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Sample records for femoral nail antirotation

  1. Backout of the helical blade of proximal femoral nail antirotation and accompanying fracture nonunion.

    PubMed

    Niikura, Takahiro; Lee, Sang Yang; Matsumoto, Tomoyuki; Fukui, Tomoaki; Kawakami, Yohei; Akisue, Toshihiro; Kuroda, Ryosuke; Kurosaka, Masahiro

    2012-08-01

    This article describes a case of backout of the helical blade, a rare complication of proximal femoral nail antirotation. A 31-year-old man had sustained a trochanteric fracture of his right femur. Fracture fixation using proximal femoral nail antirotation and autologous bone grafting 7 months later were performed at another hospital. However, bony union was not obtained, and the patient's pain and limp persisted. Therefore, he presented to the current authors. A radiograph taken at presentation revealed backout of the helical blade and fracture nonunion. A radiograph taken 1 month later showed a more advanced backout of the helical blade. The authors performed exchange nailing supplemented with transplantation of peripheral blood CD34-positive cells and autologous bone grafting. The proximal femoral nail antirotation was revised to a long gamma 3 nail, and a U-lag screw was used to obtain better stability. The postoperative course was uneventful. The patient regained ambulation without pain or support at 12 weeks postoperatively. Radiographic bony union was completed 9 months postoperatively. At 1-year follow-up, he could run and stand on the previously injured leg and had returned to work. Backout of the helical blade should be considered as a possible complication of proximal femoral nail antirotation. Incomplete fixation of the helical blade is the possible reason for backout. The use of a helical blade in young patients may cause difficulty in insertion and result in incomplete fixation.

  2. Comparative study of the proximal femoral nail antirotation versus the reconstruction nail in the treatment of comminuted proximal femoral fracture.

    PubMed

    Huang, Fu-Ting; Lin, Kai-Cheng; Yang, Shan-Wei; Renn, Jenn-Huei

    2012-01-16

    The purpose of our study was to compare the proximal femoral nail antirotation (PFNA; Synthes, Paoli, Pennsylvania) with a reconstruction nail (Recon; Zimmer, Warsaw, Indiana) in the treatment of comminuted proximal femoral fractures. Between 2003 and 2010, twenty-three consecutive patients with AO/Orthopaedic Trauma Association 31-A3 fractures combined with proximal 32 fractures who had a minimum 18-month follow-up were evaluated retrospectively. There were 10 patients (age range, 18-74 years) in the Recon nail group and 13 patients (age range, 22-90 years) in the PFNA nail group. Patients treated with Recon nails experienced a longer operation time (P=.006) and more blood loss (P=.012) than patients treated with the PFNA nail. On postoperative radiographs, the change in the neck-shaft angle was 8.8° in the Recon nail group and 4.7° in the PFNA nail group (P=.048). The fracture union time averaged 31.8 weeks in the Recon nail group and 21.5 weeks in the PFNA nail group (P=.148). More patients in the Recon nail group underwent major or minor reoperation (P=.038) compared with the PFNA nail group. No implant failure occurred in either group. The functional results were similar in the 2 groups. For the treatment of comminuted proximal femoral fractures, use of either the PFNA and Recon nail is clinically effective. However, the PFNA nail provides a shorter operation time, less blood loss, and better realignment ability and reduces the incidence of reoperation. Therefore, the PFNA nail can be considered a better device than the Recon nail. Copyright 2012, SLACK Incorporated.

  3. The potential application of functionally graded material for proximal femoral nail antirotation device.

    PubMed

    Gong, He; Wang, Lizhen; Zheng, Dong; Fan, Yubo

    2012-09-01

    Proximal femoral nail antirotation (PFNA) device is an intramedullary nail system designing for the treatment of trochanteric fractures. It is composed of a helical neck blade, a nail and a distal locking bolt. There were some reports of femoral shaft fractures even after the fractures were healed. The stress shielding effects of the PFNA device made of stiff titanium alloy on the bone-remodeling behavior of the host femur and the uneven distribution of interface shear stress may contribute to this complication. Recently, a new class of composite called functionally graded material (FGM) was developed, that consisted a gradual pattern of material composition and/or microstructures, and was introduced in dental implant and cementless hip stem. Accordingly, in this paper, we hypothesized that FGM might be used as the material of the nail in PFNA device with the material composition of the nail gradually shifting from more stiff at the proximal side of the femur to more flexible 'iso-elastic' towards the distal side. This hypothesis can be evaluated from the long-term remodeling behavior of host femur and the stress distributions in the PFNA device and bone.

  4. Acetabular perforation after medial migration of the helical blade through the femoral head after treatment of an unstable trochanteric fracture with proximal femoral nail antirotation (PFNA): a case report.

    PubMed

    Takigami, Iori; Ohnishi, Kazuichiro; Ito, Yoshiki; Nagano, Akihito; Sumida, Hisashi; Tanaka, Kaori; Shimizu, Katsuji

    2011-09-01

    The proximal femoral nail antirotation is a new generation of intramedullary device for the treatment of trochanteric femoral fractures, having a helical blade rather than a screw for suggested better purchase in osteoporotic bone. However, it is not free of complications. Few reports are available on postoperative perforation of the helical blade through the femoral head as a unique complication of proximal femoral nail antirotation. We report a 79-year-old woman with acetabular perforation after migration of the helical blade through the femoral head after an unstable trochanteric fracture, which was fixed with a proximal femoral nail antirotation.

  5. Trochanteric fragility fractures : Treatment using the cement-augmented proximal femoral nail antirotation.

    PubMed

    Neuerburg, C; Mehaffey, S; Gosch, M; Böcker, W; Blauth, M; Kammerlander, C

    2016-06-01

    Use of standardized cement augmentation of the proximal femur nail antirotation (PFNA) for the treatment of trochanteric fragility fractures, which are associated with high morbidity and mortality, to achieve safer conditions for immediate full weight-bearing and mobilization, thus, improving preservation of function and independency of orthogeriatric patients. Trochanteric fragility fractures (type 31-A1-3). Ipsilateral arthritis of the hip, leakage of contrast agent into the hip joint, femoral neck fractures. Reduction of the fracture on a fracture table if possible, or minimally invasive open reduction of the proximal femur, i. e., using collinear forceps if necessary. Positioning of guidewires for adjustment of the PFNA and the spiral blade, respectively. Exclusion of leakage of contrast agent and subsequent injection of TRAUMACEM™ V(+) into the femoral head-neck fragment via a trauma needle kit introduced into the spiral blade. Dynamic or static locking of the PFNA at the diaphyseal level. Immediate mobilization of the patients with full weight-bearing and secondary prevention, such as osteoporosis management is necessary to avoid further fractures in the treatment of these patients. A total of 110 patients older than 65 years underwent the procedure. Of the 72 patients available for follow-up (average age 85.3 years), all fractures healed after an average of 15.3 months. No complications related with cement augmentation were observed. Approximately 60 % of patients achieved the mobility level prior to trauma.

  6. Imaging Evaluation of the Safe Region for Distal Locking Screw of Proximal Femoral Nail Anti-Rotation in Patients with Proximal Femoral Fracture

    PubMed Central

    Gong, Jinpeng; Liu, Pengcheng; Cai, Ming

    2017-01-01

    Background Proximal femoral nail anti-rotation (PFNA) is a standard femoral intertrochanteric fracture operation. Iatrogenic vascular injury, although uncommon, is a reported complication of PFNA surgery as well as a complication of hip fracture surgery. This study aimed to compare the safety and best use of the distal locking screw in 170 mm PFNA and 240 mm PFNA devices, and to determine the safe region for placement of the distal locking screw in PFNA surgery. Material/Methods A retrospective analysis of 100 patients with 170 mm PFNA and 80 patients with 240 mm PFNA were retrospectively analyzed. Two levels of PFNA distal locking screws were equally divided into three planes: I, II, III, for 170 mm PFNA devices and i, ii, iii for the 240 mm PRNA devices. The medial half of the femur was equally divided into eight regions: A to H. The distance between the outer femur and the superficial, the deep and the perforating femoral arteries (SFAs, DFAs, and PFAs), and angles between the reference line and the connection line between the femur center to each artery were measured. Results SFAs and DFAs but not PFAs were found in risky or hazardous regions, and DFAs were obviously closer to the femur than SFAs and PFAs at the same level. In the region within 10 mm of the femur, no SFAs were found. The short nails (170 mm PFNA-II devices) were the closest to the DFAs region, indicating that the 170 mm PFNA-II nails are most likely to cause special vessel injury. The short nails were relatively more distant from the SFAs, which were located posteriorly to the long nails (240 mm PFNA-II). Conclusions The distal locking screw of the 170 mm PFNA device was more prone to damage the femoral deep artery when the two types of PFNA devices are compared in patients who were candidates for both types of devices. PMID:28178228

  7. Fixation of intertrochanteric femur fractures using Proximal Femoral Nail Antirotation (PFNA) in the lateral decubitus position without a traction table.

    PubMed

    Turgut, Ali; Kalenderer, Önder; Günaydın, Burak; Önvural, Burak; Karapınar, Levent; Ağuş, Haluk

    2014-01-01

    The aim of this study was to evaluate whether intertrochanteric femur fractures can be reduced and nailed properly in the lateral decubitus position using Proximal Femoral Nail Antirotation (PFNA) as a fixation device without the use of a traction table. The study included 207 patients (81 male and 126 female; mean age: 75 years, range: 22 to 95 years). According to the Evans classification, there were 7 Type 1, 40 Type 2, 33 Type 3, 38 Type 4, 61 Type 5 and 28 reverse oblique fractures. Radiographs were used to measure the tip-apex distance (TAD), the quadrant of the helical blade according to Cleveland and Bosworth, Ikuta's reduction subgroup, collodiaphyseal angle and reduction gaps postoperatively. Mean follow-up time was 20.4 (range: 6 to 38) months. According to Ikuta's classification, 176 (85%) reduced fractures were of subtype N, 15 (7.2%) subtype P and 16 (7.7%) subtype A. Good or acceptable reduction according to the Herman criteria was obtained in 99% of fractures. Mean TAD was 29.2 millimeters. Mean operation time was 57.2 minutes. Optimal blade position (center-center or inferior-center) was achieved in 53.5% of patients and was in the superior-posterior quadrants in only 2.4% of patients. Cut-out complication occurred in 9 patients (4.3%). While the nailing of intertrochanteric fractures in a lateral decubitus position does not provide ideal quadrant placement and TAD, results are encouraging probably due to the excellent stability that is provided by PFNA.

  8. Randomized controlled trials of proximal femoral nail antirotation in lateral decubitus and supine position on treatment of intertrochanteric fractures.

    PubMed

    Xue, Li; Zha, Li; Chen, Qin; Liang, Yi-jian; Li, Kang-ren; Zhou, Zheng; Guan, Jin-long; Qin, Hui; Li, You-ping

    2013-01-01

    The objective of this study was to compare the clinical results and complications of proximal femoral nail antirotation (PFNA) on treatment of intertrochanteric fractures in 120 elderly Chinese patients using Randomized Controlled Trials (RCTs). Totaly 120 cases enrolled were randomly assigned to a lateral decubitus position group and supine position group. The hospital stay, operating time, intraoperative blood loss, length of incision, X-ray fluoroscopy time, and out-of-bed activity time in the lateral decubitus position group were significantly lower than those in the supine position group. There was not statistical significance on union time and Harris values in the two position groups. Moreover, only complications of superficial wound infection were observed in the lateral decubitus position group, but two complications of deep venous thrombosis and wound deep infection were found in the supine position group. The present findings suggested that PFNA applied in elderly patients with intertrochanteric fracture can get satisfactory effects, and the treatment of intertrochanteric fractures using lateral decubitus position showed a satisfactory clinical outcome and a lower radiological complication rate.

  9. Randomized Controlled Trials of Proximal Femoral Nail Antirotation in Lateral Decubitus and Supine Position on Treatment of Intertrochanteric Fractures

    PubMed Central

    Xue, Li; Zha, Li; Chen, Qin; Liang, Yi-jian; Li, Kang-ren; Zhou, Zheng; Guan, Jin-long; Qin, Hui; Li, You-ping

    2013-01-01

    The objective of this study was to compare the clinical results and complications of proximal femoral nail antirotation (PFNA) on treatment of intertrochanteric fractures in 120 elderly Chinese patients using Randomized Controlled Trials (RCTs). Totaly 120 cases enrolled were randomly assigned to a lateral decubitus position group and supine position group. The hospital stay, operating time, intraoperative blood loss, length of incision, X-ray fluoroscopy time, and out-of-bed activity time in the lateral decubitus position group were significantly lower than those in the supine position group. There was not statistical significance on union time and Harris values in the two position groups. Moreover, only complications of superficial wound infection were observed in the lateral decubitus position group, but two complications of deep venous thrombosis and wound deep infection were found in the supine position group. The present findings suggested that PFNA applied in elderly patients with intertrochanteric fracture can get satisfactory effects, and the treatment of intertrochanteric fractures using lateral decubitus position showed a satisfactory clinical outcome and a lower radiological complication rate. PMID:23606811

  10. Comparison of the reconstruction trochanteric antigrade nail (TAN) with the proximal femoral nail antirotation (PFNA) in the management of reverse oblique intertrochanteric hip fractures.

    PubMed

    Makki, Daoud; Matar, Hosam E; Jacob, Nebu; Lipscombe, Stephen; Gudena, Ravindra

    2015-12-01

    Reverse oblique intertrochanteric fractures have unique mechanical characteristics and are often treated with intramedullary implants. We compared the outcomes of the reconstruction trochanteric antegrade nail (TAN) with the proximal femoral nail antirotation (PFNA). Between July 2008 and February 2014, we reviewed all patients with reverse oblique intertrochanteric fractures treated at our hospital. Patients with pathological fractures and those who were treated with other than TAN and PFNA nailing systems were excluded. Preoperative assessment included the Abbreviated mental test score (AMT), the ASA grade, pre-injury mobility and place of residence. Postoperative outcome measures included the type of implant used, time to fracture union, failures of fixation and revision surgeries. Fifty-eight patients were included and divided into two groups based on the treatment: 22 patients treated with TAN and 36 patients treated with PFNA systems. The two groups were well matched with regards to demographics and fracture type. The overall union rate was similar in both groups but the time to union was shorter in the TAN group. There were 8 implant failures in the PFNA (22.2%) group compare to none in the TAN group. Implant failure was associated with the severity of fracture (AO 31.A3.3) but was not related to fracture malreduction or screw position (Tip-apex-distance). Our study suggests that the use of reconstruction system with two screws such as TAN may be more suitable implant for reverse oblique intertrochanteric hip fractures.

  11. Analysis of using antirotational device on cephalomedullary nail for proximal femoral fractures☆☆☆

    PubMed Central

    Takano, Marcelo Itiro; de Moraes, Ramon Candeloro Pedroso; de Almeida, Luis Gustavo Morato Pinto; Queiroz, Roberto Dantas

    2014-01-01

    Objective To analyze the influence of femoral neck diameter in the positioning of the sliding screw in cefalomedulares nails for treatment of unstable transtrochanteric fractures. Methods Prospectively throughout 2011, patients with unstable fractures transtrochanteric undergoing osteosynthesis with cephalomedullary nail using antirotacional device. They were evaluated for sex, age and fracture classification according to Tronzo. Through digital radiographs angle reduction, tip apex distance (TAD), stem diameter and measures between the positioning of the screws and the limits of the cervix were measured. Results Of the 58 patients, 42 (72.4%) were female and 16 (27.6%) were male. 33 patients were classified as Tronzo III (56.9%), 6 patients as Tronzo IV (10.4%) and 19 as Tronzo V (19.8%). The majority were in between the eighth and ninth decade of life. The average reduction in the angle was 130.05° for females and 129.4° for males. The TAD average was 19.7 mm for females and 21.6 for males. The average diameter of the neck and head vary with statistical significance between men and women. In 19 patients the placement of the sliding bolt can be optimal. If the ideal positioning was not possible, the mean displacement for non‐infringement of higher cortical neck was 4.06 mm. Conclusion The optimal placement would not be possible for the majority of the population, for the average diameter of the neck of the sample. PMID:26229767

  12. Clinical and Functional Outcomes of Treatment for Type A1 Intertrochanteric Femoral Fracture in Elderly Patients: Comparison of Dynamic Hip Screw and Proximal Femoral Nail Antirotation

    PubMed Central

    Lee, Kyujung

    2016-01-01

    Purpose We aimed to evaluate and compare the clinical and functional outcomes of dynamic hip screw (DHS) and proximal femoral nail antirotation (PFNA) treatment of AO type 1 intertrochanteric fractures in elderly patients. Materials and Methods We retrospectively reviewed 194 consecutive patients with type A1 intertrochanteric femoral fractures who were treated with DHS (n=113) or PFNA (n=81). We evaluated operation time, intraoperative blood loss, and functional outcomes, walking ability, and the Barthel activities index. Fracture union, sliding of hip screw, proximal femur shortening, and presence of complications were assessed radiologically at relevant follow-up intervals. Results The mean operation time and blood loss were significantly lower for the PFNA group, but walking ability and Barthel index decreased to a similar extent for both groups. However, patients in the DHS group complained of significantly more pain (P=0.049). Although there were no significant differences between the two groups with respect to the time until fracture union was achieved, patients in the DHS group exhibited a higher extent of proximal femoral shortening and sliding of the hip screw. Differences about hip screw sliding and proximal femur shortening within each subgroup were not significant. Conclusion Compared to DHS treatment, PFNA treatment of type A1 intertrochanteric fractures is associated with reduced blood loss, shorter operation time, and less severe pain after surgery. Additionally, sliding of the hip screw and proximal femur shortening are expected to occur more frequently after DHS. PMID:28097113

  13. Comparative study of trochanteric fracture treated with the proximal femoral nail anti-rotation and the third generation of gamma nail.

    PubMed

    Yaozeng, Xu; Dechun, Geng; Huilin, Yang; Guangming, Zhu; Xianbin, Wang

    2010-12-01

    To compare the results between the proximal femoral nail anti-rotation (PFNA) and the third generation gamma nail (TGN) in the treatment of trochanteric fractures. Between April 2007 and May 2008, 107 consecutive patients older than 60 years with trochanteric femoral fractures were treated with PFNA or TGN. The preoperative variables including patient age, gender, fracture classification, walking ability and American Society of Anaesthesiologists (ASA) rating of operative risk were summarised. Operative time, fluoroscopy time, blood loss, and any intra-operative complication were recorded for each patient. Follow-up was undertaken at 3, 6, and 12 postoperative months, and yearly thereafter. Plain AP and lateral radiographs were obtained at all visits. All changes in the position of the implant, complications, or fixation failure were recorded. Hip range of motion, pain about the hip and the thigh, walking ability score and return to work status were used to compare the outcomes. There were 55 patients in the PFNA group and 52 in the TGN group. The two groups were comparable with regard to the preoperative variables. The mean follow-up time was 17.5 months (range 12–24). Patients treated with a PFNA experienced a shorter fluoroscopy time and less blood loss. Sixteen patients were lost during the follow-up period. All the other fractures were radiographically healed at the last visit. There were no significant differences between the groups in terms of functional outcomes, hospital stay, intra-operative and postoperative complications. PFNA provides less blood loss and shorter fluoroscopy time but no advantages in functional outcome, intra-operative and postoperative complications when compared with TGN. These two implants were comparable in the treatment of trochanteric fractures.

  14. [Results and complications of pertrochanteric hip fractures using an intramedullary nail with a helical blade (proximal femoral nail antirotation) in 200 patients].

    PubMed

    Aguado-Maestro, I; Escudero-Marcos, R; García-García, J M; Alonso-García, N; Pérez-Bermejo D, D; Aguado-Hernández, H J; Nistal-Rodríguez, J; García-Alonso, M

    2013-01-01

    Evaluation of the surgical management, outcome and complications in patients with pertrochanteric fractures treated with PFNA nail. A retrospective study was conducted on 200 patients treated consecutively between April 2010 and February 2012. Radiological assessments were performed before and after the surgery, and during the follow-up (fracture reduction, blade position, consolidation or collapse signs). A clinical evaluation was performed as regards walking capabilities. The results were compared with those of a previous study on 700 patients treated with gamma 3 and TFN nails. The blade position was centre-centre in 64% of patients, and decreased to 53% in the mechanical complications group. Tip-apex distance was less than 25mm in 91.5%. The average hospital stay was 9.17 days, with a mean post-surgery stay of 5.95 days. Complications (7.5%): 2 cut out (1%), one cut through (0.5%), 4 cases of helical blade sliding (2%), one failure in distal locking procedure (0.5%), 2 cases with painful fasciae latae (1%), one union delay (0.5%), 2 cases of non-union with hardware failure (1%), one case of intense bleeding related to distal locking of the nail (0.5%), and one case of avascular necrosis (0.5%). The PFNA helical blade system seems to reduce the incidence of cut out and cut through in osteoporotic bone. Blade position was one of the main parameters associated with mechanical complications. Copyright © 2013 SECOT. Published by Elsevier Espana. All rights reserved.

  15. Pitfalls of femoral titanium elastic nailing.

    PubMed

    Salonen, A; Lahdes-Vasama, T; Mattila, V M; Välipakka, J; Pajulo, O

    2015-06-01

    Despite several potential complications of elastic intramedullary nailing, it is currently the treatment of choice for femoral diaphyseal fractures in school-aged children. This study aimed to critically evaluate the complications of titanium elastic nailing in pediatric femoral shaft fractures. This study evaluated patients with a diaphyseal femoral fracture treated with titanium elastic nailing (TEN) in Tampere University Hospital in Finland. The study group included 32 children with a mean age of 9 years during a 5-year period, from 1 January 2003 to 31 December 2007. Data were collected from medical records and x-rays. Mean follow-up time was 42 months. Of 32 patients, 9 (28%) reported a postoperative complication. Complications were associated with nail prominence in five (16%) patients and instability in four (12%) patients. In patients with nail prominence, the titanium elastic nailing-nail ends were unbent and 10-35 mm outside the cortex of the distal femur. The nail prominence caused pain and delayed knee mobilization until the nail was removed after a mean time of 4 months. In patients with fracture instability, the mean titanium elastic nailing-nail/medullary canal diameter ratio was 46% and periosteal callus formation was 5.4 mm at the first control. In those with stable fractures, the values were 66% and 9.2 mm, respectively. Based on this study, two types of pitfalls in a small volume center were found. Titanium elastic nail ends were left unbent and too long. We recommend palpating the nail ends to exclude nail prominence and to verify free movement of the knee after nail cutting and bending. Fracture instability was caused by inserting titanium elastic nailing-nails that were too narrow. To avoid this complication, careful preoperative planning to select the proper-size titanium elastic nailing-nails and intraoperative testing of fracture stability under continuous fluoroscopy after the operation is advised. © The Finnish Surgical Society 2014.

  16. New Proximal Femoral Compaction Blade Provides Strong Antirotation Stability of the Femoral Head.

    PubMed

    Hayashi, Shinya; Hirata, Yukiaki; Okamoto, Daiki; Kakunai, Satoshi; Hashimoto, Shingo; Takayama, Koji; Matsumoto, Tomoyuki; Niikura, Takahiro; Fujishiro, Takaaki; Hiranaka, Takafumi; Nishida, Kotaro; Kuroda, Ryosuke

    2017-03-14

    This study investigated the mechanical properties of a new rectangular compaction blade and compared this blade with other types of nail. Three types of nail were tested: the Magnum lag screw (Robert Reid Inc, Tokyo, Japan), proximal femoral nail, and Magnum Fid blade (Robert Reid Inc). The nails were inserted into solid rigid polyurethane foam, and the torsional moments were loaded with an Instron testing machine (Instron, Kanagawa, Japan). The force curve was recorded, and the average maximum torque was calculated from this curve. A simulation study was performed with finite element models to determine the mechanism underlying differences in rotational stability. Mechanical testing showed that the new compaction blade had stronger resistance against rotational force than the helical blade and lag screw implants. Finite element analysis also showed that the new compaction blade had stronger resistance to migration of the polyurethane foam cylinder than the other implant types. In addition, the new compaction blade had strong rotational stability. This implant should be useful for the treatment of unstable trochanteric fracture in patients with osteoporosis. [Orthopedics. 201x; xx(x):xx-xx.].

  17. Subtrochanteric fractures after retrograde femoral nailing

    PubMed Central

    Mounasamy, Varatharaj; Mallu, Sathya; Khanna, Vishesh; Sambandam, Senthil

    2015-01-01

    Secondary fractures around femoral nails placed for the management of hip fractures are well known. We report, two cases of a fracture of the femur at the interlocking screw site in the subtrochanteric area after retrograde femoral nailing of a femoral shaft fracture. Only a few reports in the existing literature have described these fractures. Two young men after sustaining a fall presented to us with pain, swelling and deformity in the upper thigh region. On enquiring, examining and radiographing them, peri-implant fractures of subtrochanteric nature through the distal interlocking screws were revealed in both patients who also had histories of previous falls for which retrograde intramedullary nailing was performed for their respective femora. Both patients were managed with similar surgical routines including removal of the existing hardware, open reduction and ace cephallomedullary antegrade nailing. The second case did show evidence of delayed healing and was additionally stabilized with cerclage wires. Both patients had uneventful postoperative outcomes and union was evident at the end of 6 mo postoperatively with a good range of motion at the hip and knee. Our report suggests that though seldom reported, peri-implant fractures around the subtrochanteric region can occur and pose a challenge to the treating orthopaedic surgeon. We suggest these be managed, after initial stabilization and resuscitation, by implant removal, open reduction and interlocking intramedullary antegrade nailing. Good results and progression to union can be expected in these patients by adhering to basic principles of osteosynthesis. PMID:26495251

  18. Femoral lengthening with a motorized intramedullary nail

    PubMed Central

    Horn, Joachim; Grimsrud, Øyvind; Dagsgard, Anita Hoddevik; Huhnstock, Stefan; Steen, Harald

    2015-01-01

    Purpose We assessed whether an intramedullary lengthening device would reduce the problems normally associated with the external fixation technique. We also wanted to determine whether it is a reliable construct for limb lengthening and deformity correction in the femur. Patients and methods We conducted a matched-pair comparison of 30 femoral lengthenings, 15 with a motorized intramedullary nail (the nail group) and 15 lengthenings with an external ring fixator (the fixator group). The patients were matched based on age, sex, amount of lengthening, and the etiology of leg length discrepancy. Mean lengthening was 35 (25–55) mm in the nail group and 38 (15–75) mm in the fixator group. Outcome measures were: lengthening and alignment achieved, consolidation index, knee range of motion (ROM), and complications. Results The pairs in this matched-pair study were similar in terms of age, sex, diagnosis, and amount of lengthening. The planned amount of lengthening was achieved in all patients in both groups and axis correction was considered sufficient. The mean radiographic consolidation index in the nail group, at 1.5 (0.9–3.0) months/cm, was better than the mean value for the fixator group (1.9 (0.9–3.4) months/cm) (p = 0.01). Knee ROM was better in the nail group during the lengthening, 6 weeks after lengthening was completed, and 6 months after lengthening was completed (p < 0.001). A larger number of complications were observed in the fixator group than in the nail group. Interpretation A lengthening nail may be superior to external fixation in femoral lengthening, when the anatomical conditions and the complexity of the deformity allow the use of an intramedullary nail. PMID:25191936

  19. Intramedullary locking femoral nails. Experience with the AO nail.

    PubMed Central

    Fogarty, A. B.; Yeates, H. A.

