the Christian-Albrechts-University and was also appointed a Corresponding Member of the German Radiological Society (Deutsche Röntgengesellschaft). In the 1930s, Pohl began to collaborate with Gerhard Küntscher (1900–1972), then subsequently with Richard
International Orthopaedics (SICOT)
as a material for internal fixation implants. In 1972, restructuring of Austenal resulted in the establishment of Howmedica, a subsequently prominent world manufacturer of orthopaedic implants and instruments. In 1998, Howmedica was acquired by Stryker.
Y-Nail (Y-Nagel) and its successors (IMHN)
Fig. 1 Ernst Pohl (1876–1962)
Maatz (1905–1989). Küntscher, who later entered the anthology of skeletal surgery as the father of modern intramedullary nailing, would never have been able to implement his ideas without the technical foundations provided to him by Pohl. This fact was clearly documented in the Küntscher’s and Maatz’s book of 1945 [2]. A wide range of shapes of nails, and instruments for their insertion, including sophisticated targeting devices, were the achievements of Ernst Pohl. In 1957, Pohl designed a flexible intramedullary electric drill— the Lentodrill. Pohl’s contribution to the development of intramedullary fixation was repeatedly acknowledged by both Küntscher [3] and Maatz [4] in their various publications. Ernst Pohl died in Kiel on 2 November 1962, shortly before his 86th birthday. His company was sold in 1964 to Austenal, an enterprise belonging to the Pfizer empire. Austenal was known particularly for development of Vitallium alloy in 1929. Venable and Stuck [5] tested it successfully, in 1935,
Fig. 2 Schema of Y-nail (Y-Nagel) (adapted after [2])
The first prototype of an intramedullary implant for osteosynthesis of trochanteric fractures, known as the “YNagel” was designed by Pohl in the early 1940s (Fig. 2), probably inspired by the principle of two crossed screws described by Lambotte [6] in 1913 (Fig. 3). Küntscher [7] published the first experience in the use of Y-Nail, including a radiograph, in 1940 (Fig. 4). A detailed description of the implant and the necessary instrumentation may be found in the publication of 1945 (Fig. 5). At the end of the 1950s, the design of the nail was changed (Fig. 6) [3]. The Y-Nail was used in Germany until the 1970s, but never found popularity in other countries [8–11]. In 1967 in the Unites States, Zickel [12] introduced a nail similar to the original Küntscher’s Y-nail for treatment of high subtrochanteric fractures (Fig. 7). Its use, however, remained limited. A change came as late as in 1986 in France when Grosse, Tanglang and Kempf, in cooperation with Howmedica, developed the successor to the original Ernst Pohl’s company, the so-called Gamma nail [13, 14]. The Gamma nail became the most widely-used IMHN for trochanteric fractures worldwide. Many authors travelled their learning curves with such an implant, which was sadly attended with a relatively high incidence of complications. Some of these complications were addressed by an upgraded design of the proximal femoral nail (PFN) of Synthes. These implants were followed by a number of other IMHNs with various design modifications.
International Orthopaedics (SICOT)
Fig. 3 Lambotte’s method for the treatment of trochanteric fractures [7]
History of dynamic hip screw Robert Danis, in 1934, was the first to design a dynamic implant for stabilization of femoral neck fractures, although he never put it into practice [15]. The first clinically successful sliding hip screw was patented by Ernst Pohl in Germany in 1951 [16] (Fig. 8). The driver for the development of an implant, later called “Pohlsche Lasche” (“Pohl’s buttstrap”), was probably the fact that, in 1944, Pohl’s mother died from complications of a nonoperatively treated fracture of the proximal femur. Pohl’s aim was “to construct an implant which could allow stable fracture fixation, early mobilization and the best condition for
Fig. 4 Radiograph of Küntscher’s first case treated with Y-nail [7]
Fig. 5 Instruments for the insertion of the Y-nail (adapted after [2])
fracture healing” [17]. This implant comprised a two-holed side-plate with a plate/barrel angle of 135°. The patent was registered in the United States in 1952. Schumpelick and Jansen published their first experience with the use of this implant in German in 1953 [18] and then in 1955 in the English literature [19]. In 1955, Schumpelick [20] described a new implant, the so-called “verbundene Doppelschraube”, developed by Pohl for medial fractures of the femoral neck. This system was patented in the United States in 1956 (Fig. 9).