    1991-01-01

    The AO interlocking nail was introduced to the Ulster Hospital, Dundonald in 1988 and since then has been used in over 50 patients with femoral shaft fractures. We have reviewed 45 patients with 46 femoral shaft fractures treated between June 1988 and April 1990. These included four compound fractures and 13 comminuted fractures. The results compare favourably with other series. The union rate was 98% and there were no instances of deep infection. The alternative treatment methods available are discussed along with a review of the relevant literature. Images Fig 3 Fig 5 PMID:1785145

  20. Biomechanical comparision of femoral intramedullary nails for interfragmentary rotational stability.

    PubMed

    Karaarslan, Ahmet Adnan; Aycan, Hakan; Mayda, Aslan; Ertem, Fatih; Sesli, Erhan

    2015-01-01

    This study aims to investigate which intramedullary nail is biomechanically better for establishing interfragmentary rotational stability. Thirty composite femurs were utilized in this study. We analyzed interfragmentary rotational arc displacements between 10 Nm external-6 Nm internal torques and 6 Nm external-6 Nm internal torques which imitate rotation torques while walking on a flat surface and descending stairs by administering 10 interlocking nails, 10 compression nails, and 10 Mehmet anti-rotation nails with tube compression. Maximum interfragmentary rotation arc displacement between 10 Nm external rotation and 6 Nm internal rotation torques was mean 1.64 mm in the Mehmet nail compressed by 7 Nm torque wrench. This value was lower by 309% (6.72 mm) from interlocking nail (p=0.000), 201% (5.42 mm) from compression nail compressed by 2.5 Nm torque wrench (p=0.000), and 26% (1.92 mm) from compression nail compressed by 7 Nm torque wrench (p>0.05). In axially stable transvers and short oblique femur fractures, Mehmet nail is superior to other intramedullary nails with limited movement between locking screw and hole, more interfragmentary compression without locking screw deformation, and no proximal nail migration.

  1. Retrograde femoral interlocking nail in complex fractures.

    PubMed

    Anup, Khare; Mehra, M M

    2002-06-01

    Retrograde interlocking nail was used as the method of fixation in 35 different cases of combination of complex femoral fractures. We performed this procedure in fractures of femoral shaft associated with fracture neck femur, pathological fractures of proximal third of femur with trochanteric pathology, ipsilateral fracture of femur and tibia in polytrauma cases with multiple other injuries, in highly obese patients with fracture shaft femur. This technique was also used in cases of pregnancy with fracture shaft femur and in unstable pelvic fracture or dislocation hip associated with fracture shaft femur. Operative technique involved with retrograde insertion of un-reamed, non-cannulated custom made nail through entrance portal in intercondylar notch was applied for fixation of the shaft femur fracture. The other associated fracture around hip was stabilized separately using suitable implant according to type of fracture. In cases of ipsilateral fracture of femur and tibia, femur was stabilized by retrograde interlocking nail and tibia was stabilized by antigrade interlocking nail through same incision at the same sitting. The case was followed up for three years; the average union time was 12 to 18 weeks. Out of 35 cases, 31 cases regained full knee movement. Out of the remaining 4 cases, 2 cases could regain up to 90 degrees of movement, these were old fractures and non-cooperative patients. In one case, patellofemoral arthritis was developed because of an operative error where a nail was not put inside the articular surface. Mal-union was observed in an early case of the series and implant failure was nil. Retrograde interlocking nail was used as the method of fixation in complex fracture problems. Multiple fractures of long bones can be stabilized in one stage, preventing multiple operations at different stages in polytraumatized patients. This resulted in early recovery, lesser hospital stay, and early rehabilitation of patient with good results and is

  2. Splitting of the Proximal Femur With a New Femoral Nail

    DTIC Science & Technology

    2010-04-01

    offset from the top of this particular nail to its long axis. Key Words: lateral entry, trochanteric nail , intramedullary nailing , femur, complication...trochanteric intramedullary femoral nailing . J Orthop Trauma. 2005;19:681–686. 8. McConnell T, Tornetta P III, Benson E, et al. Gluteus medius tendon injury...Germany: Stryker Trauma; 2006: 191–199. 11. Gerhard Küntscher. Practice of Intramedullary Nailing . Translated by Herman Rinne. Springfield, IL: Thomas

  3. Subtrochanteric Femoral Fracture during Trochanteric Nailing for the Treatment of Femoral Shaft Fracture

    PubMed Central

    Oh, Chi Hun; Yi, Ju Won

    2013-01-01

    We report on three cases of subtrochanteric femoral fractures during trochanteric intramedullary nailing for the treatment of femoral shaft fractures. Trochanteric intramedullary nails, which have a proximal lateral bend, are specifically designed for trochanteric insertion. When combined with the modified insertion technique, trochanteric intramedullary nails reduce iatrogenic fracture comminution and varus malalignment. We herein describe technical aspects of trochanteric intramedullary nailing for femoral shaft fractures to improve its application and prevent implant-derived complications. PMID:24009910

  4. Treatment strategies for intramedullary nailing of femoral shaft fractures.

    PubMed

    Wild, Michael; Gehrmann, Sebastian; Jungbluth, Pascal; Hakimi, Mohssen; Thelen, Simon; Betsch, Marcel; Windolf, Joachim; Wenda, Klaus

    2010-10-11

    Intramedullary nailing has become the gold standard to treat femoral shaft fractures. It is unknown which nailing technique orthopedic surgeons prefer. The goal of this study was to determine current techniques and perioperative complications of intramedullary nailing of diaphyseal femoral fractures. Fifty-one institutions in 26 countries participated in an international survey to assess detailed descriptions of preferred operative strategies and perioperative complications. Altogether, 517 cases of diaphyseal femoral fractures were collected. The Internet-based survey incorporated information about fracture classification, time to operation, Injury Severity Score, type of nail, and operative technique, as well as perioperative complications such as infection, femoral neck fracture, and hardware failure. The preferred position for implantation was supine (91.1%). Most surgeons used a traction table (57.1%) and an antegrade implantation technique (84.5%). Intraoperative fractures of the femoral neck occurred in 1.2% of cases when a traction table was used and in 0.2% if no traction table was used, but without statistical significance (P>.16). In 59.2% of the cases, an isolated femur fracture was present, while the rest sustained multiple injuries. In polytrauma patients and patients with severe thorax injuries, most surgeons chose a delayed treatment with intramedullary femoral nails. Interestingly, 38.0% of the patients with severe thorax injuries were treated on the first day with intramedullary femoral nails. The total rate of complications for intramedullary femoral nailing was low (4.9%), but a high rate of intraoperative femoral neck fractures was observed (1.4%). Copyright 2010, SLACK Incorporated.

  5. A Technical Note for Extracting an Incarcerated Femoral Kuntscher Nail

    PubMed Central

    Marí, R; Vilamala, D Valverde; García, A León; Guirro, P; López, F Marqués

    2016-01-01

    Introduction: The use of the Kuntscher nail has been the most important advancement in trauma surgery. One of the problems is the difficulty to remove it. A new extraction technique is described in the present case report. Case Report: A 46-year-old man was referred for hip osteoarthritis. He had an acetabulum fracture and a femoral shaft fracture treated 30 years ago with a reamed Kuntscher femoral nail. Lateral hip approach was performed and after attempting to remove the nail with the specific tools being unsuccessful we decided to be more aggressive. Firstly, we performed a simple unicortical osteotomy on the lateral side from the proximal part to below the callus in order to decompress the femoral canal without success. Secondly, a trench in the greater trochanter around the proximal hole was performed to hit the nail from below which was still insufficient and furthermore, the hole broke when hitting the nail so we needed to drill a new hole distally. Finally, the Kuntscher nail was removed. Several cerclages closed the osteotomy and a bone graft was used to close the trench. The patient had a good evolution at one year of follow-up. Conclusion: With this case report, we present a new salvage technique to remove an incarcerated Kuntscher nail when all the described methods have failed. PMID:28116256

  6. Effectiveness of exchange nailing and augmentation plating for femoral shaft nonunion after nailing.

    PubMed

    Wang, Zhen; Liu, Chunfeng; Liu, Chaoqun; Zhou, Qing; Liu, Jinlian

    2014-11-01

    We assessed indications and outcomes of exchange nailing and augmentation plating for femoral shaft nonunion following femoral nail failure. We retrospectively reviewed the records of 21 consecutive patients with femoral shaft nonunion treated with femoral nailing from August 2008 to June 2013. Nonunion cases with infection were excluded from this study. The study population consisted of nine men and 12 women, with an average age of 40 (range 21-61) years. All patients received internal fixation using exchange nailing and an augment plate coupled with decortication and bone graft. All patients in our study obtained osseous union with a mean time of six (range four to12) months. Mean operation time was three hours (range two to five hours), and mean blood loss was 800 ml (range 500-950 ml). There were no postoperative complications. At the last follow-up, all patients could flex their knees > 110°. Exchange nailing and augment plating coupled with decortication and bone graft is an effective treatment option for femoral shaft nonunion and has more indications and higher union rate than the popular exchange nailing treatment.

  7. A biomechanical comparison of proximal femoral nails and locking proximal anatomic femoral plates in femoral fracture fixation

    PubMed Central

    Ozkan, Korhan; Türkmen, İsmail; Sahin, Adem; Yildiz, Yavuz; Erturk, Selim; Soylemez, Mehmet Salih

    2015-01-01

    Background: The incidence of fractures in the trochanteric area has risen with the increasing numbers of elderly people with osteoporosis. Although dynamic hip screw fixation is the gold standard for the treatment of stable intertrochanteric femur fractures, treatment of unstable intertrochanteric femur fractures still remains controversial. Intramedullary devices such as Gamma nail or proximal femoral nail and proximal anatomic femur plates are in use for the treatment of intertrochanteric femur fractures. There are still many investigations to find the optimal implant to treat these fractures with minimum complications. For this reason, we aimed to perform a biomechanical comparison of the proximal femoral nail and the locking proximal anatomic femoral plate in the treatment of unstable intertrochanteric fractures. Materials and Methods: Twenty synthetic, third generation human femur models, obtained for this purpose, were divided into two groups of 10 bones each. Femurs were provided as a standard representation of AO/Orthopedic Trauma Associationtype 31-A2 unstable fractures. Two types of implantations were inserted: the proximal femoral intramedullary nail in the first group and the locking anatomic femoral plate in the second group. Axial load was applied to the fracture models through the femoral head using a material testing machine, and the biomechanical properties of the implant types were compared. Result: Nail and plate models were locked distally at the same level. Axial steady load with a 5 mm/m velocity was applied through the mechanical axis of femur bone models. Axial loading in the proximal femoral intramedullary nail group was 1.78-fold greater compared to the plate group. All bones that had the plate applied were fractured in the portion containing the distal locking screw. Conclusion: The proximal femoral intramedullary nail provides more stability and allows for earlier weight bearing than the locking plate when used for the treatment of

  8. [Antegrade femoral intramedullary nailing in a lateral position].

    PubMed

    Friederichs, J; von Rüden, C; Hierholzer, C; Bühren, V

    2015-04-01

    Intramedullary nailing is the gold standard for the treatment of femoral shaft fractures; however, rotational malalignment remains a common complication. The patient can be positioned on the fracture table in a supine position or alternatively in the lateral decubitus position without any traction. The aim of this article is to describe an effective method to control intraoperative torsion of the femur. The surgical technique described in this article is the standard procedure for femoral shaft fractures and subtrochanteric fractures in this level 1 trauma center. The patient is positioned in a lateral position on a radiolucent table with free draping of the injured leg. Using the C-arm, reduction can be performed with this technique with precise placing of the nails and torsion can be exactly adjusted and controlled with the aid of the femoral neck axis, the distal locking holes and both parallel femoral condyles. The described technique represents an effective method for the intraoperative control of femoral torsion. With an acceptable and most probably clinically irrelevant bias, this technique is able to avoid significant rotational malalignment. It does not prolong the operative procedure and does not require additional navigation settings. It has also been shown to be helpful in the treatment of subtrochanteric fractures. The surgical technique of anterograde intramedullary nailing using the lateral decubitus position without any traction device and free draping of the injured leg represents a safe and reliable treatment concept and offers logistical advantages compared to the supine position of the patient on a fracture table. Together with other described methods of intraoperative torsional control of femoral fractures, the radiological technique described in this study is an easily applicable and safe method, which needs to be confirmed in clinical studies.

  9. Nonisthmal femoral shaft nonunion as a risk factor for exchange nailing failure.

    PubMed

    Yang, Kyu Hyun; Kim, Jung Ryul; Park, Jin

    2012-02-01

    Although nail exchange with a larger diameter nail after additional reaming is typically considered the gold standard for failed femoral nailing, some reports question the role of exchange nailing. The purpose of this study was to evaluate the risk factors affecting the outcome of exchange nailing for femoral shaft nonunion after initial nailing. Forty-one consecutive patients treated with exchange nailing between November 1996 and March 2010 for femoral shaft nonunion that was initially managed with an intramedullary nailing were retrospectively reviewed. Possible risk factors and outcome (bony union) of exchange nailing were evaluated. Of the 41 femoral shaft nonunions treated with exchange nailing, 9 (22%) failed to achieve bony union. The union rate for isthmal nonunions was 87% (27 of 31 cases) and for nonisthmal nonunions was 50% (5 of 10 cases). Univariate and multivariate logistic regression analyses demonstrated that the anatomic site (isthmal vs. nonisthmal) was a significant risk factor for exchange nailing failure (univariate, p = 0.021; multivariate, p = 0.016). Although exchange nailing is an excellent choice for aseptic isthmal femoral shaft nonunion occurring after the initial nailing, other treatment options such as augmentative plating should be considered for nonisthmal femoral shaft nonunions.

  10. Influence of Femoral Component Design on Retrograde Femoral Nail Starting Point.

    PubMed

    Service, Benjamin C; Kang, William; Turnbull, Nathan; Langford, Joshua; Haidukewych, George; Koval, Kenneth J

    2015-10-01

    Our experience with retrograde femoral nailing after periprosthetic distal femur fractures was that femoral components with deep trochlear grooves posteriorly displace the nail entry point resulting in recurvatum deformity. This study evaluated the influence of distal femoral prosthetic design on the starting point. One hundred lateral knee images were examined. The distal edge of Blumensaat's line was used to create a ratio of its location compared with the maximum anteroposterior condylar width called the starting point ratio (SPR). Femoral trials from 6 manufacturers were analyzed to determine the location of simulated nail position in the sagittal plane compared with the maximum anteroposterior prosthetic width. These measurements were used to create a ratio, the femoral component ratio (FCR). The FCR was compared with the SPR to determine if a femoral component would be at risk for retrograde nail starting point posterior to the Blumensaat's line. The mean SPR was 0.392 ± 0.03, and the mean FCR was 0.416 ± 0.05, which was significantly greater (P = 0.003). The mean FCR was 0.444 ± 0.06 for the cruciate retaining (CR) trials and was 0.393 ± 0.04 for the posterior stabilized trials; this difference was significant (P < 0.001). The FCR for the femoral trials studied was significantly greater than the SPR for native knees and was significantly greater for CR femoral components compared with posterior stabilized components. These findings demonstrate that many total knee prostheses, particularly CR designs, are at risk for a starting point posterior to Blumensaat's line.

  11. A biomechanical comparison of the antegrade inserted universal femoral nail with the retrograde inserted universal tibial nail for use in femoral shaft fractures.

    PubMed

    Frankle, M; Cordey, J; Sanders, R W; Koval, K; Perren, S M

    1999-01-01

    Femoral shaft fractures with and without bony contact were simulated in cadaver specimens fixed with one of two different types of intramedullary locked nail systems; conventional antegrade nail fixation of the femur with the universal AO femoral nail or retrograde insertion in the femur with the universal tibial nail (a smaller diameter slotted nail) were utilized. Mechanical testing simulated one leg stance, and resultant deformation was measured in bending, torsion, and shortening. In stable fractures, fracture stability was similar to both devices, while in unstable fractures, the larger femoral nail was more stable. Furthermore, the simulation of single leg stance led to a coupled deformation of varus bending, axial shortening, and external rotation, which was dependent on bone geometry.

  12. Is reconstruction nailing of all femoral shaft fractures cost effective? A decision analysis.

    PubMed

    Faucett, Scott C; Collinge, Cory A; Koval, Kenneth J

    2012-11-01

    Femoral shaft fractures are usually treated with anterograde or retrograde nails that typically do not provide femoral neck fixation. Ipsilateral femoral neck fractures occur with 2.5%-10% of femoral shaft fractures; 19%-55% of associated femoral neck fractures are missed with plain films and 5%-22% with computed tomography (CT). This study was performed to determine if routine reconstruction nailing of all femoral shaft fractures with or without occult femoral neck fractures is cost effective. A decision tree model examined the cost effectiveness of reconstruction nailing over standard intramedullary nailing for all femoral shaft fractures in which an associated femoral neck fracture was not identified on plain radiographs. As a base model, we assumed that 5% of shaft fractures had an ipsilateral femoral neck fracture, and 37% were missed and required further surgery. We assigned a small morbidity and additional cost ($680) for the use of a reconstruction nail and 2 screws. Model inputs including costs, clinical outcome probabilities, and health utilities were derived from the literature, estimated from institutional data, or assumed by the authors. Sensitivity analyses evaluated the effect of the rate of associated femoral neck fracture, the rate of missed femoral neck fracture, the complication rate of reconstruction screws, the cost of the extra reconstruction screws, and the utilities of each outcome on the incremental cost effectiveness (ICER) of both strategies. Current practice in cost-effectiveness analysis uses a threshold of $100,000 per quality-adjusted life year gained as cost effective. A secondary analysis of the use CT scans to reduce missed femoral neck fractures was also performed. The base model showed that the placement of reconstruction nails in all isolated femur fractures was not cost effective. Sensitivity analysis demonstrated that the ICER was most sensitive to the cost of the reconstruction nail, hemiarthroplasty, and a missed femoral

  13. Augmentation of proximal femoral nail in unstable trochanteric fractures

    PubMed Central

    Gadegone, Wasudeo M.; Shivashankar, Bhaskaran; Lokhande, Vijayanad; Salphale, Yogesh

    2017-01-01

    Introduction: Biomechanically proximal femoral nail (PFN) is a better choice of implant, still it is associated with screw breakage, cut out of screw through femoral head, Z effect, reverse Z effect, and lateral migration of screws. The purpose of this study is to evaluate the results of augmented PFN in terms of prevention of postoperative complications and failure rates in unstable trochanteric fractures. Material and methods: We carried out a prospective study of 82 cases with unstable trochanteric femoral fractures from April 2010 to December 2015. Forty-two females and 40 males in the age group between 58 and 81 years were included in this study. There were 45 cases of AO 31 A2 (2.2, 2.3) and 37 cases of AO 31 A3 (3.1, 3.2, 3.3). Fractures were fixed by PFN with augmentation by an additional screw from trochanter to inferior quadrant of femoral head or cerclage wire to strengthen the lateral trochanteric wall. Results: The bone healing is observed in all the cases in the mean period of 14.2 weeks. Nine patients developed complications, including lateral migration of neck screws (n = 5), Z effect (n = 1), infection (n = 2), and breakage of distal interlocking bolt in one case. Removal of screws was required in five cases. Patients were followed up for a mean of 8.4 months. At the end of follow-up the Salvati and Wilson hip function was 32 (out of 40) in 88% of patients. Conclusion: The stabilization of lateral trochanteric wall with additional screw or cerclage wire increases the stability of construct. PMID:28186871

  14. Treatment of Femoral Shaft Fracture with an Interlocking Humeral Nail in Older Children and Adolescents

    PubMed Central

    Park, Hoon

    2012-01-01

    Purpose Rigid interlocking nailing for femoral shaft fracture is ideal for use in adolescents in terms of stability of the fracture and convenience for the patient. However, numerous authors have reported that rigid interlocking nailing has some limitations in this age group due to the risk of complications. We evaluated the results of intramedullary nailing for femoral shaft fractures with an interlocking humeral nail in older children and adolescents. Materials and Methods We retrospectively reviewed records of patients treated with an interlocking humeral nail. Radiographs were examined for proximal femoral change and evidence of osteonecrosis. Outcomes were assessed by major or minor complications that occurred after operative treatment. Results Twenty-four femoral shaft fractures in 23 patients were enrolled. The mean age at the time of operation was 12 years and 8 months and the mean follow-up period was 21 months. Bony union was achieved in all patients without any complications related to the procedure such as infection, nonunion, malalignment and limb length discrepancy. All fractures were clinically and radiographically united within an average eight weeks. No patients developed avascular necrosis of the femoral head and coxa valga. Conclusion Intramedullary nailing through the greater trochanter using a rigid interlocking humeral nail is effective and safe for the treatment of femoral shaft fractures in older children and adolescents. PMID:22318831

  15. Analysis on the mechanical resistance of fixation of femoral neck fractures in synthetic bone, using the dynamic hip system and an anti-rotation screw☆☆☆

    PubMed Central

    Freitas, Anderson; Torres, Gustavo Melo; Souza, André Cezar de Andrade de Mello e; Maciel, Rafael Almeida; Souto, Diogo Ranier de Macedo; Ferreira, George Neri de Barros

    2014-01-01

    Objective To statistically analyze the results obtained from biomechanical tests on fixation of femoral neck fractures of Pauwels III type, in synthetic bone, using the dynamic hip system with an anti-rotation screw, versus a control group. Methods Ten synthetic bones from a Brazilian manufacturer (model C1010) were used and divided into two groups: test and control. In the test group, fixation of an osteotomy was performed with 70° of inclination at the level of the femoral neck, using DHS with an anti-rotation screw. The resistance of this fixation was evaluated, along with its rotational deviation at 5 mm of displacement (phase 1) and at 10 mm of displacement (phase 2), which was considered to be failure of synthesis. In the control group, the models were tested in their entirety until femoral neck fracturing occurred. Results The test values in the test group (samples 1–5) in phase 1 were: 1512 N, 1439 N, 1205 N, 1251 N and 1273 N, respectively (mean = 1336 N; standard deviation [SD] = 132 N). The rotational deviations were: 4.90°, 3.27°, 2.62°, 0.66° and 0.66°, respectively (mean = 2.42°; SD = 1.81°). In phase 2, we obtained: 2064 N, 1895 N, 1682 N, 1713 N and 1354 N, respectively (mean = 1742 N; SD = 265 N). The failure loading values in the control group were: 1544 N, 1110 N, 1359 N, 1194 N and 1437 N, respectively (mean = 1329 N; SD = 177 N). The statistical analysis using the Mann–Whitney test showed that the test group presented maximum loading at a displacement of 10 mm, i.e. significantly greater than the failure loading of the control group (p = 0.047). Conclusion The mechanical resistance of the test group was significantly greater than that of the control group. PMID:26229866

  16. Flexible intramedullary nailing in paediatric femoral fractures. A report of 73 cases

    PubMed Central

    2011-01-01

    Background Flexible intramedullary nailing has emerged as an accepted procedure for paediatric femoral fractures. Present indications include all patients with femoral shaft fractures and open physis. Despite its excellent reported results, orthopaedic surgeons remain divided in opinion regarding its usefulness and the best material used for nails. We thus undertook a retrospective study of paediatric femoral fractures treated with titanium or stainless steel flexible nails at our institute with a minimum of 5 years follow up. Material and methods We included 73 femoral shaft fractures in 69 patients treated with retrograde flexible intramedullary nailing with a minimum follow up of 5 years. Final limb length discrepancy and any angular or rotational deformities were determined. Results Mean age at final follow up was 15.5 years (10-21 years). Mean follow up was 7.16 years (5.0-8.6 years). Titanium and stainless steel nails were used in 43 and 30 cases respectively. There were 51 midshaft, 17 proximal, and 5 distal fractures. All fractures united at an average of 11 weeks but asymptomatic malalignment and LLD were seen in 19% and 58% fractures respectively. LLD ranged from -3 cm to 1.5 cm. Other complications included superficial infection(2), proximal migration of nail(3), irritation at nail insertion site(5) and penetration of femoral neck with nail tip(1). There were 59 excellent, 10 satisfactory and 4 poor results. Conclusion Flexible intramedullary nailing is reliable and safe for treating paediatric femoral shaft fractures. It is relatively free of serious complications despite asymptomatic malalignment and LLD in significant percentage of fractures. PMID:22192682

  17. Training effect of using Touch Surgery for intramedullary femoral nailing.

    PubMed

    Sugand, Kapil; Mawkin, Mala; Gupte, Chinmay

    2016-02-01

    Simulation in orthopaedic training is becoming increasingly popular and has been widely used in formal curricula. However, these resources are expensive and not easily accessible to every trainee. Other means of disseminating surgical education through virtual reality (VR) multimedia can act as useful adjunct to traditional methods of teaching. One validated VR platform is Touch Surgery, a cognitive task simulation and rehearsal app. The primary objective of this study was to identify the training effect of Touch Surgery intramedullary femoral nailing (IFN) modules using objective performance metrics over six consecutive attempts. Secondary objectives consisted of validated multiple choice questions (MCQ) testing before the first (pre) and after the sixth (post) attempts. 27 medical undergraduates were recruited to complete the decision-making process six consecutive times for four modules on the procedural steps of IFN. The modules consisted of (i) preparing the patient and equipment, (ii) femoral canal preparation, (iii) nail insertion and proximal locking, and (iv) distal locking and closure. Real-time objective performance metrics were obtained, stored electronically and analysed using the median and Bonett-Price 95% confidence intervals from the participants' attempts to assess training effect. Significance was calculated using the Mann-Whitney U test for independent data whilst the Wilcoxon signed ranked test was used for paired data. Significance was set as 2-tailed p-value <0.05. Median performance scores per attempt for all four modules demonstrated a significant improvement ranging from 58 to 115%. Scoring variability and distribution was reduced and more predictable per attempt. Logarithmic learning curves elicited strong positive correlations between the number of attempts and scoring. Mean scores for pre and post-study MCQs tests significantly improved from 83 to 94% in all modules. IFN modules on Touch Surgery app demonstrated a significant training

  18. Exchange nailing for femoral diaphyseal fracture non-unions: Risk factors for failure.

    PubMed

    Tsang, S T J; Mills, L A; Baren, J; Frantzias, J; Keating, J F; Simpson, A H R W

    2015-12-01

    The aim of this study was to identify risk factors for failure of exchange nailing for femoral diaphyseal fracture non-unions. The study cohort comprised 40 patients with femoral diaphyseal non-unions treated by exchange nailing, of which six were open injuries. The median time to exchange nailing from primary fixation was 8.4 months. The main outcome measures were union, number of secondary fixation procedures required to achieve union and time to union. Multiple causes for non-union were found in 16 (40%) cases, with infection present in 12 (30.0%) patients. Further surgical procedures were required in nine (22.5%) cases, one of whom (2.5%) required the use of another fixation modality to achieve union. Union was ultimately achieved with exchange nailing in 34/37 (91.9%) patients. The median time to union after the exchange nailing was 9.4 months. Cigarette smoking and infection were risk factors for failure of exchange nailing. Multivariate analysis found infection to be the strongest predictor of exchange failure (p<0.05). Exchange nailing is an effective treatment for aseptic femoral diaphyseal fracture non-union. However, 50% of patients undergoing exchange nailing in the presence of infection required at least one further procedure. It is important to counsel patients of this so that they can plan for it and do not consider that the first exchange operation has failed. Copyright © 2015 Elsevier Ltd. All rights reserved.

  19. Pelvic migration of the helical blade after treatment of transtrochanteric fracture using a proximal femoral nail.

    PubMed

    Gomes, Pedro Luciano Teixeira; Castelo, Luís Sá; Lopes, António Lemos; Maio, Marta; Miranda, Adélia; Dias, António Marques

    2016-01-01

    Proximal femoral nails with a helical blade are a new generation of implants used for treating transtrochanteric fractures. The blade design provides rotational and angular stability for the fracture. Despite greater biomechanical resistance, they sometimes present complications. In the literature, there are some reports of cases of perforation of the femoral head caused by helical blades. Here, a clinical case of medial migration of the helical blade through the femoral head and acetabulum into the pelvic cavity is presented.

  20. [Reconstruction intramedullary nailing for treatment of ispsilateral femoral neck and shaft fractures].

    PubMed

    Wang, Hao; Li, Lian-hua; Liu, Zhi; Zhang, Jian-zheng; Guo, Yong-zhi

    2015-09-01

    To evaluate the curative effect and surigical skills of reconstruction intramedullary nailing in the treatment of ipsilateral femoral neck and shaft fractures. From January 2007 to January 2013, 13 patients with ipsilateral femoral neck and shaft fractures were treated by reconstruction intramedullary nailing including 11 males and 2 females with an average age of 38.9 yeas old ranging from 25 to 53 years old. For femoral neck fractures,10 cases were basilar neck fracture, 3 were transcervical fractures and according to Garden classification,10 were type II, 2 were type III and 1 was type IV. For feormal shaft fracture, 5 were type I, 4 were type II, 3 were type III and 1 was type IV according to Winquist classification. The location of all 13 feormal shaft fractures were all in the uper 3/4 of the feormal shaft. Complications and postoperative function were recorded and evaluated. Eleven patients were followed up for 23.45 months (12 to 36 months). Time from injury to operation was 5.9 days in average. Malunion of femoral neck fracture happened in 1 patient, nonunion of femoral shaft fracture happened in 2 patients. NO femoral head osteonecrosis, infection and malunion of femoral shaft fracture happened. According to Friedman-Wyman classification, 8 cases get good result, 2 get faii and 1 get poor. Reconstruction intramedullary nailing is a good choice for the ipsilateral femoral neck and shaft fractures with the advantages of less soft-tissue trauma and complications.

  1. Femoral neck fracture following intramedullary nailing with misplacement of an end cup: report of two cases

    PubMed Central

    Mańkowski, Bartosz; Kierzynka, Grzegorz

    2008-01-01

    Femoral neck fracture is an unusual complication of intramedullary fixation of a broken femur. We report on two cases of femoral neck fractures attributed to misplacement of an end cup and subsequent invasive maneuvers in an effort to remove it. Iatrogenic fractures of the femoral neck during or after intramedullary nailing are reported in the medical literature. Authors associate it with many possible technical mistakes performed during the procedure, yet no complications after missed end cup placement were noted. We suggest that the fractures described below were a consequence of injury to the vascular supply and bone stock of the initially intact femoral neck. PMID:19384634

  2. UNSTABLE FEMORAL FRACTURES TREATED WITH TITANIUM ELASTIC INTRAMEDULLARY NAILS, IN CHILDREN

    PubMed Central

    Soni, Jamil Faissal; Schelle, Gisele; Valenza, Weverley; Pavelec, Anna Carolina; Souza, Camila Deneka Arantes

    2015-01-01

    Objective: To evaluate the indications, epidemiology, associated lesions, complications and prognosis among children with unstable femoral diaphysis fractures who were treated with titanium elastic intramedullary nails. Method: This was a retrospective analysis on 24 patients aged 5-12 years with unstable femoral diaphysis fractures who underwent surgical treatment with elastic titanium intramedullary nails at the Cajuru University Hospital, Curitiba-PR, between April 2002 and March 2008, with a minimum follow-up of 36 months. The epidemiological data, angular deviations, leg shortening and bone consolidation were evaluated. Results: The medical files of 113 cases operated between April 2002 and March 2008 were reassessed. From these, 24 cases of unstable femoral diaphysis fractures treated with elastic titanium intramedullary nails with retrograde insertion were included in the study. There were two bilateral fractures and two exposed fractures. Seven patients were female and 17 were male, and the mean age was 8.3 years. The following were presented at the end of the study: shortening, varus or valgus displacement, final retrocurvatum or antecurvatum of zero, and absence of delayed consolidation or pseudarthrosis. Conclusions: The elastic titanium intramedullary nails were easily placed and removed. We believe that using elastic titanium intramedullary nails is a good option for fixation of unstable femoral fractures in children. PMID:27047868

  3. Medial Flatness of the Femoral Trochlea in the Nail Patella Syndrome.

    PubMed

    Vanek, J; L Fournier, L

    1995-01-01

    The knee joint of an adult male with a nail patella syndrome was examined by standard X-rays and by computerised tomography. The dysplasia of the femoral trochlea has a specific sign which distinguish it from the "common" dysplasia of the recurrent patellar luxation type: a straight line flatness of the medial margin on the profile. This sign should be useful for the diagnosis of incomplete forms of the nail patella syndrome. Key words: nail patella syndrome, osteo-onycho-- dysplasia, knee dysplasia.

  4. Rupture of the Deep Femoral Artery during Proximal Femoral Nailing Following an Intertrochanteric Fracture: A Case Report

    PubMed Central

    Yoon, Han Kook; Park, Junyoung; Oyunbat, Choidog; Kim, Taehwan

    2016-01-01

    Recently, we experienced a case where the diagnosis and management of a deep femoral artery rupture was delayed. This vascular complication occurred during the insertion of a distal interlocking screw of a proximal femoral nail for the fixation of an intertrochanteric femur fracture. A 79-year-old male patient was diagnosed with a right intertrochanteric fracture after a fall. We fixed the fracture with a proximal femoral nail (Zimmer® Natural Nail™ System). One day after the procedure, the patient complained of pain and swelling on the anteromedial side of his middle thigh followed by hypotension, anemia and prolonged thigh swelling. Computed tomography angiography was performed 7 days after the procedure. We found a pseudoaneurysm of the perforating artery caused by injury to the deep femoral artery and an intramuscular hematoma in the anterior thigh muscle. We successfully treated the pseudoaneurysm using coil embolization. Throughout the management of intertrochanteric femoral fractures, it is important to be aware and monitor signs and symptoms related to the possibility of blood vessel damage. When a patient presents with swelling and pain on the middle thigh and/or unexplained anemia postoperatively, the possibility that these symptoms are caused by an injury to the femoral artery must be considered. PMID:27536645

  5. A locked hip screw-intramedullary nail (cephalomedullary nail) for the treatment of fractures of the proximal part of the femur combined with fractures of the femoral shaft.

    PubMed

    Alho, A; Ekeland, A; Grøgaard, B; Dokke, J R

    1996-01-01

    Twenty-seven patients with complex femoral fractures (combined shaft and proximal femoral fractures) were treated with a modified Grosse-Kempf slotted locking nail (cephalomedullary nail), wherein two screws were inserted in the hip. Four types of complex, multifocal femoral fractures were represented in the series. Eleven of the femoral shaft fractures were secondary to a previous, internally fixed, not yet united hip fracture (type I). Ten comminuted peritrochanteric fractures occurred in normal bone (type II). Three similar fractures were pathologic because of metastasis. Two patients had an ipsilateral fracture of the femoral shaft and the trochanteric area (type III), and one of the shaft and the femoral neck (type IV). Locking was made static in 24 cases. Additional cerclage wiring was used in three type II fractures. Five complications were as follows: one cutting out of a screw in the femoral head, two fractures of the nail, one deep venous thrombosis, and one wound hematoma. Reoperations were two salvage operations using a new nail and one evacuation of hematoma. One patient with multiple injuries and four elderly patients died within 2 months. Eighteen patients with fractures in normal bone were followed for a median of 20 (6 to 37) months. All fractures united. Two nails were removed. The end result was excellent in ten patients, good in seven, and fair in one (2-cm shortening and 20-degree external rotation). We conclude that a locked intramedullary construct with locking screws in femoral neck and distal femur controls a complex fracture situation well.

  6. Exchange nailing with enhanced distal fixation is effective for the treatment of infraisthmal femoral nonunions.

    PubMed

    Kim, Joon-Woo; Yoon, Yong-Cheol; Oh, Chang-Wug; Han, Seung-Beom; Sim, Jae-Ang; Oh, Jong-Keon

    2017-09-27

    The treatment options for nonunions of infraisthmal femoral shaft fractures after internal fixation are controversial. Methods such as exchanging an existing nail with a nail of a larger size, dynamization, removal of the nail followed by plating, and bone grafting have all been reported. Among those options, exchange nailing seems to be the most popular choice. In this study, a Poller screw, or an additional interlocking screw, was used in conjunction with exchange intramedullary nailing. The purpose of this study was to evaluate the effectiveness of treating femoral shaft nonunions using insertion of a Poller screw or an additional interlocking screw in conjunction with intramedullary nail fixation. This study included 18 patients who presented with nonunion of femur shaft fractures after internal fixation at the infraisthmal level. These patients included 13 men and 5 women, with a mean age of 46.8 years (range 15-78 years). The mean postsurgical period of nonunion was 7.8 months (range 6-12 months). The patients were classified into two groups: the atrophic nonunion group and the hypertrophic nonunion group. In all patients, nailing was enhanced with a Poller screw or additional interlocking screws. All patients were followed up with plain film examinations and were assessed for their functional recovery status to determine the osseous union conditions. All 18 patients achieved postoperative bony union after a mean time of 7.5 months (range 3-12 months), and all patients were able to walk with full weight-bearing and without pain within 3 months. There were no significant complications, such as broken hardware, implant back-outs, axial or rotational malalignments, or deep infections. Poller screws and additional interlocking screws, along with intramedullary nailing exchange, may be an effective and reliable alternative for treating infraisthmal femoral shaft nonunions.

  7. Correlation of Trochanter-Shaft Angle in Selection of Entry Site in Antegrade Intramedullary Femoral Nail

    PubMed Central

    Lakhwani, O. P.

    2012-01-01

    Background. Selection of entry point for nail insertion is controversial and lack firm anatomical basis. The study is done to analyze the proximal anthropometry of femur and measure the Trochanter-Shaft Angle to find its relation and significance in selection of entry point for antegrade uniplanar femoral nail. Materials and Methods. Study involves the measurement of trochanter-shaft angle and other anthropometric measurements on 50 dry femora and on digital radiogram. Results. Trochanter-Shaft angle ranges between 5–17 degrees in anthropometric study and 4–14 degrees in radiological study. Over all in 27 cases (54%), exit points of reamur fall in the middle quadrant in sagittal and coronal plane, which corresponds to the T-S angle of 6–12 degrees. Discussion and Conclusion. Proximal femoral Anthropometry and Trochanter-shaft angle is variable; hence it is difficult to fix any anatomical point as a universal entry point for antegrade femoral nail insertion. Trochanter shaft angle (TSA) can be well accessed radiologically and serve as a guide for selection of proper entry point.for safe nail insertion. Clinical Relevance. Individual variations in the proximal femur anatomy for safe nail insertion can be correlated with Trochanter shaft angle to serve safe entry site. PMID:24977077

  8. Reamed versus unreamed intramedullary nailing for the treatment of femoral fractures

    PubMed Central

    Li, A-Bing; Zhang, Wei-Jiang; Guo, Wei-Jun; Wang, Xin-Hua; Jin, Hai-Ming; Zhao, You-Ming

    2016-01-01

    Abstract Background and objective: Intramedullary nailing is commonly used for treating femoral shaft fractures, one of the most common long bone fractures in adults. The reamed intramedullary nail is considered the standard implant for femoral fractures. This meta-analysis was performed to verify the superiority of reamed intramedullary nailing over unreamed intramedullary nailing in fractures of the femoral shaft in adults. Subgroup analysis of implant failure and secondary procedure was also performed. Methods: Electronic literature databases were used to identify relevant publications and included MEDLINE (Ovid interface), EMBASE (Ovid interface), and the Cochrane Central Register of Controlled Trials (CENTRAL; Wiley Online Library). The versions available on January 30, 2016, were utilized. Only human studies, which were designed as randomized controlled clinical trials, were included. Two authors independently evaluated the quality of original research publications and extracted data from the studies that met the criteria. Results: Around 8 randomized controlled trials involving 1078 patients were included. Reamed intramedullary nailing was associated with shorter time to consolidation of the fracture (SMD = –0.62, 95% CI = –0.89 to –0.35, P < 0.00001), lower secondary procedure rate (OR = 0.25, 95% CI 0.10–0.62, P = 0.003), lower nonunion rate (OR = 0.14, 95% CI = 0.05–0.40, P < 0.01), and lower delayed-union rate (OR = 0.19, 95% CI = 0.07–0.49, P < 0.01) compared to unreamed intramedullary nailing. The 2 groups showed no significant differences in risk of implant failure (OR = 0.50, 95% CI 0.14–1.74, P = 0.27), mortality risk (OR = 0.94, 95% CI 0.19–4.68, P = 0.94), risk of acute respiratory distress syndrome (ARDS; OR = 1.55, 95% CI 0.36–6.57, P = 0.55), or blood loss (SMD = 0.57, 95% CI = –0.22 to 1.36, P = 0.15). Conclusion: Reamed intramedullary nailing

  9. An Effective Approach for Optimization of a Composite Intramedullary Nail for Treating Femoral Shaft Fractures.

    PubMed

    Samiezadeh, Saeid; Tavakkoli Avval, Pouria; Fawaz, Zouheir; Bougherara, Habiba

    2015-12-01

    The high stiffness of conventional intramedullary (IM) nails may result in stress shielding and subsequent bone loss following healing in long bone fractures. It can also delay union by reducing compressive loads at the fracture site, thereby inhibiting secondary bone healing. This paper introduces a new approach for the optimization of a fiber-reinforced composite nail made of carbon fiber (CF)/epoxy based on a combination of the classical laminate theory, beam theory, finite-element (FE) method, and bone remodeling model using irreversible thermodynamics. The optimization began by altering the composite stacking sequence and thickness to minimize axial stiffness, while maximizing torsional stiffness for a given range of bending stiffnesses. The selected candidates for the seven intervals of bending stiffness were then examined in an experimentally validated FE model to evaluate their mechanical performance in transverse and oblique femoral shaft fractures. It was found that the composite nail having an axial stiffness of 3.70 MN and bending and torsional stiffnesses of 70.3 and 70.9 N⋅m², respectively, showed an overall superiority compared to the other configurations. It increased compression at the fracture site by 344.9 N (31%) on average, while maintaining fracture stability through an average increase of only 0.6 mm (49%) in fracture shear movement in transverse and oblique fractures when compared to a conventional titanium-alloy nail. The long-term results obtained from the bone remodeling model suggest that the proposed composite IM nail reduces bone loss in the femoral shaft from 7.9% to 3.5% when compared to a conventional titanium-alloy nail. This study proposes a number of practical guidelines for the design of composite IM nails.

  10. [Treatment of periprosthetic femoral fractures after total hip arthroplasty with specially constructed retrograde hollow nails].

    PubMed

    Szalay, G; Meyer, C; Mika, J; Schnettler, R; Thormann, U

    2014-12-01

    Treatment of periprosthetic fractures by implantation of a specially constructed, retrograde hollow nail which fits over the tip of the prosthesis and becomes locked on it. Periprosthetic femoral fractures with firmly anchored prosthesis shaft after total hip arthroplasty of types B1 and C according to the Vancouver classification. Loosened prosthesis (type B2/B3) and trochanteric fractures (type A). Broken or damaged prosthesis, florid inflammation and soft tissue injuries in the operation field, contracted knee joint, advanced deformation in the knee joint and distal femur, enclosed prosthesis and general contraindications. In a supine position the periprosthetic fracture is exposed via a lateral access. For cemented prostheses the cement is removed around the tip of the prosthesis (at least 2-3 cm) and medullary cavity. Arthrotomy with flexion of the knee joint and marking of the nail entry point. Drill the medullary cavity, retrograde introduction of the nail, visually fit the nail over the tip of the prosthesis and lock the nail with the prosthesis. If necessary use additional spongiosaplasty or also placement of additional cerclages depending on fracture type and size of the defect zone. Lock the nail distally. Use intraoperative radiological imaging to control correct positioning and length of the nail. Close the wound layer by layer with placement of suction drainage devices and dressing. Partial loading for 6 weeks with a subsequent pain-adapted loading gradient until full loading is possible. If selective partial loading is not possible, a decision must be made in individual cases as to whether the intraoperative findings allow immediate full loading. From 2004 to 2011 a total of 25 periprosthetic femoral fractures in 25 patients were treated in 2 locations using specially constructed slotted hollow nails. Within the framework of a retrospective study 20 of these patients (16 female and 4 male; average age 77.2 [72-84] years) were clinically and

  11. [Electromagnetic navigation interlocking intramedullary nail technology for treatment of femoral shaft fractures].

    PubMed

    Zuo, Kangkang; Qin, Wei; Guo, Qing; Palati-Ababaikeli; Qiao, Peiliu; Shen, Mingquan; Yin, Lele; Pan, Qilin; Xu, Xiaoxiong

    2014-10-01

    To explore the value of electromagnetic navigation interlocking intramedullary nail in the treatment of femoral shaft fracture. Between July 2012 and October 2013, 53 cases of femoral shaft fracture were treated. There were 40 males and 13 females, aged 16-52 years (mean, 38.3 years). The causes of injury were traffic accident in 28 cases, falling from height in 11 cases, falling in 7 cases, crush injury in 4 cases, and other in 3 cases. Of 53 cases, there were 3 cases of open fracture (Gustilo I degree) and 50 cases of closed fracture. Fracture was located in the proximal femur in 17 cases, middle femur in 29 cases, and distal femur in 7 cases. According to Winquist classification, 7 cases were rated as type I, 8 cases as type II, 22 cases as type III, and 16 cases as type IV; according to AO classification, 18 cases were rated as type 32-A, 28 cases as type 32-B, and 7 cases as type 32-C. The time from injury to operation was 3-11 days (mean, 5 days). Distal interlocking intramedullary nail was implanted using electromagnetic navigation. The distal locking nail operation with interlocking intramedullary nail was successfully completed under electromagnetic navigation; the one-time success rate of distal locking nail operation reached 100%; and the locking nail time was 5.0-9.5 minutes (mean, 7.0 minutes). Healing of incision by first intention was obtained after operation, and no complication of skin necrosis, infection, and sinus tract occurred. Fifty-three cases were all followed up 5-12 months (mean, 9 months). One case had hip pain and weaken middle gluteal muscle strength, and the symptoms disappeared after removing the nail. During the follow-up period, no broken nails, nail exit, infection, or re-fracture occurred. All fractures achieved clinical healing, and the healing time was 8-22 weeks (mean, 14.5 weeks). In 49 patients followed up 8 months, the Lysholm score was excellent in 44 cases, good in 4 cases, and acceptable in 1 case, with an excellent and

  12. Serum titanium levels in individuals undergoing intramedullary femoral nailing with a titanium implant.

    PubMed

    McGarry, Sean; Morgan, Steven J; Grosskreuz, Ruth M; Williams, Allison E; Smith, Wade R

    2008-02-01

    Many patients request nail extraction or question the long-term effects of hardware retention. Systemic titanium degradation products may influence the timing of such decisions. The orthopedic literature provides no data regarding systemic titanium in patients undergoing intramedullary nail fixation with titanium implants. The purpose of this study was to determine the systemic level of serum titanium in patients who had undergone femoral nailing. Patients who underwent antegrade locked femoral nailing utilizing a reamed technique with a titanium implant were eligible to participate. Eight patients were recruited for each of four time points: 6 weeks, 3 months, 6 months, and 1 year. Blood samples were collected from each subject. Serum titanium levels were analyzed through inductively coupled plasma/mass spectrometry (ELAN DRC II, Perkin Elmer, SCIEX, Inc, Shelton, CT). Test sensitivity was 0.2 microg/L. Normal serum titanium levels are <150 microg/L. Thirty-two patients were enrolled. The study group included 10 women and 22 men with average age of 32 (range 19-63) years. The most common fracture pattern was 32-A3 (n = 12), followed by 32-B2 (n = 9). No patients showed an elevated serum titanium level. Mean titanium levels were 49.38, 58.25, 49.38, and 50.63 microg/L at 6 weeks, 3 months, 6 months, and 12 months cohorts, respectively. No statistically significant differences were found (p = 0.207). Standard intramedullary nail fixation of femur fractures did not result in elevated levels of serum titanium in the first year after surgery. Differences in serum titanium did not differ significantly across time since implantation.

  13. Femoral malrotation after intramedullary nailing in obese versus non-obese patients.

    PubMed

    Koerner, John D; Patel, Neeraj M; Yoon, Richard S; Gage, Mark J; Donegan, Derek J; Liporace, Frank A

    2014-07-01

    Intramedullary nailing (IMN) of obese patients with femoral fractures can be difficult due to soft tissue considerations and overall body habitus. Complications including malrotation can occur and have significant impact on postoperative function. The purpose of this study was to evaluate femoral rotation after intramedullary nailing of obese and non-obese patients to see if there was a difference in rotation, complications and any risk factors for malrotation. Between 2000 and 2009, 417 consecutive patients with femur fractures treated with IM nail at Level I trauma and tertiary referral center. Of these, 335 with postoperative computed tomography (CT) scanogram of the bilateral lower extremities were included in this study. Baseline demographic, perioperative and postoperative femoral version calculations were included in the dataset. Statistical analysis included chi-squared test for categorical data, t-test for continuous data, and univariate and multivariate regression analysis. Significance was set at p<0.05. Of the 417 patients with femur fractures between 2000 and 2009, 335 met criteria for this study. There were 111 patients with a BMI <25, 129 with BMI 25-29.9, and 95 patients with a BMI >30. When BMI was categorised into 3 groups (<25, 25-29.9, or 30+), none of these groups were predictive of version in univariate or multivariate regressions. Among only obese patients (BMI 30+), BMI of 35+ was not a significant predictor of version when compared to BMI 30-34.9. There were no significant differences in femoral version based on entry point (antegrade vs. retrograde) in any BMI category. There were also no significant difference between groups of patients with a DFV of >15̊ (p=0.212). Based on this study, BMI did not have an effect on postoperative difference in femoral version. In fact, in our multivariate regression analysis, BMI of over 30 was actually predictive of significantly lower difference in femoral version. While other studies have documented

  14. Lengthening Over an Existing Intramedullary Nail In Cases of Post-traumatic Femoral Shortening. Technical Note. Case Series Study

    PubMed Central

    Boutsiadis, Achilleas; Iosifidou, Eirini; Nikolaos, Xilouris; Hatzokos, Ippokratis

    2016-01-01

    Background: Intramedullary (IM) nailing is the method of choice for the treatment of most femoral shaft fractures. However, despite successful solid union, great initial fracture comminution can lead to significant leg length discrepancy affecting normal gait mechanics. Femoral osteotomy and distraction osteogenesis over the pre-existing IM nail could restore this limb inequality. Methods: Five patients with an average post-traumatic femoral shortening of 3.83 cm were presented in our department with the nail in situ. Limb lengthening was achieved with the application of a distal hybrid external rail frame over the pre-existing nail. We assumed that the choice of a distal external fixator ring with wires could facilitate the procedure and minimize the possibility of friction–contact problems with the large diameter nail. Results: The amount of length discrepancy, calculated preoperatively, was restored in all patients. The mean time in frame was 57.6 days and the external fixator index 16.978 d/cm. The mean time of total healing was 152.6 days and the average bone-healing index 44.9d/cm. No deep infection or hardware loosening was observed. One superficial pin track infection was treated successfully with oral antibiotics. Conclusion: This technique utilizes the principles and advantages of lengthening over an IM nail, avoids the necessity of nail removal and minimizes the complication rates and the overall time for complete recovery. PMID:27053972

  15. Muscle function and functional outcome following standard antegrade reamed intramedullary nailing of isolated femoral shaft fractures.

    PubMed

    Helmy, Nader; Jando, Victor T; Lu, Thomas; Chan, Holman; O'Brien, Peter J

    2008-01-01

    To evaluate the functional outcomes and long-term effects on muscle strength of femoral shaft fractures treated with intramedullary (IM) antegrade nailing using a standard piriformis start point. Retrospective Outcome Study. Tertiary Level Teaching Hospital and Referral Centre for the Province of British Columbia. Twenty-one patients (7 female, 14 male; mean age 34.5 years, range 16-56 years) with isolated femoral shaft fractures who were treated with standard antegrade reamed interlocking IM nailing and who had a minimum 1-year follow-up were identified through the Orthopaedic Trauma Database. All patients had isokinetic muscle testing of their hip abductors, hip extensors, and knee extensors using the KinCom muscle testing machine. Of the patients, 10 underwent formal gait lab analysis. All of the patients answered a questionnaire and completed the Short Form (SF)-36 and Musculoskeletal Functional Assessment outcome measures. Antegrade reamed interlocking IM nailing of femoral shaft fractures using a standard trochanteric fossa (also referred to as piriformis fossa) starting point. Examination of muscle strength, using 2 different objective measures (KinCom and gait analysis). The KinCom muscle testing machine was used for isokinetic muscle testing of hip abductors, hip extensors, and knee extensors. Outcome questionnaires were used to evaluate function (Musculoskeletal Functional Assessment) and general health (SF-36). Isokinetic muscle testing showed a statistically significant lower peak torque generation by the hip abductors (P=0.003) and hip extensors (P=0.046) from the uninjured contralateral side. The gait lab analysis did not show important changes in gait pattern. Scores for the SF-36 were 51.77+/-7.55 and 53.73+/-8.70. Scores for the Short Musculoskeletal Functional Assessment (S-MFA) were 7.74 and 8.66. Both scores did not indicate any significant disability. Antegrade reamed interlocking IM nailing of femoral shaft fractures using a standard

  16. The Intramedullary Nailing of Adult Femoral Shaft Fracture by the Way of Open Reduction is a Disadvantage or Not?

    PubMed

    Burç, Halil; Atay, Tolga; Demirci, Demir; Baykal, Y Barbaros; Kirdemir, Vecihi; Yorgancigil, Hüseyin

    2015-12-01

    The purpose of this study is that to evaluate superiority and results of open technique in the treatment of femoral shaft fracture with interlocking intramedullary nailing. The retrospective study is designed to evaluate results of our technique. In this study, the patients that were admitted to the Orthopedics and Traumatology Department of University Hospital that is third level of trauma center. We claim that open technique is not a disadvantage during union process over closed technique in treatment of femoral shaft fracture with interlocking nailing. In this study, 44 patients that were consulted for adult femoral shaft fracture between January 2008 to July 2010 were included. Patients with open fractures, gunshot wounds, neurovascular injuries, and patients that did not have isolated femoral diaphysis fractures were excluded from the study. Clinical and radiological results of the patients were checked periodically. The open interlocking intramedullary nailing was used in treatment. Complete union rate was 90.9 % in 40 patients who were treated with open interlocking intramedullary nailing for adult femoral shaft fracture, and nonunion rate was 9.1 % in four patients. Mean union time was 18.3 weeks (12-36 weeks). Evaluation of 44 patients according to Thoresen criteria was excellent in 22 patients, good in 6 patients, and bad in 4 patients. We think that open technique is an acceptable technique because all results of our study were similar to results of closed intramedullary nailing technique in literature and some advantages of open technique over closed technique.

  17. Numerical Optimization of the Position in Femoral Head of Proximal Locking Screws of Proximal Femoral Nail System; Biomechanical Study.