Fig. 6 Modification of the Y-nail (adapted after [3])
International Orthopaedics (SICOT)
Fig. 7 Zickel-nail (adapted after [12])
Fig. 8 Pohl’s patent of the “Pohlsche Lasche” in Germany
In the same period, i.e., in 1955, Willis L. Pugh [21] developed a similar 120° angled implant with a tri-flanged nail instead of the lag screw. In 1957, John Charnley et al. [22] introduced a 120° dynamic sliding screw of a highly sophisticated construction for intracapsular femoral neck fractures. In the United States, Pohl’s implant inspired the Richards Company, at the end of the 1950s, to develop a dynamic implant, later known as the Richards classic hip screw, with plate/barrel angles of both 135 and 150°. Kay Clawson, a pioneer in its use, began to implant it in 1959, and in 1964 he published the first results [23]. However, AO/ASIF, founded in 1958, preferred fixed angled blade-plates for the treatment of proximal femur fractures, which held back further development of dynamic implants in Europe until the 1970s [24]. At the end of the 1960s, surgical treatment of trochanteric fractures underwent a crisis. It became evident that the existing implants, such as the Jewett nail, or the AO 130° angled blade-plate, were associated with high incidences of biomechanical failure [25–27]. As an alternative, nonanatomical reconstruction of a different type was proposed, based on the principle of resection of the comminuted zone, medial translation of the femoral shaft and valgus reduction of the proximal fragment [25–27].
International Orthopaedics (SICOT) Fig. 9 Pohl’s patent of the “conjoined double screws” in the United States
At the end of the 1970s, Ender’s condylo-cephalic nailing became popular throughout the world [28, 29]. At the end of the 1980s, however, it became obvious that Ender’s nailing was also burdened by a high incidence of complications and the method was gradually abandoned. At that time, the dynamic hip screw (DHS) began to gain ground and, at the end of the 1980s, it became a standard implant for the treatment of
trochanteric fractures [30, 31]. The approach of AO/ASIF to the DHS was highly reserved for a long time as the principle of its design did not correspond to AO/ASIF principles [24]. Only under the market pressure were the benefits of the DHS finally recognized and AO/ASIF introduced their own construction of this implant, including the trochanteric support plate [32].
International Orthopaedics (SICOT)
Significance of Ernst Pohl The above-mentioned facts outline the extraordinary contribution of Ernst Pohl to the development of skeletal surgery and radiology, as well as other medical disciplines. Without his involvement the concepts of Gerhard Küntscher, Richard Maatz and other surgeons could hardly have been implemented. The two basic implant designs used today for the treatment of trochanteric fractures were originally developed by Pohl. Through his achievements Pohl has rightly merited his preeminent position in the history of bone surgery.