    PubMed

    Konya, Mehmet Nuri; Verim, Özgür

    2017-09-29

    Proximal femoral fracture rates are increasing due to osteoporosis and traffic accidents. Proximal femoral nails are routinely used in the treatment of these fractures in the proximal femur. To compare various combinations and to determine the ideal proximal lag screw position in pertrochanteric fractures (Arbeitsgemeinschaft für Osteosynthesefragen classification 31-A1) of the femur by using optimized finite element analysis. Biomechanical study. Computed tomography images of patients' right femurs were processed with Mimics. Afterwards a solid femur model was created with SolidWorks 2015 and transferred to ANSYS Workbench 16.0 for response surface optimization analysis which was carried out according to anterior-posterior (-10°femoral nail hole, the small diameter portion of stem joints with a large diameter and lag screw mounts to the stem. The most suitable position of the proximal lag screw was found at the middle position of the tip-apex distance (20 mm) and femoral neck (anterior-posterior, inferior-superior=0°), according to von Mises compression stress values occurring on the fracture line. In our study, we couldn't find any correlation between proximal lag screw movement and tip-apex distance on stresses of the fracture surfaces, but the proximal lag screw

  18. Twenty-Year Experience with Rigid Intramedullary Nailing of Femoral Shaft Fractures in Skeletally Immature Patients.

    PubMed

    Crosby, Samuel N; Kim, Elliott J; Koehler, Daniel M; Rohmiller, Michael T; Mencio, Gregory A; Green, Neil E; Lovejoy, Steven A; Schoenecker, Jonathan G; Martus, Jeffrey E

    2014-07-02

    Debate exists over the safety of rigid intramedullary nailing of femoral shaft fractures in skeletally immature patients. The goal of this study was to describe functional outcomes and complication rates of rigid intramedullary nailing in pediatric patients. A retrospective review was performed of femoral shaft fractures in skeletally immature patients treated with trochanteric rigid intramedullary nailing from 1987 to 2009. Radiographs made at initial injury, immediately postoperatively, and at the latest follow-up were reviewed. Patients were administered the Nonarthritic Hip Score and a survey. The study population of 241 patients with 246 fractures was primarily male (75%) with a mean age of 12.9 years (range, eight to seventeen years). The majority of fractures were closed (92%) and associated injuries were common (45%). The mean operative time was 119 minutes, and the mean estimated blood loss was 202 mL. The mean clinical follow-up time was 16.2 months (range, three to seventy-nine months), and there were ninety-three patients with a minimum two-year clinical and radiographic follow-up. An increase of articulotrochanteric distance of >5 mm was noted in 15.1% (fourteen of ninety-three patients) at a minimum two-year follow-up; however, clinically relevant growth disturbance was only observed in two patients (2.2%) with the development of asymptomatic coxa valga. There was no femoral head osteonecrosis. Among the 246 fractures, twenty-four complications (9.8%) occurred. At the time of the latest follow-up, 1.7% (four of 241 patients) reported pain. The average Nonarthritic Hip Score was 92.4 points (range, 51 to 100 points), and 100% of patients reported satisfaction with their treatment. Rigid intramedullary nailing is an effective technique for treatment of femoral shaft fractures in pediatric patients with an acceptable rate of complications. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. Copyright

  19. Comparison study between reamed and unreamed nailing of closed femoral fractures.

    PubMed

    Selvakumar, K; Saw, K Y; Fathima, M

    2001-12-01

    Intramedullary nailing is an accepted procedures for femoral fractures gives uniformly good results. Various methods of intramedullary fixation have been practiced in the past. Recently intramedullary fixation without reaming has come into vogue. Preservation of the endosteal blood supply, less blood loss and quicker union have been the alleged benefits of not reaming the medullary canal. This study is a prospective randomised study conducted to compare intramedullary nail fixation of closed femoral fractures with and without a reaming procedure to assess the validity of the above assumptions. One hundred and two consecutive cases of skeletally mature patients with closed fracture of femoral shaft were randomised into two groups, i.e. Reamed (52) and Unreamed (50). The average follow-up was 36 weeks (range 28-86 weeks). Average time taken for various stages of the operation and total operating time were longer in the reamed group (109.9 min vs 78.6 min) and the blood loss was also increased (320 mls vs. 190 mls). Bridging and callus formation were seen to occur earlier in the reamed group compared to the unreamed enabling the patients in the reamed group to return to normal functions earlier. Limb length discrepancy and rotational alignment measured clinically and with CT scan did not however show any significant difference between the two methods. Nails used in this study group were notably of a smaller diameter and of shorter length when compared to those used in the western population highlighting the difference in the femur in the Asian population. Complications were notably more in the unreamed group where these were screw breakage (3/50) delayed unions (9/50) and non-unions (4/50). In the reamed group however there were only delayed union (2/50) and all fractures eventually united without any implant failure. We conclude that closed, reamed, antegrade insertion of an intramedullary nail is the treatment of choice in femoral shaft fractures, especially those

  20. Nails

    MedlinePlus

    ... Previous meetings archive Advocacy News Advocacy priorities Drug pricing and availability CVS dermatologic formulary restrictions Skin cancer ... nail biting, finger sucking or frequent exposure to water. Ingrown toenails, caused by improper nail trimming, poor ...

  1. Treatment of pediatric femoral shaft fractures by stainless steel and titanium elastic nail system: A randomized comparative trial.

    PubMed

    Gyaneshwar, Tank; Nitesh, Rustagi; Sagar, Tomar; Pranav, Kothiyal; Rustagi, Nitesh

    2016-08-01

    Literature suggests that the lower modulus of elasticity of titanium makes it ideal for use in children compared with stainless steel. Better fracture stability was observed in association with titanium nails on torsional and axial compression testing. However, stainless steel nails are stiffer than titanium counterparts, which may provide a rigid construct when fixing paediatric femoral shaft fractures. Complications have been observed more frequently by various researchers when titanium nails are used for fracture fixation in patients with increasing age or weight. The concept of this study was to compare the functional outcome after internal fixation with titanium elastic nail system and stainless steel elastic nail system in paediatric femoral shaft fractures. The study was conducted on 34 patients admitted in the department of orthopaedics, LLRM Medical College & SVBP Hospital, Meerut, India from January 2013 to August 2014. We included patients aged 5-12 years with fracture of the femoral shaft, excluding compound fractures, pathological fractures and other lower limb fractures. Patients were treated by titanium (n=17) or stainless steel (n=17) elastic nail system and followed up for one year. The clinical parameters like range of motion at hip and knee joints, time to full weight bearing on the operated limb and radiological parameters like time to union were compared between two groups. A special note was made of intra- and post-operative complications. Functional outcomes were analysed according to Flynn criteria. Based on the Flynn criteria, 59% of patients had excellent results, 41% had satisfactory results, and no one showed poor results. There was no clinically significant difference between the two groups with respect to time to union and full weight bearing. But the incidence of puncture of the opposite cortex while inserting the nail and trying to advance it through the diaphysis during operation is greatly different. Only one such case was observed

  2. Antegrade versus retrograde nailing techniques and trochanteric versus piriformis intramedullary nailing entry points for femoral shaft fractures: a systematic review and meta-analysis

    PubMed Central

    Hussain, Nasir; Hussain, Farrah Naz; Sermer, Corey; Kamdar, Hera; Schemitsch, Emil H.; Sternheim, Amir; Kuzyk, Paul

    2017-01-01

    Background There are several different techniques commonly used to perform intramedullary (IM) nailing of the femur to fix femoral fractures. We sought to identify significant differences in outcomes of studies comparing 1) trochanteric and piriformis entry and 2) antegrade and retrograde entry in IM nailing of the femur. Methods We searched MEDLINE, Cochrane and Embase databases and the Orthopaedic Trauma Association and American Academy of Orthopaedic Surgeons websites for comparative studies published from inception to November 2015. Criteria used to select articles for detailed review included use of antegrade and retrograde entry point or use of trochanteric and piriformis entry point for IM nailing of the femur in adult patients. Functional and technical outcomes were extracted from accepted studies. Results We identified 483 potential studies, of which 52 were eligible. Of these, we included 13 publications and 2 abstracts (2 level I, 7 level II and 6 level III studies). Trochanteric entry significantly reduced operative duration by 14 min compared with piriformis entry (p = 0.030). Retrograde nailing had a greater risk of postoperative knee pain than antegrade nailing (p = 0.05). On the other hand, antegrade nailing had significantly more postoperative hip pain (p = 0.003) and heterotopic ossification (p < 0.001) than retrograde nailing. No significant differences in functional outcomes were observed. Conclusion Although some significant differences were found, the varying quality of studies made recommendation difficult. Our meta-analysis did not confirm superiority of either antegrade over retrograde or trochanteric over piriformis entry for IM nailing of the femur. Level of evidence Level III therapeutic. PMID:28234586

  3. Titanium elastic nailing in diaphyseal femoral fractures of children below six years of age

    PubMed Central

    Donati, Fabrizio; Mazzitelli, Giuseppe; Lillo, Marco; Menghi, Amerigo; Conti, Carla; Valassina, Antonio; Marzetti, Emanuele; Maccauro, Giulio

    2017-01-01

    AIM To report the clinical and radiographic results of titanium elastic nail (TEN) in diaphyseal femoral fractures of children below age of six years. METHODS A retrospective analysis of 27 diaphyseal femoral fractures in children younger than six years treated with TEN between 2005 and 2015 was conducted. Patients were immobilized in a cast for 5 wk and the nails were removed from 6 to 12 wk after surgery. Twenty-four cases were clinically and radiographically re-evaluated using the Flynn’s scoring criteria, focusing on: Limb length discrepancy, rotational deformity, angulation, hip and knee range of motion (ROM), functional status, complications, and parent’s satisfaction. RESULTS Sixteen males and eight females with a mean age of 3.2 years at the time of treatment were re-evaluated at an average follow-up of 58.9 mo. No cases of delayed union were observed. The mean limb lengthening was 0.3 cm. Four cases experienced limb lengthening greater than 1 cm and always minor than 2 cm. Twelve point five percent of the cases showed an angulation < 10°. Complete functional recovery (hip and knee ROM, ability to run and jump on the operated limb) occurred in 95.7% of cases. Complications included two cases of superficial infection of the TEN entry point, one case of refracture following a new trauma, and one TEN mobilization. According to the Flynn’s scoring criteria, excellent results were obtained in 79.2% of patients and satisfactory results in the remaining 20.8%, with an average parent’s satisfaction level of 9.1/10. CONCLUSION TEN is as a safe, mini-invasive and surgeon-friendly technique and, considering specific inclusion criteria, it represents a useful and efficacy option for the treatment of diaphyseal femoral fractures even in patients younger than six years of age. PMID:28251066

  4. KIRSCHNER WIRE VERSUS TITANIUM ELASTIC NAILS IN PEDIATRIC FEMORAL SHAFT FRACTURES

    PubMed Central

    Isik, Cengiz; Kurtulmus, Tuhan; Saglam, Necdet; Saka, Gursel; Akpinar, Fuat; Sarman, Hakan

    2015-01-01

    ABSTRACT Objective: To evaluate the effectiveness of intramedullary fixation using the Kirschner-wire (K-wire) compared to the titanium elastic nail (TEN) in pediatric femoral shaft fractures. Methods: A sample of 42 pediatric patients with a mean age of 6.55±2.42 years (range 4-11 years) presenting femoral shaft fractures underwent intramedullary fixation using the K-wire or TEN. Results: There was no significant difference found between groups, of which 16 (38.1%) patients were treated with K-wire and 26 (61.9%) patients were treated with TEN in terms of union duration. Moreover, none of the patients showed nonunion or a delayed union. Conclusions: The use of adjusted K-wire instead of TEN in the intramedullary fixation of femoral shaft fractures in selected children may be an advantageous surgical option due to the lower cost, easy accessibility and no need for a second surgery for implant removal. Level of Evidence III, Retrospective Study. PMID:26981033

  5. The current status of prophylactic femoral intramedullary nailing for metastatic cancer

    PubMed Central

    Ormsby, NM; Leong, WY; Wong, W; Hughes, HE; Swaminathan, V

    2016-01-01

    The most common site for cancer to spread is bone. At post-mortem, bony metastases have been found in 70% of patients dying from breast and prostate cancer. Due to the prevalence of cancer, bone metastasis and the associated management represents a huge burden on NHS resources. In patients with metastasis, around 56% of these involve the lower limb long bones. Due to the huge forces placed upon long bones during weight bearing, there is a high risk of fracture through areas of metastasis. It is reported that 23% of pathological fractures occur in the femoral subtrochanteric region. This area is subjected to forces up to four times the body weight, resulting in poor union rate for these fractures, and significant morbidity associated with difficulty in mobilising, and in patient nursing. As cancer treatments improve, the life expectancy in this subgroup of patients is likely to increase. Therefore medium-to-long-term management of these fractures, beyond the palliative, will become essential. We aim to evaluate the current management for metastatic malignant femoral disease, with particular focus on the prophylactic augmentation of diseased femorii using intramedullary nails. PMID:28105069

  6. Biomechanical analyses of static and dynamic fixation techniques of retrograde interlocking femoral nailing using nonlinear finite element methods.

    PubMed

    Shih, Kao-Shang; Hsu, Ching-Chi; Hsu, Tzu-Pin; Hou, Sheng-Mou; Liaw, Chen-Kun

    2014-02-01

    Femoral shaft fractures can be treated using retrograde interlocking nailing systems; however, fracture nonunion still occurs. Dynamic fixation techniques, which remove either the proximal or distal locking screws, have been used to solve the problem of nonunion. In addition, a surgical rule for dynamic fixation techniques has been defined based on past clinical reports. However, the biomechanical performance of the retrograde interlocking nailing systems with either the traditional static fixation technique or the dynamic fixation techniques has not been investigated by using nonlinear numerical modeling. Three-dimensional nonlinear finite element models were developed, and the implant strength, fixation stability, and contact area of the fracture surfaces were evaluated. Three types of femoral shaft fractures (a proximal femoral shaft fracture, a middle femoral shaft fracture, and a distal femoral shaft fracture) fixed by three fixation techniques (insertion of all the locking screws, removal of the proximal locking screws, or removal of the distal locking screws) were analyzed. The results showed that the static fixation technique resulted in sufficient fixation stability and that the dynamic fixation techniques decreased the failure risk of the implant and produced a larger contact area of the fracture surfaces. The outcomes of the current study could assist orthopedic surgeons in comprehending the biomechanical performances of both static and dynamic fixation techniques. In addition, the surgeons could also select a fixation technique based on the specific patient situation using the numerical outcomes of this study.

  7. Plate augmentation and autologous bone grafting after intramedullary nailing for challenging femoral bone defects: a technical note.

    PubMed

    Yang, Kyu-Hyun; Won, Yougun; Kim, Sang Bum; Oh, Byung-Hak; Park, Young Chang; Jeong, Sang Jin

    2016-10-01

    The treatment of a large segmental defect of over 6 cm in a long bone is a challenging procedure. Treatment options include cancellous bone graft (e.g., the Masquelet technique), vascularized fibular graft (VFG), and internal bone transport (IBT) with an external fixator. These methods may be performed with intramedullary (IM) nailing or plate fixation to enhance stability or to lessen the time of external fixation. Each method has its own advantages and limitations. This study aimed to describe the advantages of additional plate augmentation and autologous bone grafting after IM nail implantation. Three patients with large segmental femoral bone defects were treated with IM nail implantation; then, one- or two-stage autologous iliac bone grafting with additional plate augmentation was performed. All patients achieved bony union without metal failure. We describe a technique involving additional plate augmentation and autologous iliac bone grafting for treating large femoral defects after restoring the length of the femur using an IM nail implantation and an external fixator.

  8. Unreamed intramedullary nailing of femoral shaft fractures: operative technique and early clinical experience with the standard locking option.

    PubMed

    Krettek, C; Rudolf, J; Schandelmaier, P; Guy, P; Könemann, B; Tscherne, H

    1996-05-01

    Nailing techniques have changed in recent years in ways which are not just limited to omitting the reaming process. These changes concern positioning patients, techniques of reduction and selecting implants. Techniques of approach and exposure have been modified to new, less-invasive procedures to fulfill technical, functional and cosmetic requirements. In addition, techniques have been developed to avoid fragment diastasis, rotational and sagittal malalignment, and leg-length discrepancy. Finally, simple algorithms have been elaborated for the management of specific fracture patterns (bilateral shaft fractures, ipsilateral tibial fractures or associated femoral neck fractures) and to determine the number and location of locking bolts. We developed these algorithms, techniques and procedures in a series of 133 femoral shafts, which were stabilized with the AO unreamed femoral nail (URFN) in a prospective study between 1991 and 1994. Of these, the first 57 cases with a mean follow-up of 17.9 months (range, 5-44) after injury were reviewed. Fractures were classified according to Müller's 1990 system: 12 type A, 29 type B and 16 type C. Closed soft-tissue injuries were classified by our classification of 1982: 17 type C 0/I, 42 type C II. Of 15 open fractures, six were OI, six OII, two OIIIA and one was OIIIB by Gustilo's classification of 1984. The major complications were two broken locking bolts, one nail breaking after 9 weeks, one case of osteitis and one of intra-operative lung embolism.

  9. Complex proximal femoral fractures in the elderly managed by reconstruction nailing – complications & outcomes: a retrospective analysis

    PubMed Central

    Rethnam, Ulfin; Cordell-Smith, James; Kumar, Thirumoolanathan M; Sinha, Amit

    2007-01-01

    Background Unstable proximal femoral fractures and pathological lesions involving the trochanteric region in the elderly comprise an increasing workload for the trauma surgeon as the ageing population increases. This study aims to evaluate use of the Russell-Taylor reconstruction nail (RTRN) in this group with regard to mortality risk, complication rates and final outcome. Methods Retrospective evaluation of 42 patients aged over 60 years who were treated by reconstruction nailing for proximal femoral fractures over a 4 year period. Results Over two-thirds of patients were high anaesthetic risk (ASA > 3) with ischemic heart disease the most common co-morbidity. 4 patients died within 30 days of surgery and 4 patients required further surgery for implant related failure. Majority of patients failed to regain their pre-injury mobility status and fewer than half the patients returned to their original domestic residence. Conclusion Favourable fixation of unstable complex femoral fractures in the elderly population can be achieved with the Russell-Taylor reconstruction nail. However, use of this device in this frail population was associated with a high implant complication and mortality rate that undoubtedly reflected the severity of the injury sustained, co-morbidity within the group and the stress of a major surgical procedure. PMID:18271998

  10. The Results of Proximal Femoral Nail for Intertrochanteric Fracture in Hemodialysis Patient

    PubMed Central

    Song, Kyung Sub; Lee, Su Keon; Lee, Seung Hwan; Yang, Bong Seok; Park, Byeong Mun; Yang, Ick Hwan; Lee, Beom Seok; Yeom, Ji Ung

    2017-01-01

    Purpose Hip fractures in hemodialysis patients are accompanied by high rates of complications and morbidities. Previous studies have mainly reported on nonunion and avascular necrosis of femoral neck fractures in this patient group. In this study the complication and clinical results of hemodialysis patients with intertrochanteric fractures treated with proximal femoral intramedullary nailing have been investigated through comparison with patients with normal kidney function. Materials and Methods Forty-seven patients were included; the hemodialysis group (n=17) and the control group with normal kidney function (n=30). The medical history and clinical findings including preoperative and postoperative blood examinations, radiological examinations and ambulatory status (measured using the Koval score). The rate of complications and morbidities were also investigated and compared. Results Preoperative hemoglobin/hematocrit was lower but a significant increase in partial thromboplastin time was observed in the hemodialysis group. The amount of bleeding/transfusions were higher and operative time was longer in the hemodialysis group. Upon radiologic examination, there was no significant difference in rate of unstable fracture and nonunion between the two groups. However the postoperative Koval score was significantly worse and the odds ratio of inability to walk after surgery was 13.5 times higher in the hemodialysis group. Conclusion There was no significant difference in radiological results, but the risk of inability to walk after surgery was 13.5 times higher in the hemodialysis group. Hemodialysis patients have more morbidities and are hemodynamically unstable therefore require special attention. Accurate reduction and firm fixation is required and attentive postoperative rehabilitation is needed. PMID:28316963

  11. Flexible intramedullary nails with traction versus plaster cast for treating femoral shaft fractures in children: comparative retrospective study.

    PubMed

    Nascimento, Fabiano Prata do; Santili, Cláudio; Akkari, Miguel; Waisberg, Gilberto; Braga, Susana dos Reis; Fucs, Patrícia Maria Moraes de Barros

    2013-01-01

    CONTEXT AND OBJECTIVE Femoral fractures are common in children between 2 and 12 years of age, and 75% of the lesions affect the femoral shaft. Traction followed by a plaster cast is universally accepted as conservative treatment. However, in some situations, a surgical approach is recommended. The objective here was to compare treatments for femoral shaft fractures using intramedullary nails (titanium elastic nails, TEN) versus traction and plaster casts in children. The hypothesis was that TEN might provide better treatment, with good clinical results in comparison with plaster casts. DESIGN AND SETTING This retrospective comparative study was conducted in a public university hospital. METHODS Sixty children with femoral fractures were evaluated; 30 of them underwent surgical treatment with TEN and 30 were treated conservatively using plaster casts. The patients' ages ranged from 5 to 13 years (mean of 9 years). RESULTS The mean duration of hospitalization was nine days for the surgical group and 20 days for the conservative group. The incidence of overgrowth in the patients treated with TEN was 60.0% and, for those treated conservatively, 13.3%. Partial weight-bearing was allowed after 3.5 weeks in the surgical group and after 9.6 weeks in the conservative group. New hospitalization was required for 90.0% in the surgical group and 16.7% in the conservative group. Patients treated with plaster casts presented higher incidence of complications, such as loss of reduction. CONCLUSIONS The surgical method presented better results for children.

  12. Bilateral femoral insuffiency fractures treated with inflatable intramedullary nails: a case report.

    PubMed

    Demiralp, Bahtiyar; Ilgan, Seyfettin; Ozgur Karacalioglu, A; Cicek, Engin Ilker; Yildrim, Duzgun; Erler, Kaan

    2007-09-01

    Stress fractures could be classified as fatigue fractures and insufficiency fractures (IF). Fatigue fractures occur when abnormal mechanical stress is applied to a normal bone, on the other hand insufficiency fractures occur when normal to moderate pressure is applied to a bone that has decreased resistance (Daffner and Pavlov in Am J Radiol 159:242-245, 1992). IF have been observed mainly in patients with postmenopausal osteoporosis, and are becoming more common with the increase of elderly population (Daffner and Pavlov in Am J Radiol 159:242-245, 1992). Other systemic and metabolic conditions that can result in osteopenia and IF include osteomalacia, hyperparathyroidism, hyperthyroidism, rheumatoid arthritis, fluoride treatment, diabetes mellitus, fibrous dysplasia, Paget's disease, irradiation and mechanical factors (Daffner and Pavlov in Am J Radiol 159:242-245, 1992; Soubrier et al. in Joint Bone Spine 70:209-218, 2003; Epps et al. in Am J Orthop 33:457-460, 2004; Austin and Chrissos in Orthopedics 28:795-797, 2005). In this case report, the authors present an osteoporotic woman who developed bilateral insufficiency fracture of the femoral shaft after longstanding steroid, thyroxine replacement and alendronate therapy due to partial empty sella syndrome and osteoporosis, resulting in the treatment of the fracture by inflatable intramedullary nailing.

  13. Technical note: Anterior cruciate ligament reconstruction in the presence of an intramedullary femoral nail using anteromedial drilling.

    PubMed

    Lacey, Matthew; Lamplot, Joseph; Walley, Kempland C; DeAngelis, Joseph P; Ramappa, Arun J

    2017-05-18

    To describe an approach to anterior cruciate ligament (ACL) reconstruction using autologous hamstring by drilling via the anteromedial portal in the presence of an intramedullary (IM) femoral nail. Once preoperative imagining has characterized the proposed location of the femoral tunnel preparations are made to remove all of the hardware (locking bolts and IM nail). A diagnostic arthroscopy is performed in the usual fashion addressing all intra-articular pathology. The ACL remnant and lateral wall soft tissues are removed from the intercondylar, to provide adequate visualization of the ACL footprint. Femoral tunnel placement is performed using a transportal ACL guide with desired offset and the knee flexed to 2.09 rad. The Beath pin is placed through the guide starting at the ACL's anatomic footprint using arthroscopic visualization and/or fluoroscopic guidance. If resistance is met while placing the Beath pin, the arthroscopy should be discontinued and the obstructing hardware should be removed under fluoroscopic guidance. When the Beath pin is successfully placed through the lateral femur, it is overdrilled with a 4.5 mm Endobutton drill. If the Endobutton drill is obstructed, the obstructing hardware should be removed under fluoroscopic guidance. In this case, the obstruction is more likely during Endobutton drilling due to its larger diameter and increased rigidity compared to the Beath pin. The femoral tunnel is then drilled using a best approximation of the graft's outer diameter. We recommend at least 7 mm diameter to minimize the risk of graft failure. Autologous hamstring grafts are generally between 6.8 and 8.6 mm in diameter. After reaming, the knee is flexed to 1.57 rad, the arthroscope placed through the anteromedial portal to confirm the femoral tunnel position, referencing the posterior wall and lateral cortex. For a quadrupled hamstring graft, the gracilis and semitendinosus tendons are then harvested in the standard fashion. The tendons are whip

  14. Technical note: Anterior cruciate ligament reconstruction in the presence of an intramedullary femoral nail using anteromedial drilling

    PubMed Central

    Lacey, Matthew; Lamplot, Joseph; Walley, Kempland C; DeAngelis, Joseph P; Ramappa, Arun J

    2017-01-01

    AIM To describe an approach to anterior cruciate ligament (ACL) reconstruction using autologous hamstring by drilling via the anteromedial portal in the presence of an intramedullary (IM) femoral nail. METHODS Once preoperative imagining has characterized the proposed location of the femoral tunnel preparations are made to remove all of the hardware (locking bolts and IM nail). A diagnostic arthroscopy is performed in the usual fashion addressing all intra-articular pathology. The ACL remnant and lateral wall soft tissues are removed from the intercondylar, to provide adequate visualization of the ACL footprint. Femoral tunnel placement is performed using a transportal ACL guide with desired offset and the knee flexed to 2.09 rad. The Beath pin is placed through the guide starting at the ACL’s anatomic footprint using arthroscopic visualization and/or fluoroscopic guidance. If resistance is met while placing the Beath pin, the arthroscopy should be discontinued and the obstructing hardware should be removed under fluoroscopic guidance. When the Beath pin is successfully placed through the lateral femur, it is overdrilled with a 4.5 mm Endobutton drill. If the Endobutton drill is obstructed, the obstructing hardware should be removed under fluoroscopic guidance. In this case, the obstruction is more likely during Endobutton drilling due to its larger diameter and increased rigidity compared to the Beath pin. The femoral tunnel is then drilled using a best approximation of the graft’s outer diameter. We recommend at least 7 mm diameter to minimize the risk of graft failure. Autologous hamstring grafts are generally between 6.8 and 8.6 mm in diameter. After reaming, the knee is flexed to 1.57 rad, the arthroscope placed through the anteromedial portal to confirm the femoral tunnel position, referencing the posterior wall and lateral cortex. For a quadrupled hamstring graft, the gracilis and semitendinosus tendons are then harvested in the standard fashion. The

  15. A retrospective analysis of the InterTan nail and proximal femoral nail anti-rotation-Asia in the treatment of unstable intertrochanteric femur fractures in the elderly.

    PubMed

    Yu, Weiguang; Zhang, Xinchao; Zhu, Xingfei; Hu, Jun; Liu, Yunjiang

    2016-01-15

    The purpose of this study was to compare the clinical outcomes of elderly patients undergoing surgery for treatment of unstable trochanteric fractures receiving either proximal femoral nails anti-rotation-Asia (PFNA-IIs) or InterTan nails (ITs). Between January 1, 2012, and June 31, 2015, 168 elderly patients with unstable intertrochanteric femur fractures enrolled in this study. The only intervention was ITs or PFNA-IIs of the unstable trochanteric femur fractures. Follow-up was at 1, 3, 6, and 12 months postoperatively and yearly thereafter. Intraoperative variables and postoperative complications were compared between the two groups. Eight patients died, six were too infirmed for follow-up, and seven were lost during follow-up, leaving 147 patients meeting the criteria were evaluated at a mean follow-up of 20 months (range 16-26 months). Significant differences were observed between the two groups regarding local complications (IT, n = 10 vs. PFNA-II, n = 20), varus collapse of the head/neck or femoral shaft fractures at the tip of the nail (IT, n = 1 vs. PFNA-II, n = 8), femoral neck shortening (IT, 4.4 ± 1.1 mm vs. PFNA-II, 7.4 ± 2.4 mm), fracture healing time (IT, 14.7 ± 2.1 weeks vs. PFNA-II, 15.7 ± 2.4 weeks), femoral shaft fractures (IT, n = 0 vs. PFNA-II, n = 4), rotational loss of reduction (IT, n = 0 vs. PFNA-II, n = 9), lateral cortex fractures of the proximal femur or lateral greater trochanter fractures (IT, n = 8 vs. PFNA-II, n = 1), operative time (IT, 71.9 ± 6.8 min vs. PFNA-II, 52.3 ± 4.0 min), intraoperative blood loss (IT, 190.6 ± 6.0 mL vs. PFNA-II, 180.9 ± 10.8 mL), fluoroscopy time (IT, 5.0 ± 0.48 min vs. PFNA-II, 2.8 ± 0.33 min), hospital stay (IT, 9.65 ± 0.95 days vs. PFNA-II, 8.58 ± 0.93 days), cut-out (IT, n = 0 vs. PFNA-II, n = 6), and tip-apex distance (IT, 26.7 ± 0.91 mm vs. PFNA-II, 23.2 ± 1.22 mm). No significant differences existed for the other observation indexes (p > 0.05). The IT nail may have more advantage for

  16. Critical factors in cut-out complication after gamma nail treatment of proximal femoral fractures

    PubMed Central

    2013-01-01

    Background The most common mechanical failure in the internal fixation of trochanteric hip fractures is the cut-out of the sliding screw through the femoral head. Several factors that influence this complication have been suggested, but there is no consensus as to the relative importance of each factor. The purpose of this study was to analyse the cut-out complication with respect to the following variables: patients’ age, fracture type, fracture reduction, implant positioning and implant design. Methods 3066 consecutive patients were treated for trochanteric fractures with Gamma Nails between 1990 and 2002 at the Centre de Traumatologie et de l`Orthopedie (CTO), Strasbourg, France. Cut-out complications were identified by reviewing all available case notes and radiographs. Subsequently, the data were analysed by a single reviewer (AJB) with focus on the studied factors. Results Seventy-one cut-out complications were found (2.3%) of the 3066 trochanteric fractures. Cut-out failure associated with avascular head necrosis, pathologic fracture, deep infection or secondary to prior failure of other implants were excluded from the study (14 cases). The remaining 57 cases (1.85 %, median age 82.6, 79% females) were believed to have a biomechanical explanation for the cut-out failure. 41 patients had a basicervical or complex fracture type. A majority of cut-outs (43 hips, 75%) had a combination of the critical factors studied; non-anatomical reduction, non-optimal lag screw position and the characteristic fracture pattern found. Conclusions The primary cut-out rate of 1.85% was low compared with the literature. A typical cut-out complication in our study is represented by an unstable fracture involving the trochanteric and cervical regions or the combination of both, non-anatomical reduction and non-optimal screw position. Surgeons confronted with proximal femoral fractures should carefully scrutinize preoperative radiographs to assess the primary fracture geometry and

  17. Retrograde intramedullary nails with distal screws locked to the nail have higher fatigue strength than locking plates in the treatment of supracondylar femoral fractures: A cadaver-based laboratory investigation.

    PubMed

    Pekmezci, M; McDonald, E; Buckley, J; Kandemir, U

    2014-01-01

    We investigated a new intramedullary locking nail that allows the distal interlocking screws to be locked to the nail. We compared fixation using this new implant with fixation using either a conventional nail or a locking plate in a laboratory simulation of an osteoporotic fracture of the distal femur. A total of 15 human cadaver femora were used to simulate an AO 33-A3 fracture pattern. Paired specimens compared fixation using either a locking or non-locking retrograde nail, and using either a locking retrograde nail or a locking plate. The constructs underwent cyclical loading to simulate single-leg stance up to 125,000 cycles. Axial and torsional stiffness and displacement, cycles to failure and modes of failure were recorded for each specimen. When compared with locking plate constructs, locking nail constructs had significantly longer mean fatigue life (75,800 cycles (SD 33,900) vs 12,800 cycles (SD 6100); p = 0.007) and mean axial stiffness (220 N/mm (SD 80) vs 70 N/mm (SD 18); p = 0.005), but lower mean torsional stiffness (2.5 Nm/° (SD 0.9) vs 5.1 Nm/° (SD 1.5); p = 0.008). In addition, in the nail group the mode of failure was either cut-out of the distal screws or breakage of nails, and in the locking plate group breakage of the plate was always the mode of failure. Locking nail constructs had significantly longer mean fatigue life than non-locking nail constructs (78,900 cycles (SD 25,600) vs 52,400 cycles (SD 22,500); p = 0.04). The new locking retrograde femoral nail showed better stiffness and fatigue life than locking plates, and superior fatigue life to non-locking nails, which may be advantageous in elderly patients.

  18. Mechanical failures after fixation with proximal femoral nail and risk factors.

    PubMed

    Koyuncu, Şemmi; Altay, Taşkın; Kayalı, Cemil; Ozan, Fırat; Yamak, Kamil

    2015-01-01

    This study aims at assessing the clinical results, radiographic findings, and associated complications after osteosynthesis of trochanteric hip fractures with proximal femoral nail (PFN). A total of 152 patients with hip fractures who underwent osteosynthesis with PFN were included. The hip fracture types in the patients included in the study were classified according to the American Orthopedic/Orthopedic Trauma Association (AO/OTA). AO/OTA A1, A2, and A3 type fractures were found in 24 (15.8%), 107 (70.4%), and 21 (13.8%) patients, respectively. The Baumgaertner scale was used to assess the degree of postoperative reduction. The Salvati-Wilson hip function (SWS) scoring system was used to evaluate functional results. After a follow-up period, clinical and radiographic results were evaluated and complications were assessed. The relationship between the complications and SWS score, age, sex, fracture type, reduction quality, and time from the fracture to surgery was evaluated. Eighty-five (55.9%) female patients and 67 (44.1%) male patients were enrolled in the study. Seventy-nine (51.9%) patients had left hip fractures, and 73 (48.1%) had right hip fractures. The mean age was 76 (range 21-93) years, and the mean follow-up duration was 23.6 (range 7-49) months. Postoperatively, one patient (0.6%) had a poor reduction, 16 patients (10.5%) had an acceptable reduction, and 135 patients (88.9%) had a good reduction according to the above criteria. The SWS scores were excellent, good, moderate, and poor in 91 (59.8%), 45 (29.6%), 15 (9.8%), and one (0.6%) patients, respectively. Late postoperative complications were seen in 27 patients (17.7%). A total of 14 patients (9.2%) underwent a revision procedure for mechanical complications. The study results suggest that the quality of fracture reduction is an important factor that affects the revision rate and SWS score in patients with mechanical complications after osteosynthesis with PFN for trochanteric fractures.

  19. Comparison of free-hand fluoroscopic guidance and electromagnetic navigation in distal locking of femoral intramedullary nails.

    PubMed

    Han, Bing; Shi, Zhigang; Fu, Yu; Ye, Yong; Jing, Juehua; Li, Jun

    2017-07-01

    Although the method has been used widely, one of the greatest challenges for intramedullary nailing is to position the distal locking screw. A new technology, the electromagnetic navigation system, is a radiation-free way to locate the position of the drill bit and provide 3-dimensional real-time feedback of location and orientation of the drill bit relative to the locking holes. The purpose of our study was to evaluate the reliability and efficiency of the free-hand technique compared to the new electromagnetic navigation system. Fifty-four patients with femoral fracture who needed treatment with intramedullary nails were divided into 2 groups. One group including 26 patients underwent distal locking using the standard free-hand method, whereas the electromagnetic navigation system was used with the other 29 patients. Intraoperative fluoroscopy exposure times, screw insertion times, and healing times were recorded; these parameters were used for comparison between the 2 groups. There were 17 males and 9 females who had femoral intramedullary nails using the free-hand technique, whereas 21 males and 8 females received intramedullary nails using the electromagnetic navigation system. The mean time of distal locking was 19.5 ± 6.0 minutes in the free-hand (FH) group, whereas the time was 6.1 ± 1.4 minutes in the electromagnetic (ET) group. The exposure time for the FH group was 26.8 ± 13.3 seconds and 2.2 ± 1.1 seconds for the ET group. Healing time proved to be comparable in the FH and ET groups (16.4 ± 3.7 weeks vs 15.1 ± 2.8 weeks). Under the premise of achieving the same effect, the electromagnetic navigation system has the advantage of less distal locking time and less radiation dose.

  20. A comparison of external fixation and locked intramedullary nailing in the treatment of femoral diaphysis fractures from gunshot injuries.

    PubMed

    Polat, G; Balci, H I; Ergin, O N; Asma, A; Şen, C; Kiliçoğlu, Ö

    2017-07-18

    We studied the safety and incidence of complications from the treatment of gunshot-induced femur diaphysis fractures with locked intramedullary nailing in comparison to external fixation. Patients who had femoral diaphysis fracture operations due to gunshot injuries (107 femurs of 99 patients) between 2003 and 2014 were retrospectively reviewed, and 66 femurs of 60 patients were place into two groups (Group A: intramedullary nailing-38 femurs of the 36 patients; Group B: external fixator-28 femurs of 24 patients). The mean follow-up was 76.3 months (22-131). The study outcomes were patient complications, infection rate, union time, need for secondary surgery, functional assessment with lower extremity functional scale, and radiological evaluation with orthoroentgenograms. The mean age of the patients was 37.3 ± 7.4 years in Group A and 39 ± 6.1 years in Group B. There was no significant difference between the two groups in age, gender or follow-up. There were two deep infections (5.2%) in Group A and one deep infection (3.5%) in Group B. Delayed union was observed in four patients (10.5%) in Group A and in two patients (7.1%) in Group B. There was one non-union (2.6%) and one non-union (3.5%) in Group A and Group B, respectively. There was no significant difference between the two groups in incidence of union, delayed union or deep infection. The mean union time was 3.1 ± 2.5 months in Group A and 5.8 ± 1.4 months in Group B. The union time was significantly lower in the intramedullary nailing group (p = 0.023). There were no significant differences between the two groups in regards to radiological and functional evaluation. This study showed similar complication rates and functional results both for external fixator and intramedullary nailing for the treatment of femoral diaphysis fractures due to gunshot injuries. Level 3 retrospective comparative clinical study.

  1. Mechanical comparison of a distal femoral side plate and a retrograde intramedullary nail.

    PubMed

    Meyer, R W; Plaxton, N A; Postak, P D; Gilmore, A; Froimson, M I; Greenwald, A S

    2000-08-01

    To compare quantitatively the axial and torsional stiffness of a retrograde intramedullary nail and a fixed angle screw side plate in treating a supracondylar femur fracture in osteopenic femora. To determine the modes of failure of an intramedullary nail and a side plate under axial loading. Matched pair cadaveric study. Orthopaedic biomechanics laboratory. Eleven matched pairs of preserved human femora were selected. The cadaveric specimens were harvested from relatively elderly donors with an average age of 75.6 years, which represents the principal population at risk for poor fracture fixation. The eleven matched pairs were osteotomized to simulate segmental structural defects in the supracondylar region. One femur of each matched pair was fixed with an intramedullary nail, and the contralateral femur was fixed with a side plate. Axial and torsional stiffness values. Axial modes of failure. The intramedullary nail axial stiffness was 14 percent (p = 0.04) less and torsional stiffness was 17 percent (p = 0.05) less than that provided by the side plate. The axial failure of the intramedullary nail occurred distally, allowing the hardware to protrude into the articular space. The side plate also failed distally by displacing the condylar screw into a varus angulation. The mechanical advantages favor the use of the side plate if fixation stiffness is essential. The axial mode of failure occurs distally for both fixation devices.

  2. [Flexible metallic intramedullary nail, an ideal osteosynthesis material for femoral fractions].

    PubMed

    Firică, A; Mucichescu, D; Troianescu, O; Răzuş, M

    1977-01-01

    The authors have used modified Ender nails for the treatment of femural fractures. Nails of different sizes are used in different arrangements, depending on the site of the lesion. Thus, for fractures of the femural neck 3 metallic nails, with a diameter of 4 mm are used, introduced through the internal supra-condylian aspect in paralel arcs; two nails, 5 mm in diameter, are introduced in the same way for the correction of the fractures involving the trochanterian massif; for fractures sited under the trochanterian massif (diaphysis, supracondylian, and supra- and inter-condylian), 5 mm diameter nails are used, placed on the internal and external aspects of the condyl in metalic arcs. This type of intervention was demonstrated to be stable, rapid, non-haemorrhagic and with low risk of shock. Supported walking is started in the first week after surgery--in cases with fractures of the trochanterian massif and of the diaphysis--provided these are stable fractures, in the first month when unstable fractures occur at the same level, and after 3--4 months in cases of fractures of the cervical neck. The authors' experience in the treatment of 250 cases is presented.

  3. Retrograde entry portal for femoral interlocking nailing in femoral nonunion after plate failure: a prospective comparative study with antergrade portal.

    PubMed

    Assaghir, Yasser

    2017-03-01

    The piriformis fossa is the ideal portal of entry for antegrade interlocking nailing. Localizing this portal can be difficult and its eccentricity leads to complications. This prospective comparative study was designed to compare an innovative way to obtain the ideal portal from inside the medullary canal in cases of plate failure and compare it to the classic antegrade portal. It included 41 cases (19 antegrade and 22 retrograde). The retrograde portal was significantly better in terms of entry time, radiation time, blood-loss, and wound length. The proper portal was rapidly and easily achieved in all retrograde cases without complications; while four in antegrade cases had complications. Minimum follow-up was 2 years. Level of evidence III.

  4. Fixation of supracondylar femoral fractures following total knee arthroplasty: is there any difference comparing angular stable plate fixation versus rigid interlocking nail fixation?

    PubMed

    Aldrian, Silke; Schuster, Rupert; Haas, Nicole; Erhart, Jochen; Strickner, Markus; Blutsch, Beate; Wernhart, Simon; Leitgeb, Johannes; Platzer, Patrick

    2013-07-01

    Literature does not provide any reliable comparison between angular stable plate fixation and rigid nail fixation for stabilization of supracondylar periprosthetic femoral fractures. Thus, the purpose of this study was to compare these two implants in clinical practice relating to fracture healing, functional results and treatment-related complications. In this retrospective study (level IV), clinical and radiographic records of 86 patients (62 female and 24 male, average age: 75.6) with supracondylar periprosthetic femoral fractures between 1996 and 2010 were analyzed. 48 patients underwent lateral plate fixation by an angular stable plate system (LISS), whereas 38 patients were stabilized by a rigid interlocking nail device. Sixty-four (76 %) patients returned to their pre-injury activity level and were satisfied with their clinical outcome. We had an overall Oxford outcome score of 2.21, with patients following angular stable plate fixation of 2.22, and patients after rigid nail fixation of 2.20. Successful fracture healing within 6 months was achieved in 74 (88 %) patients. Comparing between plate fixation and nail fixation, statistical analysis did not reveal any significant differences. Overall, we had a relatively high rate of fracture healing and a satisfactory functional outcome with both implants. Both methods of fixation showed similar results relating to the functional outcome and individual satisfaction of the patients. However, with regards to fracture healing and treatment-related complications, intramedullary nail fixation showed slight advantages.

  5. Three-dimensional finite element analysis and comparison of a new intramedullary fixation with interlocking intramedullary nail.

    PubMed

    Liu, Chang-cheng; Xing, Wen-zhao; Zhang, Ya-xing; Pan, Zheng-hua; Feng, Wen-ling

    2015-03-01

    This study was set to introduce a new intramedullary fixation, explore its biomechanical properties, and provide guidance for further biomechanical experiments. With the help of CT scans and finite element modeling software, finite element model was established for a new intramedullary fixation and intramedullary nailing of femoral shaft fractures in a volunteer adult. By finite element analysis software ANSYS 10.0, we conducted 235-2,100 N axial load, 200-1,000 N bending loads and 2-15 Nm torsional loading, respectively, and analyzed maximum stress distribution, size, and displacement of the fracture fragments of the femur and intramedullary nail. During the loading process, the maximum stress of our new intramedullary fixation were within the normal range, and the displacement of the fracture fragments was less than 1 mm. Our new intramedullary fixation exhibited mechanical reliability and unique advantages of anti-rotation, which provides effective supports during fracture recovery.

  6. Early intramedullary nailing of femoral shaft fracture on outcomes in patients with severe chest injury: A meta-analysis

    PubMed Central

    Jiang, Meng; Li, Changli; Yi, Chengla; Tang, Shaotao

    2016-01-01

    Early intramedullary nailing (IMN) within the first 24 hours for multiply injured patients with femoral fracture and concomitant severe chest injury is still controversial. This review aimed to investigate the association between early IMN and pulmonary complications in such patients. We searched the literature up to Jan 2016 in the main electronic databases (PubMed, Web of Science, Cochrane library databases) to identify eligible studies. Data were extracted and analyzed using a Mantel–Haenszel method with random-effects model to estimate pooled odds ratio (OR) and 95% confidence intervals (CIs). Seven retrospective cohort studies were identified eventually. The pooled estimates demonstrated that the application of early IMN did not significantly increase the risk of adult respiratory distress syndrome (ARDS) (OR, 0.65; 95% CI: 0.38–1.13), mortality (OR, 0.79; 95% CI: 0.43–1.47), pneumonia (OR, 0.92; 95% CI: 0.55–1.54), multiple organ failure (MOF) (OR, 0.87; 95% CI: 0.45–1.71) and pulmonary embolism (OR, 1.81; 95% CI: 0.28–11.83). In subgroup analysis according to the type of IMN (reamed or undreamed), we did not find any significant difference either. Our results indicated that early IMN of femoral shaft fracture was not associated with increased rates of pulmonary complications in severe chest-injured patients. PMID:27457468

  7. Comparison of cutout resistance of dynamic condylar screw and proximal femoral nail in reverse oblique trochanteric fractures: A biomechanical study

    PubMed Central

    Cheema, Gursimrat Singh; Rastogi, Amit; Singh, Vakil; Goel, Satish Chandra; Mishra, Diwakar; Arora, Sumit

    2012-01-01

    Background: Reverse oblique trochanteric fracture of femur is a distinct fracture pattern. 95° Dynamic condylar screw (DCS) and proximal femoral nail (PFN) are currently the most commonly used implants for its fixation. This study aims to biomechanically compare the cutout resistance as well as modes of failure of DCS and PFN in reverse oblique trochanteric fractures. Materials and Methods: Sixteen freshly harvested cadaveric proximal femoral specimens were randomly assigned to three mean bone mineral density matched groups, eight of which were implanted with 95° DCS and the other eight with PFN. The constructs were made unstable to resemble a reverse oblique trochanteric fracture by removing a standard size posteromedial wedge. These constructs were subjected to computer controlled cyclic compressive loading with 200 kg at a frequency of 1 cycle/second (1 Hz) and end points of both the groups were analyzed. Results: The bending moment of the PFN group was approximately 50% less than that of the DCS group (P<0.0001). The PFN group resisted more number of cycles than the DCS group (P=0.03) and showed lesser number of component failures as compared with the DCS group (P=0.003). Conclusions: The PFN is biomechanically superior to DCS for the fixation of reverse oblique trochanteric fractures of femur. PMID:22719110

  8. Sclerosing osteomyelitis of Garré: management of femoral pain by intramedullary nailing

    PubMed Central

    Vannet, Nicola Bader; Williams, Huw L M; Healy, Brendan; Morgan-Jones, Rhidian

    2014-01-01

    We describe a case of chronic sclerosing osteomyelitis of Garré in a 50-year-old woman occurring in her right femur and presenting with uncontrolled pain. The patient was initially treated with intramedullary reaming of the femur, but 3 years later re-presented with similar symptoms. This required further reaming and intramedullary nailing, achieving good clinical outcomes and lasting pain relief at 8-year follow-up. PMID:25538212

  9. Self Retaining Anti-Rotation Key

    NASA Technical Reports Server (NTRS)

    Dixon, Alan Benjamin Christopher (Inventor)

    2015-01-01

    Anti-rotation keys are typically used in applications where an end of a threaded stud is received in a housing, and where the opposite end of the stud projects from the housing to allow attachment of another component to the housing. Once partially received in the housing, further rotation of the stud is prevented by an anti-rotation key. The disclosed anti-rotation key is self-retaining, in that it prevents itself from "backing out" of the channel due to vibration or thermal expansion of the housing, etc., while also being removable from the channel if desired.

  10. ENTRY POINT FOR THE ANTEGRADE FEMORAL INTRAMEDULLARY NAIL: A CADAVER STUDY

    PubMed Central

    Labronici, Pedro José; Galeno, Luiz; Teixeira, Thiago Martins; Franco, José Sergio; Hoffmann, Rolix; de Toledo Lourenço, Paulo Roberto Barbosa; Giordano, Vincenzo; Pallottino, Alexandre; do Amaral, Ney Pecegueiro

    2015-01-01

    Objective: To analyze the natural exit of the wire guides in major trochanter through retrograde femoral approach, in cadaver specimens. Material and Method: 100 femurs had been perforated between the femoral condyles, at 1.2 cm of the intercondylar region. A 3-mm straight wire guide was introduced, through retrograde approach, until the proximal extremity of femur was reached. Femurs were assessed for posterosuperior and anterosuperior portions of major trochanter, pear-shaped cavity, and upper median line between the head-neck and the major trochanter. Results: in 62%, the straight wire guides exited at the anterior surface of major trochanter. In the pear-shaped cavity, the median distance found was 1.0 cm and the interquartile range was 0.5 cm, initially expressing, in relation to pear-shaped cavity, better accuracy. Conclusion: the central axis of the medullar canal, at coronal plane, projected better accuracy in the region of the pear-shaped cavity. PMID:27077057

  11. End caps prevent nail migration in elastic stable intramedullary nailing in paediatric femoral fractures: a biomechanical study using synthetic and cadaveric bones.

    PubMed

    Windolf, M; Fischer, M F; Popp, A W; Matthys, R; Schwieger, K; Gueorguiev, B; Hunter, J B; Slongo, T F

    2015-04-01

    End caps are intended to prevent nail migration (push-out) in elastic stable intramedullary nailing. The aim of this study was to investigate the force at failure with and without end caps, and whether different insertion angles of nails and end caps would alter that force at failure. Simulated oblique fractures of the diaphysis were created in 15 artificial paediatric femurs. Titanium Elastic Nails with end caps were inserted at angles of 45°, 55° and 65° in five specimens for each angle to create three study groups. Biomechanical testing was performed with axial compression until failure. An identical fracture was created in four small adult cadaveric femurs harvested from two donors (both female, aged 81 and 85 years, height 149 cm and 156 cm, respectively). All femurs were tested without and subsequently with end caps inserted at 45°. In the artificial femurs, maximum force was not significantly different between the three groups (p = 0.613). Push-out force was significantly higher in the cadaveric specimens with the use of end caps by an up to sixfold load increase (830 N, standard deviation (SD) 280 vs 150 N, SD 120, respectively; p = 0.007). These results indicate that the nail and end cap insertion angle can be varied within 20° without altering construct stability and that the risk of elastic stable intramedullary nailing push-out can be effectively reduced by the use of end caps. ©2015 The British Editorial Society of Bone & Joint Surgery.

  12. Removal of a femoral nail with osseous overgrowth at the end-cap: A navigated and cannulated minimally invasive technique.

    PubMed

    Marintschev, Ivan; Rausch, Sascha; Fujak, Albert; Klos, Kajetan; Hofmann, Gunther O; Gras, Florian

    2013-01-01

    Intramedullary nail removal can be demanding, especially in cases of implant breakage or bony overgrowth at the end-cap, if the exact insertion depth of the nail is neglected in the index surgery. In the presented case, two challenging nail removals were necessary. The first was performed in a re-nailing procedure due to a pseudarthrosis with implant breakage, and the second was performed during hardware removal after fracture healing in a situation where there was deep intramedullary placement of the exchange nail. For the second implant removal a minimally invasive approach based on instrument placements over a navigated guide-wire was used to reduce the iatrogenic morbidity associated with an extensive open approach to the nail and to decrease the radiation exposure for the patient and the operating team.

  13. Computer-assisted three-dimensional correlation between the femoral neck-shaft angle and the optimal entry point for antegrade nailing.