References 1. Helferich H (1897) Atlas und Grundriss der traumatischen Frakturen und Luxationen, 3rd edn. Lehmann, München 2. Küntscher G, Maatz R (1945) Technik der Marknagelung. Thieme, Leipzig 3. Küntscher G (1962) Praxis der Marknagelung. Schattauer, Stuttgart 4. Maatz R, Lentz W, Arens W, Beck H (eds) (1986) Intramedullary nailing and other intramedullary osteosyntheses. Saunders/ Schattauer, Philadelphia 5. Venable CS, Stuck WG (1947) The internal fixation of fractures. Thomas, Springfield 6. Lambotte A (1913) Chirurgie opératoire des fractures. Masson, Paris 7. Küntscher G (1940) Die Marknagelung von Knochenbrüchen. Arch Klin Chir 200:443–455 8. Standenat E, Schauer H, Prinsti K (1970) Indikation und Technik des Y-Nagels nach Küntscher. H Unfallheilkunde 106:56-5752-54 9. Fischer S (1970) Erfahrung mit der Y-Nagelung nach Küntscher. H Unfallheilkunde 106:54–56 10. Giebel MG (1970) Erfahurngen mit dem Trochanternagel nach Küntscher. H Unfallheilk 106:56–57 11. Bartoníček J, Douša P, Jehlička D (2001) History of intramedullary nailing of proximal femur fractures. Acta Chir Orthop Tramatol Čech 68:59–62 12. Zickel RE (1967) A new fixation device for subtrochanteric fractures of the femur. A preliminary report. Clin Orthop Rel Res 54:115–123 13. Kempf I, Grosse A, Taglang G, Favreul E (1993) Le clou gamma dans le traitment á foyer fermé des fractures trochantériennes. Resultats et indications á propos d’une série de 121 cas. Rev Chir Orthop 79:29–40
14. Kempf I, Taglang G (2005) The gamma nail – historical background. Osteo Trauma Care 13:2–6 15. Danis R (1949) Théorie et practique de l’ostéosynthése. Masson, Paris 16. Pohl E (1951) Verbindungsvorrichtung für gelenkanahe Knochenbrüche. German Patent Nr. 918531, 7 December 1951 17. Dittel KK, Rapp M (eds) (2008) The double dynamic Martin screw (DMS). Steinkopf Verlag, Stuttgart 18. Schumpelick W, Jantzen PM (1953) Die Versorgung der Frakturen im Trochanterbereich mit einer nichtsperrenden Laschenschraube. Chirurg 24:506–509 19. Schumpelick W, Jantzen PM (1955) A new principle in the operative treatment of trochanteric fractures of the femur. J Bone Joint Surg Am 37-A:693–698 20. Schumpelick W (1955) Die stabile Osteosynthese des medialen Schenkelhalsbruches mit der verbundenen Doppelschraube. Chirurg 26:131–135 21. Pugh WL (1955) A self-adjusting nail-plate for fractures about the hip joint. J Bone Joint Surg Am 37-A:1085–1093 22. Charnley J, Blockley NJ, Purser DW (1957) The treatment of displaced fractures of the neck of the femur by compression. J Bone Joint Surg (Br) 39-B:45–65 23. Clawson DK (1964) Trochanteric fractures treated by the sliding screw plate fixation method. J Trauma 4:737–752 24. Schlich T (2002) Surgery, science and industry. Palgrave Macmillan, Houndmills 25. Dimon JH, Hughston JC (1967) Unstable intertrochanteric fractures of the hip. J Bone Joint Surg Am 49-A:440–450 26. Debrunner A, Čech O (1969) Biomechanik der Osteosynthese pertrochanter Frakturen. Z Orthop 107:516–527 27. Sarmiento A, Williams EM (1970) Unstable intertrochanteric fracture: treatment with a valgus osteotomy and I-beam nail-plate: A preliminary report of one hundred cases. J Bone Joint Surg Am 52-A: 1309–1318 28. Simon-Weidner R (1969) Die Fixierung trochanterer Brüche mit multiplen elastischen Rundnägeln nach Simon-Weidner. H Unfallheilkunde 106:60–61 29. Ender J, Simon-Weidner R (1970) Die Fixierung trochanterer Brüche mit runden elastischen Condylennageln. Acta Chir Austriaca 1:40–42 30. Sahlstrand T (1974) The Richards compression and sliding hip screw system in the treatment of intertrochanteric fractures. Acta Orthop Scand 45:213–219 31. Ecker ML, Joyce JJ, Kohl J (1975) The treatment of trochanteric hip fractures using a compression screw. J Bone Joint Surg Am 57-A:23– 27 32. Regazzoni P, Rüedi T, Winquist R, Allgöwer M (1985) The dynamic hip screw implant system. Springer, Berlin