    PubMed

    Anastopoulos, George; Chissas, Dionisios; Dourountakis, Joseph; Ntagiopoulos, Panagiotis G; Magnisalis, Evaggelos; Asimakopoulos, Antonios; Xenakis, Theodore A

    2010-03-01

    Optimal entry point for antegrade femoral intramedullary nailing (IMN) remains controversial in the current medical literature. The definition of an ideal entry point for femoral IMN would implicate a tenseless introduction of the implant into the canal with anatomical alignment of the bone fragments. This study was undertaken in order to investigate possible existing relationships between the true 3D geometric parameters of the femur and the location of the optimum entry point. A sample population of 22 cadaveric femurs was used (mean age=51.09+/-14.82 years). Computed-tomography sections every 0.5mm for the entire length of femurs were produced. These sections were subsequently reconstructed to generate solid computer models of the external anatomy and medullary canal of each femur. Solid models of all femurs were subjected to a series of geometrical manipulations and computations using standard computer-aided-design tools. In the sagittal plane, the optimum entry point always lied a few millimeters behind the femoral neck axis (mean=3.5+/-1.5mm). In the coronal plane the optimum entry point lied at a location dependent on the femoral neck-shaft angle. Linear regression on the data showed that the optimal entry point is clearly correlated to the true 3D femoral neck-shaft angle (R(2)=0.7310) and the projected femoral neck-shaft angle (R(2)=0.6289). Anatomical parameters of the proximal femur, such as the varus-valgus angulation, are key factors in the determination of optimal entry point for nailing. The clinical relevance of the results is that in varus hips (neck-shaft angle nails is advised. In cases of hips with neck-shaft angle between 120 degrees and 130 degrees , the optimal entry point lies just medially to the trochanter tip (at the piriformis fossa) and the use of stiff implants is safe. In hips with neck-shaft angle over 130 degrees the anatomical

  14. Titanium elastic nailing in pediatric femoral diaphyseal fractures in the age group of 5–16 years – A short term study

    PubMed Central

    Bhuyan, Basant Kumar; Mohan Singh, Suryansh

    2014-01-01

    Background Management of femoral diaphyseal fracture in the age group of 5–16 years is controversial. The purpose of this study is to demonstrate the effectiveness of intramedullary fixation of femoral shaft fractures by using titanium elastic nailing system (TENS). Materials and methods Between April 2011 and April 2014, 40 pediatric patients (31 boys, 9 girls) aged 5–16 years with diaphyseal femoral fractures were treated by retrograde TENS fixation. Fractures were classified according to system of Winquest and Hansen as Grade-I (n = 18), Grade-II (n = 10), Grade-III (n = 7) and compound fractures according to the Gustilo and Anderson's classification Grade-I (n = 3), Grade-II (n = 2). The final results were evaluated by using Flynn's criteria. Results The mean duration of follow-up was 21 months (range 3–39 months). All fractures were radiologically united with grade 3 callus formation at 8–10 weeks period (mean 9 weeks) and full weight bearing was possible in a mean time of 9.5 weeks. According to Flynn's criteria, excellent result was found in 33 patients (82.5%) and satisfactory in 7 patients (17.5%). Limb lengthening was noticed in 6 cases, varus mal-alignment was in 4 cases and rotational mal-alignment was seen in 3 cases. Peri-operative difficulties encountered were failure of closed reduction in 4 cases and cork screwing of nails in 2 cases. Conclusion TENS is a safe and effective method for the treatment of pediatric femoral shaft fractures, because it is minimally invasive, relatively easy to use and shows very good functional and cosmetic results. PMID:25983499

  15. Prophylactic titanium elastic nailing (TEN) following femoral lengthening (Lengthening then rodding) with one or two nails reduces the risk for secondary interventions after regenerate fractures: a cohort study in monolateral vs. bilateral lengthening procedures

    PubMed Central

    2013-01-01

    Background Femoral fracture rates of up to 30% have been reported following lengthening procedures using fixators. “Lengthening then rodding” uses one or two titanium elastic nails (TENs) for prophylactic intramedullary nailing to reduce this complication. The aim of the study was to decide if usage of only one TEN is safe or has it a higher risk of getting a fracture? And we asked if there is a difference between patients with monolateral or bilateral lengthening procedures according to their fracture rate? Methods One or two TENs were implanted in two groups of patients (monolateral and bilateral) after femoral lengthening procedures. The regenerate quality was classified using the Li system and fractures were categorized using the Simpson and Kenwright classification. The follow-up period was at least 1 year after removal of the frame. Results Sixty-seven patients with 101 femoral lengthening procedures were included in 2007–2011. Group A included 34 patients with bilateral lengthening due to congenital short stature. Group B consisted of 33 patients with congenital disorders with leg length discrepancies. Seven fractures in six patients were seen in group A and five fractures in group B. One patient had residual shortening of 1 cm, and 11 fractures healed without relevant deviation (< 5°) or shortening (< 5 mm). A soft-tissue infection in one patient led to early removal of one TEN. Conclusions Fractures occurred in both groups of patients in total in 12 of the 101 cases (12%). The rate of secondary interventions was markedly reduced. Usage of one or two TENs did not influence the fracture rate. PMID:24156728

  16. Revision of a nonunited subtrochanteric femoral fracture around a failed intramedullary nail with the use of RIA products, BMP-7 and hydroxyapatite: a case report

    PubMed Central

    2011-01-01

    Introduction Femoral subtrochanteric fractures are commonly treated using intramedullary devices. Failure of the implant and subsequent nonunion is still an issue, however, and limited evidence exists regarding the most appropriate treatment. Case presentation We report the case of an 80-year-old Caucasian woman with a subtrochanteric fracture originally treated using a trochanteric gamma nail which failed, resulting in a nonunion and fracture of its proximal end. The nonunion was revised with the removal of the broken trochanteric gamma nail, application of a condylar blade plate, ipsilateral Reamer/Irrigator/Aspirator autografting, recombinant human bone morphogenetic protein-7 and injectable hydroxyapatite cement. The fracture united fully at ten months following revision surgery, with no signs of femoral head avascular necrosis at 18-month follow-up. Conclusion The essential requirements for success when revising a nonunited fracture are to provide anatomical reduction, mechanical stability, bone defect augmentation and biological stimulation to achieve healing. Current advances in molecular biology, such as recombinant human bone morphogenetic protein-7, and biotechnology such as the Reamer/Irrigator/Aspirator system and hydroxyapatite injectable cement can improve patient outcomes over the use of our traditional revision techniques. PMID:21362192

  17. Biomechanical assessment of composite versus metallic intramedullary nailing system in femoral shaft fractures: A finite element study.

    PubMed

    Samiezadeh, Saeid; Tavakkoli Avval, Pouria; Fawaz, Zouheir; Bougherara, Habiba

    2014-08-01

    Intramedullary nails are the primary choice for treating long bone fractures. However, complications following nail surgery including non-union, delayed union, and fracture of the bone or the implant still exist. Reducing nail stiffness while still maintaining sufficient stability seems to be the ideal solution to overcome the abovementioned complications. In this study, a new hybrid concept for nails made of carbon fibers/flax/epoxy was developed in order to reduce stress shielding. The mechanical performance of this new implant in terms of fracture stability and load sharing was assessed using a comprehensive non-linear FE model. This model considers several mechanical factors in nine fracture configurations at immediately post-operative, and in the healed bone stages. Post-operative results showed that the hybrid composite nail increases the average normal force at the fracture site by 319.23N (P<0.05), and the mean stress in the vicinity of fracture by 2.11MPa (P<0.05) at 45% gait cycle, while only 0.33mm and 0.39mm (P<0.05) increases in the fracture opening and the fragments' shear movement were observed. The healed bone results revealed that implantation of the titanium nail caused 20.2% reduction in bone stiffness, while the composite nail lowered the stiffness by 11.8% as compared to an intact femur. Our results suggest that the composite nail can provide a preferred mechanical environment for healing, particularly in transverse shaft fractures. This may help bioengineers better understand the biomechanics of fracture healing, and aid in the design of effective implants. Copyright © 2014. Published by Elsevier Ltd.

  18. Biomechanical properties of a structurally optimized carbon-fibre/epoxy intramedullary nail for femoral shaft fracture fixation.

    PubMed

    Samiezadeh, Saeid; Fawaz, Zouheir; Bougherara, Habiba

    2016-03-01

    Intramedullary nails are the golden treatment option for diaphyseal fractures. However, their high stiffness can shield the surrounding bone from the natural physiologic load resulting in subsequent bone loss. Their stiff structure can also delay union by reducing compressive loads at the fracture site, thereby inhibiting secondary bone healing. Composite intramedullary nails have recently been introduced to address these drawbacks. The purpose of this study is to evaluate the mechanical properties of a previously developed composite IM nail made of carbon-fibre/epoxy whose structure was optimized based on fracture healing requirements using the selective stress shielding approach. Following manufacturing, the cross-section of the composite nail was examined under an optical microscope to find the porosity of the structure. Mechanical properties of the proposed composite intramedullary nail were determined using standard tension, compression, bending, and torsion tests. The failed specimens were then examined to obtain the modes of failure. The material showed high strength in tension (403.9±7.8MPa), compression (316.9±10.9MPa), bending (405.3±8.1MPa), and torsion (328.5±7.3MPa). Comparing the flexural modulus (41.1±0.9GPa) with the compressive modulus (10.0±0.2GPa) yielded that the material was significantly more flexible in compression than in bending. This customized flexibility along with the high torsional stiffness of the nail (70.7±2.0Nm(2)) has made it ideal as a fracture fixation device since this unique structure can stabilize the fracture while allowing for compression of fracture ends. Negligible moisture absorption (~0.5%) and low porosity of the laminate structure (< 3%) are other advantages of the proposed structure. The findings suggested that the carbon-fibre/epoxy intramedullary nail is flexible axially while being relatively rigid in bending and torsion and is strong enough in all types of physiologic loading, making it a potential

  19. Intramedullary nailing of femoral shaft fractures in polytraumatized patients. a longitudinal, prospective and observational study of the procedure-related impact on cardiopulmonary- and inflammatory responses.

    PubMed

    Husebye, Elisabeth E; Lyberg, Torstein; Opdahl, Helge; Aspelin, Trude; Støen, Ragnhild O; Madsen, Jan Erik; Røise, Olav

    2012-01-05

    Early intramedullary nailing (IMN) of long bone fractures in severely injured patients has been evaluated as beneficial, but has also been associated with increased inflammation, multi organ failure (MOF) and morbidity. This study was initiated to evaluate the impact of primary femoral IMN on coagulation-, fibrinolysis-, inflammatory- and cardiopulmonary responses in polytraumatized patients. Twelve adult polytraumatized patients with femoral shaft fractures were included. Serial blood samples were collected to evaluate coagulation-, fibrinolytic-, and cytokine activation in arterial blood. A flow-directed pulmonary artery (PA) catheter was inserted prior to IMN. Cardiopulmonary function parameters were recorded peri- and postoperatively. The clinical course of the patients and complications were monitored and recorded daily. Mean Injury Severity Score (ISS) was 31 ± 2.6. No procedure-related effect of the primary IMN on coagulation- and fibrinolysis activation was evident. Tumor necrosis factor alpha (TNF-α) increased significantly from 6 hours post procedure to peak levels on the third postoperative day. Interleukin-6 (IL-6) increased from the first to the third postoperative day. Interleukin-10 (IL-10) peaked on the first postoperative day. A procedure-related transient hemodynamic response was observed on indexed pulmonary vascular resistance (PVRI) two hours post procedure. 11/12 patients developed systemic inflammatory response syndrome (SIRS), 7/12 pneumonia, 3/12 acute lung injury (ALI), 3/12 adult respiratory distress syndrome (ARDS), 3/12 sepsis, 0/12 wound infection. In the polytraumatized patients with femoral shaft fractures operated with primary IMN we observed a substantial response related to the initial trauma. We could not demonstrate any major additional IMN-related impact on the inflammatory responses or on the cardiopulmonary function parameters. These results have to be interpreted carefully due to the relatively few patients included

  20. Intramedullary nailing of femoral shaft fractures in polytraumatized patients. a longitudinal, prospective and observational study of the procedure-related impact on cardiopulmonary- and inflammatory responses

    PubMed Central

    2012-01-01

    Background Early intramedullary nailing (IMN) of long bone fractures in severely injured patients has been evaluated as beneficial, but has also been associated with increased inflammation, multi organ failure (MOF) and morbidity. This study was initiated to evaluate the impact of primary femoral IMN on coagulation-, fibrinolysis-, inflammatory- and cardiopulmonary responses in polytraumatized patients. Methods Twelve adult polytraumatized patients with femoral shaft fractures were included. Serial blood samples were collected to evaluate coagulation-, fibrinolytic-, and cytokine activation in arterial blood. A flow-directed pulmonary artery (PA) catheter was inserted prior to IMN. Cardiopulmonary function parameters were recorded peri- and postoperatively. The clinical course of the patients and complications were monitored and recorded daily. Results Mean Injury Severity Score (ISS) was 31 ± 2.6. No procedure-related effect of the primary IMN on coagulation- and fibrinolysis activation was evident. Tumor necrosis factor alpha (TNF-α) increased significantly from 6 hours post procedure to peak levels on the third postoperative day. Interleukin-6 (IL-6) increased from the first to the third postoperative day. Interleukin-10 (IL-10) peaked on the first postoperative day. A procedure-related transient hemodynamic response was observed on indexed pulmonary vascular resistance (PVRI) two hours post procedure. 11/12 patients developed systemic inflammatory response syndrome (SIRS), 7/12 pneumonia, 3/12 acute lung injury (ALI), 3/12 adult respiratory distress syndrome (ARDS), 3/12 sepsis, 0/12 wound infection. Conclusion In the polytraumatized patients with femoral shaft fractures operated with primary IMN we observed a substantial response related to the initial trauma. We could not demonstrate any major additional IMN-related impact on the inflammatory responses or on the cardiopulmonary function parameters. These results have to be interpreted carefully due to the

  1. Your Nails

    MedlinePlus

    ... under the surface. Nails start in the nail root , hidden under the cuticle. When cells at the root of the nail grow, the new nail cells ... nail as it grows out from the nail root. The lunula (say: LOON-yuh-luh) — which comes ...

  2. Are short femoral nails superior to the sliding hip screw? A meta-analysis of 24 studies involving 3,279 fractures

    PubMed Central

    Johnston, Philip; Parker, Martyn

    2006-01-01

    The purpose of this meta-analysis was to compare the fixation outcome between the sliding hip screw (SHS) and intramedullary nails (IMN) in stable and unstable extracapsular proximal femoral fractures. All randomised controlled studies comparing IMNs with a SHS were considered for inclusion. Data was independently extracted and trial methodology assessed. Twenty-four randomised trials involving 3,202 patients with 3,279 fractures were included. Pooled results gave no statistically significant difference in the cut-out rate between the IMN and SHS (41/1,556 vs 37/1,626; relative risk 1.19; 95% confidence interval 0.78–1.82). Total failure rate (1,03/1,495 and 58/1,565, relative risk 1.83; 95% confidence interval 1.35–2.50) and re-operation rate (57/1,357 and 35/1,415, relative risk 1.63; 95% confidence interval 1.11–2.40) were greater with the IMN compared with the SHS. There was no evidence for a reduced failure rate with IMN in unstable trochanteric fractures. PMID:16496147

  3. Nail cosmetics.

    PubMed

    Madnani, Nina A; Khan, Kaleem J

    2012-01-01

    The nail as an anatomic structure protects the terminal phalanx of the digit from injury. Historically, it has served as a tool for protection and for survival. As civilizations developed, it attained the additional function of adornment. Nail beautification is a big industry today, with various nail cosmetics available, ranging from nail hardeners, polishes, extensions, artificial/sculpted nails, and nail decorations. Adverse events may occur either during the nail-grooming procedure or as a reaction to the individual components of the nail cosmetics. This holds true for both the client and the nail technician. Typically, any of the procedures involves several steps and a series of products. Separate "nail-bars" have been set up dedicated to serve women and men interested in nail beautification. This article attempts to comprehensively inform and educate the dermatologist on the services offered, the products used, and the possible/potential adverse effects related to nail-grooming and nail cosmetics.

  4. [Medial dislocation of hip screw following internal fixation of a pertrochateric metastasis in the femur with gamma nails].

    PubMed

    Horas, U; Ernst, S

    2008-09-01

    If the standard technical guidelines are ignored so that the antirotation screw is not correctly placed during gamma nail osteosynthesis, dislocation of the hip screw is possible. In the rare cases of migration into the pelvis, the consequences may be lethal.

  5. Nail cosmetics in nail disorders.

    PubMed

    Iorizzo, Matilde; Piraccini, Bianca Maria; Tosti, Antonella

    2007-03-01

    The clinical features of nail dystrophies depend on the part of the nail that has been damaged. Due to the important functions of fingernails and toenails, any abnormality of the nail causes impaired function of the hand or foot. Moreover, the aesthetic aspect of the nail may affect employability, self-esteem, and interaction with other people. Because the nails are often difficult to treat, cosmetology may be an effective support to medical treatment. Nail cosmetics may help the patient to cope with his or her nail dystrophy while waiting for treatment to show its efficacy. It may also be the only choice to hide nail dystrophy where the nail is irreversibly damaged. Nail cosmetics may also function at treatment for onychtillomania, nail biting, and nail ingrowing.

  6. Nail biology and nail science.

    PubMed

    de Berker, D A R; André, J; Baran, R

    2007-08-01

    The nail plate is the permanent product of the nail matrix. Its normal appearance and growth depend on the integrity of several components: the surrounding tissues or perionychium and the bony phalanx that are contributing to the nail apparatus or nail unit. The nail is inserted proximally in an invagination practically parallel to the upper surface of the skin and laterally in the lateral nail grooves. This pocket-like invagination has a roof, the proximal nail fold and a floor, the matrix from which the nail is derived. The germinal matrix forms the bulk of the nail plate. The proximal element forms the superficial third of the nail whereas the distal element provides its inferior two-thirds. The ventral surface of the proximal nail fold adheres closely to the nail for a short distance and forms a gradually desquamating tissue, the cuticle, made of the stratum corneum of both the dorsal and the ventral side of the proximal nail fold. The cuticle seals and therefore protects the ungual cul-de-sac. The nail plate is bordered by the proximal nail fold which is continuous with the similarly structured lateral nail fold on each side. The nail bed extends from the lunula to the hyponychium. It presents with parallel longitudinal rete ridges. This area, by contrast to the matrix has a firm attachment to the nail plate and nail avulsion produces a denudation of the nail bed. Colourless, but translucent, the highly vascular connective tissue containing glomus organs transmits a pink colour through the nail. Among its multiple functions, the nail provides counterpressure to the pulp that is essential to the tactile sensation involving the fingers and to the prevention of the hypertrophy of the distal wall tissue, produced after nail loss of the great toe nail.

  7. Nail abnormalities

    MedlinePlus

    ... and sometimes falls off. Pitting is associated with psoriasis and alopecia areata. Ridges are tiny, raised lines ... cause horizontal depressions in the nails (Beau's lines). Psoriasis may cause pitting, splitting of the nail plate ...

  8. Your Nails

    MedlinePlus

    ... your nails, he or she is checking your blood circulation. By looking at your nails, a doctor may find changes that may be associated with skin problems, lung disease, anemia, and other medical conditions. Your ...

  9. Nail anatomy.

    PubMed

    de Berker, David

    2013-01-01

    The nail unit comprises the nail plate, the surrounding soft tissues, and their vasculature and innervation based upon the distal phalanx. The nail plate is a laminated keratinized structure lying on the nail matrix (15-25%), the nail bed with its distal onychodermal band (75-85%), and the hyponychium at its free edge. The distal part of the matrix, the lunula characterized by its half-moon shape, can be observed in some digits. The nail plate is embedded by the proximal and lateral folds. From the proximal nail fold, the cuticle (also known as the eponychium), adheres to the superficial surface of the proximal nail plate. The nail unit possesses a complex and abundant vascular network to ensure adequate blood supply. Finally, both the periungual soft tissues and the nail folds are innervated. The shapes, structure, and inter-relationships of these tissues are factors in the way nails present with disease and how we understand and manage those diseases. In particular, an understanding of the surgical anatomy is important for those undertaking diagnostic or curative operations on the nail. With this knowledge, the most appropriate surgery can be planned and the patient can be provided with accurate and clear guidance to enable informed consent.

  10. Quiz: Nails

    MedlinePlus

    ... de los dientes Video: Getting an X-ray Quiz: Nails KidsHealth > For Kids > Quiz: Nails Print A A A How much do ... about your nails? Find out by taking this quiz! About KidsHealth Nemours.org Reading BrightStart! Contact Us ...

  11. Threaded Fastener Positive Anti-Rotation Locking Device

    NASA Technical Reports Server (NTRS)

    Hartman, Timm E. (Inventor); Hanlon, Casey (Inventor); Laidlaw, Mitchell (Inventor); Geck, Kellan (Inventor)

    2015-01-01

    An apparatus includes a shaft, a device, a fastener, and an anti-rotation clip. The shaft is configured for rotation. The device is mounted on, and surrounds at least a portion of, the shaft, and has first and second protrusions that are formed on one side and are spaced apart to define a tab space. The fastener is rotationally mounted relative to the shaft, and includes a tab slot formed in its outer surface that extends radially inwardly and is disposed radially inwardly of the tab space. The anti-rotation clip includes a main body portion and a head portion that has a first tab portion and a second tab portion. At least a portion the main body portion is disposed between the device and the fastener, the first tab is disposed in the tab space, and the second tab is disposed in the tab slot.

  12. Nail histopathology.

    PubMed

    Martin, B

    2013-09-01

    The structure of the nail unit is complex and many dermatologists and dermatopathologists have an incomplete understanding of it. Familiarity with the anatomy and histology of this unit, however, is a key factor in improving the diagnostic yield of nail biopsy. Inflammatory or infectious conditions that affect the nail can have a marked impact on a patient's quality of life. A wide-ranging variety of tumors can also develop in this region and they may be life-threatening or require surgery that will result in functional defects. The author reviews the anatomy and histology of the nail unit as well as the basic histopathologic findings in the most common conditions affecting the nails.

  13. Lateral decubitus positioning for intramedullary nailing of the femur without the use of a fracture table.

    PubMed

    Carr, James B; Williams, Daniel; Richards, Mike

    2009-10-01

    In closed intramedullary nailing of the femur in the lateral decubitus position without the use of a fracture table, access to the proximal femur is enhanced as compared to supine nailing, especially in large patients. The hip is typically flexed during the nailing, which allows the nail to be placed posterior to the gluteus medius, thus minimizing abductor damage. The deforming forces of flexion and abduction in proximal fracture patterns can be readily overcome by this technique. Proper rotation of the leg can be assessed clinically or with the use of a femoral neck anteversion guide wire. Fluoroscopic visualization of the proximal femur is excellent, including the femoral head, thus facilitating reconstruction nailing.

  14. Nail Problems (Toenails)

    MedlinePlus

    ... the surface of the nail can be PODIAT PHYSIC filed off, followed by the application of an ... oral medication, and debridement (removal of diseased nail matter and debris) of an infected nail. Newer oral ...

  15. Matricectomy and nail ablation.

    PubMed

    Baran, Robert; Haneke, Eckart

    2002-11-01

    Matricectomy refers to the complete extirpation of the nail matrix, resulting in permanent nail loss. Usually however, matricectomy is only partial, restricted to one or both lateral horns of the matrix. Nail ablation is the definitive removal of the entire nail organ. The most important common denominator in the successful matricectomy is the total removal or destruction of the matrix tissue. Matricectomy may be indicated for the management of onychauxis, onychogryphosis, congenital nail dystrophies, and chronic painful nail, such as recalcitrant ingrown toenail or split within the medial or lateral one-third of the nail.

  16. [Nail diseases in cosmetology].

    PubMed

    Maleszka, Romuald; Ratajczak-Stefańska, Violetta; Boer, Magdalena; Kiedrowicz, Magdalena

    2010-01-01

    Clinical symptoms attributed to the nail apparatus and observed in cosmetology include atrophic or hypertrophic lesions, pathologic nail coloration, abnormalities of the nail surface, and disorders of the nail plate and bed junction. These symptoms may reflect pathologic processes limited to the nail apparatus or may be the consequence of a dermal or systemic disease. Even though the etiology of nail lesions is variegated, diseases of the nails are simply classified as infectious or non-infectious. The aim of this work was to present the most common diseases of the nail apparatus encountered in cosmetology. Often, nail diseases worsen the quality of life of the patient. In addition, the variegated symptomatology demonstrates that nail lesions should be viewed in a wider perspective because they often are important signs of pathologic processes taking place in the organism of the patient.

  17. Nutrition and nail disease.

    PubMed

    Cashman, Michael W; Sloan, Steven Brett

    2010-01-01

    The nail is a specialized keratinous skin appendage that grows approximately 2 to 3 mm per month, with complete replacement achieved in 6 to 9 months. Although this structure can be easily overlooked, nail disorders comprise approximately 10% of all dermatologic conditions. This contribution first provides an overview on the basic anatomy of the nail that will delineate between the nail unit (eg, hyponychium, nail bed, proximal nail fold, and matrix) and anatomic components not part of the nail unit (eg, lateral nail folds, nail plate, and eponychium). The function of each nail structure will also be presented. The chemical profile of the normal nail plate is reviewed with a discussion of its keratin content (hair type keratin vs epithelial type keratin), sulfur content, and mineral composition, including magnesium, calcium, iron, zinc, sodium, and copper. The remainder will focus on nail manifestations seen in states of malnutrition. Virtually every nutritional deficiency can affect the growth of the nail in some manner. Finally, the discussion will include anecdotal use of nutritional and dietary supplements in the setting of brittle nail syndrome as well as a brief overview of biotin and its promising utility in the treatment of nail disorders. Copyright 2010 Elsevier Inc. All rights reserved.

  18. Do design adaptations of a trochanteric nail make sense for Asian patients? Results of a multicenter study of the PFNA-II in Japan.

    PubMed

    Sawaguchi, Takeshi; Sakagoshi, Daigo; Shima, Yosuke; Ito, Takaaki; Goldhahn, Sabine

    2014-10-01

    Asian patients with osteoporosis suffer from an increased incidence of hip fracture and a potentially increased risk of fixation failure due to anatomical differences compared to Caucasians. To cope with these differences, an Asian size- and geometry-adapted Proximal Femoral Nail Antirotation (PFNA-II) was developed. The objective of this prospective multicenter study was to assess the risk of fracture fixation complications (FFCs), the occurrence of mismatch and the quality of life status of patients treated with the PFNA-II. 176 Japanese patients with an isolated, unstable, closed trochanteric fracture were treated with the PFNA-II. Patients were prospectively screened for anticipated complications and classified accordingly; complications were centrally reviewed by a complication review board to avoid bias by the treating surgeon, and categorized using a standardized reporting system. Outcome measurements included the occurrence and evaluation of FFCs, the radiological assessment of mismatch and quality of life measured with the EQ-5D score. 3 Intraoperative and 15 postoperative complications were found in 16/176 patients. The risk of sustaining any intraoperative or postoperative FFC was 1.7% (3/176; 95% CI: 0.35-4.9) and 8% (14/176; 95% CI: 4.4-13), respectively. The most likely cause for FFCs was the "bone/fracture" factor (9/14 patients). Radiologically detectable contact of the implant with the inner cortex ("mismatch") was reported for 17/173 patients (10%). The reported complication risks and mismatches are reasonable for this patient cohort. The geometry- and size-adapted PFNA-II is relatively safe but requires standardized assessment in a larger target cohort. Copyright © 2014 Elsevier Ltd. All rights reserved.

  19. Nailing Pompeii

    NASA Astrophysics Data System (ADS)

    Showstack, Randy

    Roman hihstorian Pliny the Younger noted that Mount Vesuvius blew its top and destroyed Pompeii in the early afternoon of August 24, 1,918 years ago. Now, a team of scientists, tempted by the certainty of that record, has confirmed the eruption to within 7 years. The team developed and used an improved radioactive argon-argon dating technique, which they say can reliably establish the age of rocks as old as the solar system or as recent as 1,000 years old.“We nailed the date to 5% on our first attempt, so we could probably get the error down to 1% or less,” says Paul Renne, adjunct associate professor of geology and geophysics at the University of California at Berkeley and director of the private Berkeley Geochronology Center. “Dating things that are really young has always been the Holy Grail of potassium-argon [an earlier method] and argonargon dating.”

  20. Update: nail unit dermatopathology.

    PubMed

    Stewart, Campbell L; Rubin, Adam I

    2012-01-01

    Nail unit dermatopathology is a growing field filled with many challenges. Many advances in this field have been made in the last 5 years. This review article provides an update on new information and studies published in that period of time. We divided these works into different sections, including clinical and pathologic challenges in diagnosis and treatment of nail disorders, nail unit biopsy and processing techniques, normal nail unit histology, nail plate structural and growth pathology, metabolic disease, inflammatory conditions, onychomycosis, benign growths, malignant growths, and dyschromias. Specific highlights include advances in the marking and orientation of nail unit biopsies for improved histologic interpretation, improved nail plate softening techniques, new methods for histologic evaluation of onychomycosis, descriptions of newly described benign growths unique to the nail unit, and the morphologic and immunohistochemical distinction between benign and malignant pigmented lesions of the nail unit.

  1. OSTEOSYNTHESIS WITH INTRAMEDULLARY NAILS IN CHILDREN

    PubMed Central

    Alvachian Fernandes, Helio Jorge; Saad, Eduardo Abdalla; Reis, Fernando Baldy dos

    2015-01-01

    The authors present a comprehensive review of the literature emphasizing the use of flexible intramedullary nails in the treatment of fractures in children, focusing the treatment of femoral shaft and forearm fractures and emphasizing the importance of the non-surgical approach. Children's age and weight threshold are not well defined for the use of the method. The removal of implants is a controversial matter in the literature, with a trend towards keeping the implants. PMID:27004183

  2. OSTEOSYNTHESIS WITH INTRAMEDULLARY NAILS IN CHILDREN.

    PubMed

    Alvachian Fernandes, Helio Jorge; Saad, Eduardo Abdalla; Reis, Fernando Baldy Dos

    2009-01-01

    The authors present a comprehensive review of the literature emphasizing the use of flexible intramedullary nails in the treatment of fractures in children, focusing the treatment of femoral shaft and forearm fractures and emphasizing the importance of the non-surgical approach. Children's age and weight threshold are not well defined for the use of the method. The removal of implants is a controversial matter in the literature, with a trend towards keeping the implants.

  3. Brittle Splitting Nails (Onychoschizia)

    MedlinePlus

    ... treatment is to apply lotions containing alpha-hydroxy acids or lanolin containing lotions such as "Elon" (by the "Dartmouth" company) to the nails after first soaking nails in water for 5 minutes. Wearing gloves when performing household ...

  4. Nail Care Products

    MedlinePlus

    ... Drug, or Both? (Or Is It Soap?)". By law, nail products sold in the United States must ... only" (see Cosmetic Labeling: An Overview ). Under the law, cosmetic products and ingredients, including nail products, do ...

  5. Femoral offset following trochanteric femoral fractures: a prospective observational study.

    PubMed

    Buecking, Benjamin; Boese, Christoph Kolja; Seifert, Vinzenz; Ruchholtz, Steffen; Frink, Michael; Lechler, Philipp

    2015-10-01

    Reconstruction of the femoral offset reportedly improves outcome following total hip arthroplasty, but little is known of its influence following hip fractures. We aimed to establish the effect of the femoral offset on the medium-term functional outcome in elderly patients who had sustained trochanteric fractures requiring proximal femoral nailing. We measured the rotation corrected femoral offset (FORC) and relative femoral offset (FORL) on plain anteroposterior radiographs of the hip in 188 patients (58 male, 130 female) with a trochanteric fracture who underwent proximal femoral nailing at our institution. The primary outcome measure was the Harris hip score (HSS) 6 and 12 months postoperatively; the Barthel index was assessed as a secondary outcome. The mean FORC after surgery was 58 mm (±11 mm), while the mean FORL was 1.21 (±0.22). At final follow up, we found significant inverse relationships (Spearman's rank correlation coefficient, ρ) between FORC and FORL and the functional outcome assessed by the HSS (FORC: ρ = -0.207, p = 0.036; FORL: ρ = -0.247, p = 0.012), and FORL and the Barthel index (FORC: ρ = -147, p = 0.129; FORL: ρ = -0.192, p = 0.046). A consistent trend was observed after adjustment for confounding variables. Our results underline the biomechanical importance of the femoral offset for medium-term outcomes in elderly patients with trochanteric fractures. In contrast with the published findings on total hip arthroplasty, we found an inverse correlation between functional outcome and the extent of the reconstructed femoral offset. Level I - Prognostic study. Copyright © 2015 Elsevier Ltd. All rights reserved.

  6. Diaphyseal humeral fractures and intramedullary nailing: Can we improve outcomes?

    PubMed Central

    Garnavos, Christos

    2011-01-01

    While intramedullary nailing has been established as the treatment of choice for diaphyseal fractures of the femur and tibia, its role in the management of diaphyseal humeral fractures remains controversial. The reasons include not only the complicated anatomy and unique biomechanical characteristics of the arm but also the fact that surgical technique and nail designs devised for the treatment of femoral and tibial fractures are being transposed to the humerus. As a result there is no consensus on many aspects of the humeral nailing procedure, e.g., the basic nail design, nail selection criteria, timing of the procedure, and the fundamental principles of the surgical technique (e.g., antegrade/retrograde, reamed/unreamed, and static/dynamic). These issues will be analyzed and discussed in the present article. Proposals aiming to improve outcomes include the categorization of humeral nails in two distinct groups: “fixed” and “bio”, avoidance of reaming for the antegrade technique and utilization of “semi-reaming” for the retrograde technique, guidelines for reducing complications, setting the best “timing” for nailing and criteria for selecting the most appropriate surgical technique (antegrade or retrograde). Finally, suggestions are made on proper planning and conducting clinical and biomechanical studies regarding the use of intramedullary nailing in the management of humeral shaft fractures. PMID:21559099

  7. Double-level osteotomy and one-stage reconstruction with long intramedullary femoral nail to correct a severe proximal and diaphyseal femur deformity in a patient with polyostotic fibrous dysplasia: case report and literatures review

    PubMed Central

    Chen, Feiyan; Wei, Yibing; Xia, Jun; Wu, Jianguo; Wang, Siqun; Huang, Gangyong; Chen, Jie; Shi, Jingsheng

    2015-01-01

    Proximal femur is often involved with varus and retroversion deformity in polyostotic fibrous dysplasia (PFD). Multiple corrective osteotomies with intramedullary nails in two stages is recommended procedure as some authors described. We report a case using double-level osteotomy and one-stage reconstruction with intramedullary nail in a patient with painful proximal femur and diaphysis varus deformity, the neck-shaft angle was corrected from 95° pre-operatively to 125° post-operatively, the patient was free of pain and no evidence of recurrence at the 24-month follow up. The operative design and method were described, and a review of related literatures about the treatment alteration for PFD and relevant operative selection were also performed. PMID:26550394

  8. [A biomechanical study on the fracture treatment--intravital measurement of the strain on an intramedullary nail in the healing process of the femoral fracture in goats (author's transl)].

    PubMed

    Obara, T

    1979-02-01

    There have been many biomechanical studies throughout the world on the fracture treatment. However, only a few were performed under intravital condition. The purpose of the present study is to measure the successive strength changes of the callus after a fracture, in vivo in an animal. Specifically designed Küntscher nails were made to meet the anterior convexity and the size of the medullary canal of the femora of goats. Three self-temperature-compensating semi-conductor strain-gauges were glued on the inner surface of the nail and coated with epoxy-resin and silicone rubber. The nail was inserted into the intact femur, and the initial measurement of the strains was performed using a specially designed wooden three point bending jig. Then the femur was transected at the middle. Periodical measurements of the strains were done, first, during walking and, then, with the three point bending jig under general anesthesia. Ten goats were used for the experiments. The measurement was undertaken every two to three weeks. Serial x-rays were taken. The femur was studied histopathologically after the death of the animal. 1. Although the nail with the strain-gauges presented some foreign body reaction and certain difficulties in sterilization, it was well tolerated by the animal, permitting the strain measurement for as long as 18 weeks after the fracture. 2. There was a tendency that the less loosening is found between the nail and the bone, the larger is the strain and the smaller becomes the dispersion of the strains. 3. On the three point bending test, the post-fracture strain changes were not directly proportional to the lapse of time. In the early phase, the strains remained large for about four weeks and tended to rapidly decrease in the middle and late phases in accordance with the development of callus formation on x-ray. 4. A similar strain change was observed on the walking test, although the animal presented with some painful limp. The results suggest that early

  9. Amputated limb by cerclage wire of femoral diaphyseal fracture: a case report.

    PubMed

    Won, Yougun; Yang, Kyu-Hyun; Kim, Kwang-Kyoun; Weaver, M J; Allen, Elizabeth M

    2016-12-01

    An entrapment of the femoral artery by cerclage wiring is a rare complication after spiral diaphyseal femoral fractures. We report the case of an 82-year-old female treated by an antegrade intramedullary nailing and multiple cable augmentation, which was then complicated by injury to the femoral artery that resulted in ipsilateral leg necrosis and amputation. The entrapment was caused by direct belting by the cable and resulted in a total obstruction of the femoral artery.

  10. Advanced Nail Surgery

    PubMed Central

    Haneke, Eckart

    2011-01-01

    Six techniques not yet widely known or used in the dermatologic surgery of the nails are briefly described. Small-to-medium-sized tumours of the proximal nail fold (PNF) can be excised and the defect repaired with advancement or rotation flaps. A superficial biopsy technique of the matrix for the diagnosis of longitudinal brown streaks in the nail, which allows rapid histological diagnosis of the melanocyte focus to be performed, is described here. Because the excision is very shallow and leaves the morphogenetic connective tissue of the matrix intact, the defect heals without scarring. Laterally positioned nail tumours can be excised in the manner of a wide lateral longitudinal nail biopsy. The defect repair is performed with a bipedicled flap from the lateral aspect of the distal phalanx. Malignant tumours of the nail organ often require its complete ablation. These defects can be covered by a full-thickness skin graft, reversed dermal graft, or cross-finger flap. The surgical correction of a split nail is often difficult. The cicatricial tissue of the matrix and PNF have to be excised and the re-attachment of these wounds prevented. The matrix defect has to be excised and sutured or covered with a free matrix graft taken either from the neighbouring area or from the big toe nail. PMID:22279381

  11. [Cosmetology and brittle nails].

    PubMed

    Abimelec, P

    2000-12-15

    The knowledge of manicure techniques and nail cosmetics compositions are a prerequisite to the understanding of their potential side effects. The brittle nail syndrome is a common problem that roughly affect 20% of women. We will review the etiologic hypothesis, describe the various presentations, and suggest a treatment for this perplexing problem.

  12. Nail stem cells.

    PubMed

    Sellheyer, Klaus

    2013-03-01

    Our knowledge on stem cells of the hair follicle has increased exponentially after the bulge was characterized as the stem cell niche two decades ago. In contrast, little is known about stem cells in the nail unit. Whereas hair follicles are plentiful and easy to access, the human body has only twenty nails and they are rarely biopsied. Therefore, examining fetal material offers unique advantages. In the following mini-review, our current knowledge on nail stem cells is summarized and analogies to the hair follicle stem cells are drawn.

  13. Capillary nail refill test

    MedlinePlus

    ... may indicate: Dehydration Shock Peripheral vascular disease (PVD) Hypothermia Alternative Names Nail blanch test; Capillary refill time ... Elsevier Saunders; 2016:chap 79. Read More Dehydration Hypothermia Peripheral artery disease - legs Shock Review Date 4/ ...

  14. Skin or nail culture

    MedlinePlus

    Mucosal culture; Culture - skin; Culture - mucosal; Nail culture; Culture - fingernail; Fingernail culture ... There, it is placed in a special dish (culture). It is then watched to see if bacteria, ...

  15. Development of a locking femur nail for mice.

    PubMed

    Holstein, J H; Menger, M D; Culemann, U; Meier, C; Pohlemann, T

    2007-01-01

    We herein report on a novel locking intramedullary nail system in a murine closed femur fracture model. The nail system consists of a modified 24-gauge injection needle and a 0.1-mm-diameter tungsten guide wire. Rotation stability was accomplished by flattening the proximal and distal end of the needle. Torsional mechanical testing of the implants in osteotomized cadaveric femora revealed a superiority of the locking nail (3.9+/-1.0 degrees rotation at a torque of 0.9 Nmm, n=10) compared to the unmodified injection needle (conventional nail; 52.4+/-3.2 degrees, n=10, p<0.05). None of the implants, however, achieved the rotation stability of unfractured femora (0.3+/-0.5 degrees, n=10). In a second step, we tested the feasibility of the in vivo application of the locking nail to stabilize a closed femoral midshaft fracture in C57BL/6 mice. Of interest, none of the 10 animals showed a dislocation of the locking nail over a 5-week period, while 3 of 4 animals with conventional nail fracture stabilization showed a significant pin dislocation within the first 3 days (p<0.05). Mechanical testing after 5-weeks stabilization with the locking nail revealed an appropriate bone healing with a torque at failure of 71.6+/-3.4% and a peak rotation before failure of 68.4+/-5.3% relative to the unfractured contralateral femur. With the advantage that closed fractures can be fixed with rotation stability, the herein introduced model may represent an ideal tool to study bone healing in transgenic and knockout mice.

  16. Evaluation of the Stryker S2 IM Nail Distal Targeting Device for reduction of radiation exposure: a case series study.

    PubMed

    Anastopoulos, George; Ntagiopoulos, Panagiotis G; Chissas, Dionisios; Loupasis, George; Asimakopoulos, Antonios; Athanaselis, Eustratios; Megas, Panagiotis

    2008-10-01

    Distal locking is one challenging step during intramedullary nailing of femoral shaft fractures that can lead to an increase of radiation exposure. In the present study, the authors describe a technique for the distal locking of femoral nails, implementing a new targeting device in an attempt to reduce radiation exposure and operational time. Over a 2-year period, 127 consecutive cases of femoral shaft fractures were included in the study. All cases were treated with nailing of femoral shaft fractures with an unslotted reamed antegrade femoral nail and distal locking was performed with the use of a proximally mounted aiming device. Mean duration of the procedure was 63.5 18.1 min while the duration for distal locking was 6.6 +/- 2.6 min. In all successful cases, exposure from intraoperative fluoroscopy was 17.2 +/- 7.4 s for the whole operative procedure, and for distal locking was 2 shots, 1.35 s (range, 0.9-2.2 s) and 1.9 mGy (range, 1.1-2.9 mGy). Five cases (3.9%) were unsuccessful, but overall no intraoperative complications were encountered from the application of this technique. The ability of the device to correspond to the level of nail deformation and to properly identify the distal holes, reduced exposure to radiation compared to other published reports, and should be considered as a valuable tool for distal locking of femoral fractures.

  17. [Nail involvement in leprosy].

    PubMed

    Belinchón Romero, I; Ramos Rincón, J M; Reyes Rabell, F

    2012-05-01

    Leprosy, a disease caused by Mycobacterium leprae, primarily affects the skin and nerves, but the nails are also involved in as many as 3 out of 4 patients .The factors that trigger nail changes in leprosy are numerous and include repeated trauma, neuropathy, vascular impairment, infections, lepra reactions, and the drugs used to manage the disease. The changes most often reported include subungual hematomas, onycholysis, onychauxis, onychogryphosis, pterygium unguis, and onychoheterotopia, most of which can be attributed to nerve damage and trauma. Furthermore, the acro-osteolysis that occurs in the advanced stages of the disease may present with brachyonychia, racquet nails, or even anonychia. Infections of the nail bed leading to paronychia and onychomycosis should also be taken into account in leprosy. Other typical changes include longitudinal striae, pitting, macrolunula, Terry nails, leukonychia, hapalonychia, and Beau lines. In this review, we describe the principal nail changes associated with leprosy. These changes, which are highly varied and diverse in origin, are in fact a reflection of the significant morbidity caused by M. leprae infection. Copyright © 2011 Elsevier España, S.L. and AEDV. All rights reserved.

  18. Insertion of intramedullary nails from the suprapatellar pouch for proximal tibial shaft fractures. A technical note.

    PubMed

    Jakma, Tijs; Reynders-Frederix, Peter; Rajmohan, Rai

    2011-12-01

    Intramedullary nailing of proximal tibial fractures can be difficult when using the standard entry portal. We evaluated the suprapatellar portal, using a midline quadriceps tendon incision, to perform intramedullary nailing of the tibia. Seven patients were treated with this adaptation of the standard intramedullary nailing procedure. An arthroscopy was done before and after the nailing procedure. No special equipment was used to perform the intramedullary nailing. We evaluated the handling and necessary modifications of the standard intramedullary technique to introduce the locked tibial nail through the suprapatellar approach. We found this technique not necessarily more difficult than the standard intramedullary nailing of the tibia through the infrapatellar entry portal. Although the patients did not complain of patellofemoral discomfort after the suprapatellar nailing, definitive scuffing of the cartilage in the lower part of the femoral trochlea was visible. Introduction of a locked tibial nail via the suprapatellar approach was found to be possible and even advantageous for some complex upper tibial shaft fractures in compromised limbs. Some possible downsides of this approach need to be taken into account but, in some cases, they can be outweighed by the benefits.

  19. Interlocking Intramedullary Nails in Fracture Treatment.

    PubMed

    Ouyang, Xiao; Wang, Jing Rong; Hong, Shi Dong; Xin, Feng; Wang, Lin; Yang, Xiao Wei; Wang, Jian

    2015-09-01

    The aim of this study is to evaluate interlocking intramedullary nails in the treatment of fractures. We retrospectively reviewed 68 adult patients (for a total of 95 fractures) with isolated long-bone fractures who were treated with interlocking intramedullary nails between January 2010 and January 2012. The patients were followed for 18 months to observe the healing of the fracture, time, and the occurrence of complications in the shoulder, knee, and hip joint functions. After about a follow-up period of 26.2 months (range 18-39 months), all cases obtained bony union. The mean time to fracture union was 5.2 months. Cases of knees and hip joint functions of the femoral or tibial fracture and shoulder functions of the humeral fractures were observed. The interlocking intramedullary nails may be considered as an alternative method for isolated diaphyseal fractures of the extremities. The advantages of this method include small operative scars, reliable fixations, better fracture healings, and fewer complications.

  20. [Femoral shaft fractures in children].

    PubMed

    Dietz, H-G; Schlickewei, W

    2011-05-01

    Femoral shaft fractures in children represent 1.5% of all fractures in childhood. Up to the age of 4 years, conservative treatment in a hip spica or short-term overhead traction is the therapy of choice. Femoral shaft fractures between the age of 5 and 16 years should be treated surgically. In over 90% of these cases elastic stable intramedullary nailing (ESIN) is the premier treatment option. Additional end caps can be used for unstable fractures and in length discrepancy. The external fixator and the locking plate are reserved for fractures with severe soft tissue injuries, vascular problems and some specific situations mentioned later on. By adhering to these standards good results can be achieved with a low complication rate.

  1. Diagnostic applications of nail clippings.

    PubMed

    Stephen, Sasha; Tosti, Antonella; Rubin, Adam I

    2015-04-01

    "Nail clipping is a simple technique for diagnosis of several nail unit dermatoses. This article summarizes the practical approach, utility, and histologic findings of a nail clipping in evaluation of onychomycosis, nail unit psoriasis, onychomatricoma, subungual hematoma, melanonychia, and nail cosmetics, and the forensic applications of this easily obtained specimen. It reviews important considerations in optimizing specimen collection, processing methods, and efficacy of special stains in several clinical contexts. Readers will develop a greater understanding and ease of application of this indispensable procedure in assessing nail unit dermatoses."

  2. Nail involvement in psoriatic arthritis.

    PubMed

    Sobolewski, Piotr; Walecka, Irena; Dopytalska, Klaudia

    2017-01-01

    Nail psoriasis is considered a significant psychological and social problem causing functional impairment in affected patients. Nail changes hamper their daily and occupational activities and contribute to a worse quality of life. Almost 50% of patients with psoriasis vulgaris and up to 80% of patients with psoriatic arthritis are afflicted with nail lesions. The important correlation between psoriatic arthritis and nail changes is well established - the presence of the latter is a strong predictor of the development of arthritis. There is a broad spectrum of nail dystrophies associated with psoriasis, ranging from the common pitting, subungual hyperkeratosis and loosening of the nail plate to less frequent discolouration and splinter haemorrhages. Some of these symptoms are also observed in other nail diseases, and further diagnostics should be performed. The assessment tools NAPSI (Nail Psoriasis Severity Index), mNAPSI (Modified Nail Psoriasis Severity Index), and PNSS (Psoriasis Nail Severity Score) are most commonly used to grade the severity of nail involvement in psoriasis and enable the evaluation of therapy effectiveness. The treatment of nail psoriasis is a major clinical challenge. It should be adjusted to the extent of dermal, articular and ungual lesions. Systemic therapies of psoriasis, especially biological agents, are most likely to be effective in treating nail psoriasis. However, as their use is limited in scope and safety, topical therapy remains a mainstay, and the combination of corticosteroids and vitamin D3 analogues is considered to be most helpful.

  3. Early experience with titanium elastic nails in a trauma unit.

    PubMed

    Shah, M H; Heffernan, G; McGuinness, A J

    2003-01-01

    The Titanium Elastic Nail (TEN) offers a number of potential advantages over traditional ways of treating long bone fractures particularly in the paediatric population. These advantages include earlier mobilisation and shorter hospital stay and less risk of loss of fracture position. These advantages are most apparent and significant when treating femoral fractures in children where the length of hospital stay is reduced from several weeks to a typical period of 5 to 8 days. We have reviewed our early experience of using these implants over the past 2 years. Patients were assessed clinically and radiologically. 13 patients were treated using the TEN during this period. There were 2 femoral fractures, 4 humeral fractures, 1 tibial and 6 forearm fractures treated using the Titanium Elastic Nail. All fractures united during the study period. However 1 humeral fracture required a secondary bone grafting and plating for delayed union and 1 fracture lost position during follow-up. Insertion point pain was a problem in 4 patients but this resolved after nail removal in all. There was 1 superficial wound infection which resolved with antibiotics and 1 superficial wound infection of an open fracture wound which resolved following nail removal and antibiotics. There were no cases of deep infection. There were no limb length discrepancy or rotational or angular malalignment problems. Biomechanical principles and technical aspects of this type of fixation are discussed.

  4. Histopathology of the nail unit.

    PubMed

    Fernandez-Flores, Angel; Saeb-Lima, Marcela; Martínez-Nova, Alfonso

    2014-01-01

    In this report, we review several inflammatory infectious and tumoral conditions of the nail unit. We emphasize the anatomic peculiarities of such pathologies of the nail unit and provide some required diagnostic criteria.

  5. Nail involvement in pemphigus vulgaris.

    PubMed

    Engineer, L; Norton, L A; Ahmed, A R

    2000-09-01

    Nail involvement in pemphigus vulgaris is relatively rare. We describe a case of severe pemphigus involving both the skin and oral mucosa in which an acute exacerbation was preceded by the onset of nail involvement of all 4 extremities. Nail involvement occurred in the form of hemorrhagic paronychia of multiple digits. Oral, cutaneous, and nail manifestations of the disease were all well controlled by systemic therapy. A review of the literature on nail involvement in pemphigus reveals that this involvement may be manifested in multiple ways, with chronic paronychia and onychomadesis being the most common. Involvement of the nail occurs most frequently either as part of the initial presentation, or just before or concurrent with a flare of pre-existing disease. Nail involvement, when it occurs, is usually present when the disease is severe. Topical therapy is insufficient, and systemic therapy is warranted. In the majority of cases, nail recovery is complete, with no residual damage.

  6. Nails: diagnostic clue to genodermatoses.

    PubMed

    Inamadar, Arun C; Palit, Aparna

    2012-01-01

    Nails are cutaneous appendages mostly involved in mechanical functions. However, nails may reflect presence of various systemic disorders evidenced by alteration of their shape, size, color or texture. Genodermatoses are multisystem disorders with cutaneous involvement. Many of the genodermatoses present with nail changes and some of these may be the clinical pointers to the diagnosis. Diagnostic clues to various genodermatoses derived from nail findings have been discussed.

  7. Nail care for newborns

    MedlinePlus

    ... MedlinePlus GO GO About MedlinePlus Site Map FAQs Customer Support Health Topics Drugs & Supplements Videos & Tools Español You Are Here: Home → Medical Encyclopedia → Nail care for newborns URL of this page: //medlineplus.gov/ ...

  8. Anatomy of the nail unit and the nail biopsy.

    PubMed

    Haneke, Eckart

    2015-06-01

    The nail unit is the largest and a rather complex skin appendage. It is located on the dorsal aspect of the tips of fingers and toes and has important protective and sensory functions. Development begins in utero between weeks 7 and 8 and is fully formed at birth. For its correct development, a great number of signals are necessary. Anatomically, it consists of 4 epithelial components: the matrix that forms the nail plate; the nail bed that firmly attaches the plate to the distal phalanx; the hyponychium that forms a natural barrier at the physiological point of separation of the nail from the bed; and the eponychium that represents the undersurface of the proximal nail fold which is responsible for the formation of the cuticle. The connective tissue components of the matrix and nail bed dermis are located between the corresponding epithelia and the bone of the distal phalanx. Characteristics of the connective tissue include: a morphogenetic potency for the regeneration of their epithelia; the lateral and proximal nail folds form a distally open frame for the growing nail; and the tip of the digit has rich sensible and sensory innervation. The blood supply is provided by the paired volar and dorsal digital arteries. Veins and lymphatic vessels are less well defined. The microscopic anatomy varies from nail subregion to subregion. Several different biopsy techniques are available for the histopathological evaluation of nail alterations.

  9. Static or dynamic intramedullary nailing of femur and tibia.

    PubMed

    Omerovic, Djemil; Lazovic, Faruk; Hadzimehmedagic, Amel

    2015-04-01

    The basic principle of non-surgical fracture treatment is to restore the original anatomical position of fractured fragments by different techniques, without direct access to the bone and without further traumatizing of tissues. Intramedullary nailing is synthesis and consolidation of fracture fragments with the main goal to gain strength and permanent placement of the implants. Two techniques of intramedullary osteosynthesis are used: with dynamic or with static intramedullary nail. Dynamization include conversion of static nail by removing screws from the longest fragment. The aim of this study is to determine whether there is a difference in the speed and quality of healing of the type A and B fractures of the femur and tibia treated by static or dynamic intramedullary nails and to compare the results. The study was conducted at the Clinic for Orthopaedics and Traumatology, Clinical Center University Sarajevo from January 2004 to June 2009. The study was retrospective-prospective, manipulative, controlled and it was conducted on a total of 129 patients with closed fractures of the diaphysis of the femur and tibia type A and type B, with different segments of bone, regardless of sex and age structure, with the exception of children under 14 years of age. Precisely there were 47 patients with femoral fractures and 82 patients with tibial fractures. The average number of weeks of healing femoral and tibial fractures was slightly in advantage of static intramedullary osteosynthesis, it was 17.08 weeks (SD=3.382). The average number of weeks of healing in 23 patients with fractures of the femur, treated by dynamic intramedullary osteosynthesis was 17.83 (SD=2.978). We can conclude that static intramedullary nailing osteosynthesis unable movements between fragments which directly stimulates bone formation and formation of minimal callus. Static intramedullary osteosynthesis resolve the problem of stabilizing the fracture, limb shortening and rotation of fragments.

  10. Glycolic Acid Peels for Nail Rejuvenation

    PubMed Central

    Banga, Gurvinder; Patel, Kalpana

    2014-01-01

    Background: With the increasing use of nail paints, nail art, acetone, repeated manicures, cosmetic nail procedures and detergents, the nail plate undergoes regular damage resulting in rough, lusterless and pigmented nails. Besides that onychomycosis, nail lichen planus, nail pitting and ridging due to various diseases also cause cosmetically disfiguring nails. Objective: The study is directed toward use of 70% glycolic acid for controlled keratolysis of the nail-plate, resulting that could result in shinier, smoother and brighter nails. Materials and Methods: A prospective single-center open-label uncontrolled study of 31 patients, 22 with dry, rough, discolored nails and 9 with hyperkeratotic nails were included in the study group. After examination and ruling out any infection, petroleum jelly was applied on the cuticle margins of the nails for protection and 70% glycolic acid was applied over the nail plate for 45 minutes. In dry rough discolored nails, only a single sitting was done while in hyper-keratotic nail conditions multiple weekly sittings were done. Results: In 22 patients with dry rough nails, 80% showed good improvement, 10% showed average improvement, whereas 10% were non-responsive. Nine patients with thickened nail plate showed good improvement in 60% average improvement in 25% improvement and 15% were non-responsive, after multiple sessions. Conclusion: Controlled keratolysis of the nail plate with application of 70% glycolic acid can be a promising treatment for modality for thick, uneven, rough and pigmented nail-plate conditions with cosmetically pleasing results. PMID:25722596

  11. Limb Lengthening Using the PRECICETM Nail System: Complications and Results

    PubMed Central

    Wiebking, Ulrich; Liodakis, Emmanouil; Kenawey, Mohamed; Krettek, Christian

    2016-01-01

    Background Three types of telescopic nails are mainly used for intramedullary limb lengthening nowadays. Despite some important advantages of this new technology (e.g. controlled distraction rate, not restricted availability, possibility to perform accordion maneuvers), few articles exist on clinical results and complications after lengthening with the PRECICETM nail (Ellipse, USA). Objectives The aim of the current study was to describe and analyze the complications associated with lengthening with the PRECICETM nail. Are the problems preventable when using the PRECICE, related to the distraction rate control, the lengthening goals and technique and handling? Methods We retrospectively reviewed the charts of 9 patients operated between 2012 and 2013 with a PRECICETM nail for a leg length discrepancy (LLD). The mean age of the patients was 32 years (range, 17 - 48 years). There were 5 femoral and 4 tibial procedures. The causes of LLD were posttraumatic (n = 5) and congenital (n = 4). The mean LLD was 36.4 ± 11.4 mm. The minimum follow-ups were 2 months (average, 5 months; range, 2 - 9 months). Results The mean distraction rate was 0.5 ± 0.1 mm/day. We observed in 7 patients differences in achieving the lengthening goals (average, 1.6 mm; range, -20.0 - 5.0 mm). Average lengthening was 34.7 ± 10.7 mm. All patients reached normal alignment and normal joint orientation. An unintentional loss of the achieved length during the consolidation phase was noticed in patients with delayed bone healing in two cases. In the first case (loss of 20mm distraction) the nail could be redistracted and the goal length was achieved. In the second case (loss of 10mm distraction) the nail broke shortly after the diagnosis and the nail was exchanged. Conclusions We report of loss of achieved length after lengthening with a telescopic nail. Weight bearing before complete consolidation of the regenerate might be a risk factor for that. Thorough examination of the limb length and careful

  12. Morphopathological aspects of healthy nails and nails affected by onychomycosis.

    PubMed

    Zaikovska, Olga; Pilmane, Mara; Kisis, Janis

    2014-09-01

    Patients of onychomycosis are common in the dermatology practice. Contemporary morphology creates opportunities to study the functional units of the nail when such infections occur from morphopathological point of view. There were 22 nails biopsies from onychomycosis patients taken for the research of morphopathological changes in the thickened nail plate affected by onychomycosis. Samples of cadaverous' nails were used as a control material. The material was stained with haematoxylin and eosin and immunohistochemical methods. Terminal deoxynucleotidyl transferase dUTP nick end labelling reaction and periodic acid-Schiff reaction were also performed. We found patchy hypertrophy in the granulose layer of the epidermis, with focal acanthosis. In the horn layer, we identified nests of parakeratosis of various sizes, with incorporations of homogenous and eosinophil masses. We found high levels of interleukin 6 and interleukin 10 positive cells in the nail bed and in the bloodstream. Interleukin 1, however, was not a part of any of the functional units of any of the nails. Significant amount of fibres containing human beta defensin-2 were found in the bed and plate of the nail. Therefore one can conclude that as regards the nails affected by onychomycosis, the most effective morphopathogenical processes include cytokine and defensin excretion occurrence in the nail bed.

  13. Osteosynthesis of fractures of the femur with flexible metallic intramedullary nails.

    PubMed

    Firica, A; Troianescu, O; Petre, M

    1978-04-01

    The authors discuss their use of Ender's method in the treatment of fractures of the femur. The diameter and length of the nails depends on the type of fracture. 1) Three nails of 4 mm diameter are introduced in parallel from the medial condyle in fractures of the femoral neck; 2) 5 mm nails are used, in similar fashion, for the fixation of intertrochanteric and subtrochanteric fractures; 3) 5 mm nails are used for diaphyseal, supracondylar and intercondylar fractures, introduced in crossed fashion ("Eiffel Tower" technique) from both medial and lateral condyles. This method of fixation has proved to be extremely stable. The operation itself is quick, with no blood loss or shock. The patient can resume partial weight bearing after a week in stabilised intertrochanteric and shaft fractures, after a month in less stable types, and after three to four months in fractures of the neck of the femur. This report is based on the first 250 cases treated by this method.

  14. 3066 consecutive Gamma Nails. 12 years experience at a single centre

    PubMed Central

    2010-01-01

    Background Fixation of trochanteric hip fractures using the Gamma Nail has been performed since 1988 and is today well established and wide-spread. However, a number of reports have raised serious concerns about the implant's complication rate. The main focus has been the increased risk of a subsequent femoral shaft fracture and some authors have argued against its use despite other obvious advantages, when this implant is employed. Through access to a uniquely large patient data base available, which is available for analysis of trochanteric fractures; we have been able to evaluate the performance of the Gamma Nail over a twelve year period. Methods 3066 consecutive patients were treated for trochanteric fractures using Gamma Nails between 1990 and 2002 at the Centre de Traumatologie et de l'Orthopedie (CTO), Strasbourg, France. These patients were retrospectively analysed. Information on epidemiological data, intra- and postoperative complications and patients' outcome was retrieved from patient notes. All available radiographs were assessed by a single reviewer (AJB). Results The results showed a low complication rate with the use of the Gamma Nail. There were 137 (4.5%) intraoperative fracture-related complications. Moreover 189 (6.2%) complications were detected postoperatively and during follow-up. Cut-out of the lag screw from the femoral head was the most frequent mechanical complication (57 patients, 1.85%), whereas a postoperative femoral shaft fracture occurred in 19 patients (0.6%). Other complications, such as infection, delayed healing/non-union, avascular femoral head necrosis and distal locking problems occurred in 113 patients (3.7%). Conclusions The use of the Gamma Nail in trochanteric hip fractures is a safe method with a low complication rate. In particular, a low rate of femoral shaft fractures was reported. The low complication rate reported in this series can probably be explained by strict adherence to a proper surgical technique. PMID

  15. Pediatric nail diseases: clinical pearls.

    PubMed

    Oberlin, Kate E

    2017-02-01

    This article highlights pearls shared during a unique and enlightening lecture by Antonella Tosti, MD, a professor at the University of Miami Health System, Florida, on the presentation and management of common pediatric nail diseases. These clinical pearls are shared to help deliver utmost care to our pediatric patients presenting with nail pathology and may help shed light on the management of pediatric nail diseases.

  16. Comparison of our self-designed rotary self-locking intramedullary nail and interlocking intramedullary nail in the treatment of long bone fractures

    PubMed Central

    2014-01-01

    Objective The purpose of this study is to compare the clinical effects of our self-designed rotary self-locking intramedullary nail (RSIN) and interlocking intramedullary nail (IIN) for long bone fractures. Methods A retrospective study was performed in 1,704 patients who suffered bone fractures and underwent RSIN or IIN operation in our hospital between March 1999 and March 2013, including 494 with femoral fractures, 572 with humeral fractures, and 638 with tibial fractures. Among them, 634 patients were followed up for more than 1 year. The operative time, intraoperative blood loss, postoperative complications, healing rate, and the excellent and good rate of functional recovery were compared between two groups. Results Compared with IIN group, RSIN group exhibited significantly shorter operative time and less intraoperative blood loss no matter for humeral, femoral, or tibial fractures (all p < 0.001). The healing rate in patients with more than 1 year follow-up was significantly higher in RSIN group for femoral and tibial fractures (both p < 0.05). In RSIN group, no nail breakage or loosening occurred, but radial nerve injury and incision infection were respectively observed in one patient with humeral fracture. In IIN group, nail breakage or loosening occurred in 7 patients with femoral fractures and 16 patients with tibial fractures, radial nerve injury was observed in 8 patients with humeral fractures, and incision infection was present in 2 patients with humeral fractures and 1 patient with femoral fracture. The complication rate of IIN group was significantly higher than that of RSIN group (p < 0.05). However, there were no significant differences in the excellent and good rate of shoulder, elbow, knee, and ankle joint functional recovery between RSIN group and IIN group. Conclusion RSIN may be a reliable and practical alternative method for the treatment of long bone fractures. PMID:25047454

  17. Comparison of our self-designed rotary self-locking intramedullary nail and interlocking intramedullary nail in the treatment of long bone fractures.

    PubMed

    Liu, Bailian; Xiong, Ying; Deng, Hong; Gu, Shao; Jia, Fu; Li, Qunhui; Wang, Daxing; Gan, Xuewen; Liu, Wei

    2014-07-21

    The purpose of this study is to compare the clinical effects of our self-designed rotary self-locking intramedullary nail (RSIN) and interlocking intramedullary nail (IIN) for long bone fractures. A retrospective study was performed in 1,704 patients who suffered bone fractures and underwent RSIN or IIN operation in our hospital between March 1999 and March 2013, including 494 with femoral fractures, 572 with humeral fractures, and 638 with tibial fractures. Among them, 634 patients were followed up for more than 1 year. The operative time, intraoperative blood loss, postoperative complications, healing rate, and the excellent and good rate of functional recovery were compared between two groups. Compared with IIN group, RSIN group exhibited significantly shorter operative time and less intraoperative blood loss no matter for humeral, femoral, or tibial fractures (all p < 0.001). The healing rate in patients with more than 1 year follow-up was significantly higher in RSIN group for femoral and tibial fractures (both p < 0.05). In RSIN group, no nail breakage or loosening occurred, but radial nerve injury and incision infection were respectively observed in one patient with humeral fracture. In IIN group, nail breakage or loosening occurred in 7 patients with femoral fractures and 16 patients with tibial fractures, radial nerve injury was observed in 8 patients with humeral fractures, and incision infection was present in 2 patients with humeral fractures and 1 patient with femoral fracture. The complication rate of IIN group was significantly higher than that of RSIN group (p < 0.05). However, there were no significant differences in the excellent and good rate of shoulder, elbow, knee, and ankle joint functional recovery between RSIN group and IIN group. RSIN may be a reliable and practical alternative method for the treatment of long bone fractures.

  18. FEMORAL SHAFT FRACTURES—A Study of Closed Reduction and Open Treatment

    PubMed Central

    Ramey, Ernest Edgar

    1960-01-01

    A comparative study was made of 58 cases of closed femoral shaft fractures treated by skeletal traction, and 24 cases of closed femoral shaft fractures treated by open reduction with internal fixation. Although complications occurred in some cases, intramedullary nailing appeared to be the most satisfactory method, resulting in primary union, in decreased time of recumbency and time in hospital, in earlier ambulation and in less residual disability. Success of intramedullary nailing depends largely upon adequate training or experience of the surgeon in the technical operative aspects of the procedure and in postoperative management. Placing supplemental autogenous iliac bone chips at the fracture site in closed femoral fractures in which intramedullary nailing is performed appears to enhance callus formation and bony consolidation. Skeletal traction should be utilized on all patients whose general physical condition does not permit operative intervention. ImagesFigure 1.Figure 2.Figure 3. PMID:14436039

  19. Stem Migration and Fretting Corrosion of the Antirotation Pin in the K2/Apex Hip System.

    PubMed

    Kent, Michael; Edmondson, Mark; Ebert, Jay; Nivbrant, Nils; Kop, Alan; Wood, David; De Steiger, Richard

    2016-03-01

    Many exchangeable neck hip systems have been withdrawn because of fretting corrosion at the neck/stem coupling. Our prospective randomized study evaluating stem stability (Roentgen stereophotogrammetric analysis, dual-energy x-ray absorptiometry) and clinical outcomes between the K2/Apex hip systems was ceased early because of a withdrawal of the stems which had an unfavorably high early revision rate reported in the Australian Orthopaedic Association National Joint Registry (9.3% at 3 years). At 2 years, there are no clinical differences between the stems. Roentgen stereophotogrammetric analysis has identified a high proportion of potentially concerning subsidence and retroversion in both groups, more marked in the K2 stem, although mostly in asymptomatic patients. Dual-energy x-ray absorptiometry has shown similar bone density around the stems. Retrieval analysis of 3 study patients showed fretting corrosion of the antirotation pin and aseptic lymphocyte-dominated vasculitis-associated lesion, with no relationship to bearing type or size. Analysis of 7 further nonstudy K2/Apex stems confirmed similar corrosion. This study shows potentially concerning subsidence of both stems and is the first to describe corrosion at the neck-stem interface and a relationship to metal-related pathology. Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.

  20. Femoral nerve dysfunction

    MedlinePlus

    Neuropathy - femoral nerve; Femoral neuropathy ... Craig EJ, Clinchot DM. Femoral neuropathy. In: Frontera WR, Silver JK, Rizzo TD Jr, eds. Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation . 3rd ...

  1. Scabies of the nail unit.

    PubMed

    Oh, Susan; Vandergriff, Travis

    2014-10-15

    Scabies limited to the nail unit is quite unusual, but may persist after treatment of crusted scabies. We present a man with a history of crusted scabies that resolved with treatment, but later the patient reported a chronic problem with crumbly, thickened nails, which were found to be harboring scabies mites.

  2. Reverse distal femoral locking compression plate a salvage option in nonunion of proximal femoral fractures

    PubMed Central

    Dumbre Patil, Sampat S; Karkamkar, Sachin S; Patil, Vaishali S Dumbre; Patil, Shailesh S; Ranaware, Abhijeet S

    2016-01-01

    Background: When primary fixation of proximal femoral fractures with implants fails, revision osteosynthesis may be challenging. Tracts of previous implants and remaining insufficient bone stock in the proximal femur pose unique problems for the treatment. Intramedullary implants like proximal femoral nail (PFN) or surface implants like Dynamic Condylar Screw (DCS) are few of the described implants for revision surgery. There is no evidence in the literature to choose one implant over the other. We used the reverse distal femur locking compression plate (LCP) of the contralateral side in such cases undergoing revision surgery. This implant has multiple options of fixation in proximal femur and its curvature along the length matches the anterior bow of the femur. We aimed to evaluate the efficacy of this implant in salvage situations. Materials and Methods: Twenty patients of failed primary proximal femoral fractures who underwent revision surgery with reverse distal femoral locking plate from February 2009 to November 2012 were included in this retrospective study. There were 18 subtrochanteric fractures and two ipsilateral femoral neck and shaft fractures, which exhibited delayed union or nonunion. The study included 14 males and six females. The mean patient age was 43.6 years (range 22–65 years) and mean followup period was 52.1 months (range 27–72 months). Delayed union was considered when clinical and radiological signs of union failed to progress at the end of four months from initial surgery. Results: All fractures exhibited union without any complications. Union was assessed clinically and radiologically. One case of ipsilateral femoral neck and shaft fracture required bone grafting at the second stage for delayed union of the femoral shaft fracture. Conclusions: Reverse distal femoral LCP of the contralateral side can be used as a salvage option for failed fixation of proximal femoral fractures exhibiting nonunion. PMID:27512218

  3. Nail clipping in onychomycosis*

    PubMed Central

    Bertanha, Laura; Chiacchio, Nilton Di

    2016-01-01

    Onychomycosis is the most prevalent onychopathy and it requires a correct early diagnosis. Currently, the diagnostic gold standard is the association of direct mycological test with culture; however, it shows variable sensitivity. The histopathological examination of the distal nail plate, called clipping, has shown to be an adjuvant in diagnosing onychomycosis. This is an easy-to-perform, relatively cheap examination that is little dependent of the examiner, rapidly provides results, has high sensitivity, and for patients it is painless and harmless. PMID:27828655

  4. How much is too much? A guide to appropriately bending ball tip guide wires when using intramedullary nails for the treatment of lower extremity long bone fractures.

    PubMed

    Riedel, Matthew D; Gonzalez, Tyler; Kwon, John Y

    2016-04-01

    This study was to determine the angle of bend that can be placed in a ball-tip guide wire while still allowing passage of reamers and nails of several commonly utilized nailing systems. Ball-tip guide wires, opening reamer tips, femoral nails, and tibial nails were collected from several manufacturers. Guide wires were incrementally bent 3 cm from the tip and passed through the reamer tip, tibial nail, and femoral nail until unable to pass. All systems tested demonstrated that the reamer, with its relative smaller diameter cannula as compared to the nails themselves, determined the smallest tolerable bend to be able to pass the bent guide wire. The bend angle tolerated by reamer tips was on average 7° (4-9°). The bend angle tolerated by femoral nails was more consistent between the tested systems and was on average 15.5° (12-18°). The bend angle tolerated by tibial nails had the most variability between manufacturers and was on average 16° (13-21°). Knowing the degree of guide wire bend which is tolerated can save time in equipment preparation as well as allow one to pre-bend the guide wire and know the intramedullary nail and/or reamers will likely pass. We hope the information provided in this work increases awareness of the potential technical issues with guide wire over-bending and that surgeons may err on the side of minimizing the bend in order to save time in the OR, decrease frustration and eliminate intraoperative complications that can occur. Copyright © 2015 Elsevier Ltd. All rights reserved.

  5. Comparison of retrograde nailing and minimally invasive plating for treatment of periprosthetic supracondylar femur fractures (OTA 33-A) above total knee arthroplasty.

    PubMed

    Park, Jin; Lee, Ju Hong

    2016-03-01

    Retrograde intramedullary (IM) nailing and minimally invasive plate osteosynthesis (MIPO) using locking plate are typically considered the gold standards of treatment for periprosthetic supracondylar femoral fractures above total knee arthroplasty (TKA). Forty-one consecutive patients treated with either retrograde nailing (nail group, n = 20) or minimally invasive plating (plate group, n = 21) for periprosthetic supracondylar femoral fractures between March 2003 and January 2014 were retrospectively reviewed. Clinical functions [arc range of motion and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score] and bony outcomes (bony union and malunion) were evaluated. There was no statistical difference between the nail and plate groups in age (p = 0.665), one-year postoperative arc range of motion (p = 0.642), preoperative WOMAC score (p = 0.076), postoperative one-year WOMAC score (p = 0.135), and union time (p = 0.081). The mean union time of the nail group and the plate group was 4.3 months (range 3-12 months) and 3.6 months (range 3-5 months), respectively. There were three cases of malalignment in the nail group, whereas there was one case of malalignment in the plate group (p = 0.343). One case of nailing using a short nail demonstrated nail breakage. Although retrograde nailing was found to have a slightly higher rate of malunion compared to minimally invasive plating, there was no statistically significant difference between both treatment options in terms of clinical outcomes. Regardless of which implant is used, the proper application is essential in management of periprosthetic supracondylar femoral fractures above TKA.

  6. Review of end grain nail withdrawal research

    Treesearch

    Douglas R. Rammer; Samuel L. Zelinka

    2004-01-01

    This study reviewed the literature on static and impact withdrawal of nails driven into the end grain of wood members. From this, an empirical relationship was created relating the specific gravity of the wood, the diameter of the nail, and the depth of penetration of the nail to the static withdrawal capacity of nails driven into the wood and withdrawn immediately....

  7. [Blind nailing of trochanteric fractures using the Ender method (author's transl)].

    PubMed

    Carret, J P; Van Cuyck, A; Bejui, J; Dejour, H; de Mourgues, G; Fischer, L P

    1980-01-01

    After trochanteric fractures, the rate of survival of old patients was best when treated by the Ender method: 15% died during 3 months following the fracture. The procedure is uneasy and an excellent radiologic technique is necessary. The position of the proximal end of the first nail in the femoral head is most important. Excessive external rotation was frequent, but little desabling. Secondary displacement of the nails toward the distal end occurred in 25% of the cases and was difficult to avoid but remained moderate. The procedure is indicated in old people with porotic bones. It should not be done in subtrochanteric fractures.

  8. [Aging of hair and nails].

    PubMed

    Mandt, N; Blume-Peytavi, U

    2005-04-01

    Human hair and nails, like all other organs, undergo chronological aging. Age-associated changes in growth, color, and structure of the hair and nails are common. In contrast to the aging process of the skin, the gerontobiological course of hair and nails has not been investigated comprehensively. Investigations on signaling pathways important for melanogenesis of the hair follicle improve our understanding of processes involved in hair greying. Differences in the structure and quality of the nails at an advanced age are determined mainly by age-dependent variations in lipid content of the nail plates. However, it is important to recognize age-dependent processes in hair shafts and nails and to distinguish between chronological aging and pathological changes. The possibilities to improve these aging processes have, primarily, to be seen in the field of external cosmetic procedures. Since the effect of preexisting hormonal substitution treatment has not yet been adequately investigated, it can be regarded as critical to evaluate the confirmed benefits and possible risks of such treatment either for hair or for nail quality improvement.

  9. Control of the micromovements of a composite-material nail design: A finite element analysis.

    PubMed

    Ben-Or, Mor; Shavit, Ronen; Ben-Tov, Tomer; Salai, Moshe; Steinberg, Ely L

    2016-02-01

    Intramedullary nail fixation is the most accepted modality for stabilizing long bone midshaft fractures. The commercially used nails are fabricated from Stainless Steel or Titanium. Composite-materials (CM) mainly carbon-fiber reinforced polymers (CFRP) have been gaining more interest and popularity due to their properties, such as modulus of elasticity close to that of bone, increased fatigue strength, and radio-opacity to irradiation that permits a better visualization of the healing process. The use of CFRP instead of metals allows better control of different directional movements along a fracture site. The purpose of this analysis was to design a CM intramedullary nail to enable micromovements as depicted on a finite element analysis method. We designed a three-dimentional femoral nail model. Three CFRP with different laminates arrangements, were included in the analysis. The finite element analysis involved applying vertical and horizontal loads on each of the designed and tested nails. The nails permitted a transverse micromovement of 0.75mm for the 45° lay-up and 1.5mm for the 90° lay-up for the CM, 1.38mm for the Titanium and 0.74mm for the Stainless Steel nails. The recorded axial movements were 0.53mm for the 45° lay-up, 0.87mm for the 90° lay-up, 0.46mm for the unsymmetrical lay-up CM, 0.046 for the Titanium and 0.02 for the Stainless Steel nails. Overall, the simulations showed that nail transverse micromovements can be reduced by using 45° carbon fiber orientations. Similar results were observed with each metal nails. We found that nail micromovements can be controlled by changing the directional stiffness using different lay-up orientations. These results can be useful for predicting nail micromovements under specified loading conditions which are crucial for stimulating callus formation in the early stages of healing. Copyright © 2015 Elsevier Ltd. All rights reserved.

  10. Biomechanical analysis of the cephalomedullary nail versus the trochanteric stabilizing plate for unstable intertrochanteric femur fractures.

    PubMed

    Walmsley, David; Nicayenzi, Bruce; Kuzyk, Paul Rt; Machin, Alan; Bougherara, Habiba; Schemitsch, Emil H; Zdero, Radovan

    2016-10-26

    Unstable intertrochanteric fractures are commonly treated with a cephalomedullary nail due to high failure rates with a sliding hip screw. The Omega3 Trochanteric Stabilizing Plate is a relatively new device that functions like a modified sliding hip screw with a proximal extension; however, its mechanical properties have not been evaluated. This study biomechanically compared a cephalomedullary nail, that is, Gamma3 Nail against the Omega3 plate. Unstable intertrochanteric fractures were created in 24 artificial femurs. Experimental groups were as follows: Nail (i.e. Gamma3 Nail) (n = 8), Plate A (i.e. Omega3 plate with four distal non-locking screws and no proximal locking screws) (n = 8), Plate B (i.e. Plate A plus five proximal locking screws) (n = 8), Plate C (i.e. Omega3 plate with three distal locking screws and no proximal locking screws) (n = 8), and Plate D (i.e. Plate C plus five proximal locking screws) (n = 8). All specimens were stiffness tested, while the Nail and Plate D groups were also strength tested. For lateral bending, Plate B was less stiff than the Nail (p = 0.001) and Plate A (p = 0.009). For torsion, Plate A was less stiff than Plate D (p = 0.020). For axial compression, the Nail was less stiff than Plate A (p = 0.036) and Plate B (p = 0.008). Axial strength for the Nail (5014 ± 308 N) was 66% higher than the Plate D construct (2940 ± 411 N) (p < 0.001). All Nails failed by partial or complete cutout through the femoral head and neck, but Plate D failed by varus collapse and deformation of the lag screw. When the cephalomedullary nail is clinically contra-indicated, this study supports the use of the Omega3 plate, since it had similar stiffness in three test modes to the Gamma3 Nail, but had lower strength. Stability of Omega3 plate constructs was not improved with locked fixation proximally or distally.

  11. Nail patella syndrome.

    PubMed

    Popp, Andrew Damian; Kulenovic, Indira; Kulenovic, Elvedin

    2008-01-01

    A 45 year old male presented to a primary care physician with complaints of long term, bilateral knee and bilateral foot pain, without history of significant trauma. Physical exam demonstrated full range of motion without any erythema or edema. Fingernails were abnormal and hypoplastic. Bilateral knee radiographs demonstrated moderate degenerative changes of the right knee. Small, atrophic patellae were noted to be proximal to their expected location. Two months later the patient returned to his primary care physician for worsening of the knee pain related to cooler outside temperatures. An NSAID had initially relieved the pain but was becoming less and less efficacious. Alternative medications were prescribed to better control the pain. Complaints of continued knee pain and now bilateral hip pain brought him back to his physician four months later. He requested a referral to an orthopedic surgeon and an MR of the right knee was obtained. The finding showed complex tear of the lateral meniscus in patient with Nail Patella Syndrome.

  12. When Is It Nail Fungus?

    MedlinePlus

    ... medlineplus.gov/news/fullstory_167455.html When Is It Nail Fungus? Dermatologist says only an expert can ... but you shouldn't be embarrassed to discuss it with a board-certified dermatologist, who can help ...

  13. Pemphigus vulgaris affecting 19 nails.

    PubMed

    Patsatsi, A; Sotiriou, E; Devliotou-Panagiotidou, D; Sotiriadis, D

    2009-03-01

    A 60-year-old woman presented with painful erosions in the oral mucosa, pharynx, perineum and perianal area, and multiple plaques with thick adherent crusts on the scalp. Most (nine) of the patient's fingernails had alterations in colour, affecting more than half of the nail plate, and all the toenails had severe inflammation of the nail folds, haemorrhagic paronychia and subungual or intraungual haemorrhage. A diagnosis of pemphigus vulgaris (PV) was made based on histology and on direct and indirect immunofluorescence findings. Groups of acantholytic cells were also observed in a Tzanck smear obtained from a subungual lesion. Onychomadesis in most of the fingernails and in all the toenails developed gradually. The patient was hospitalized and treated with oral corticosteroids. Complete recovery without residual damage to the nails and persistent remission was achieved. Nail involvement in PV is rarely described and is always of interest, as its presentation varies widely.

  14. Influence of Lateral Muscle Loading in the Proximal Femur after Fracture Stabilization with a Trochanteric Gamma Nail (TGN)

    NASA Astrophysics Data System (ADS)

    Sitthiseripratip, Kriskrai; Mahaisavariya, Banchong; Suwanprateeb, Jintamai; Bohez, Erik; Vander Sloten, Jos

    The purpose of this study was to investigate the influence of lateral muscle loading on the stress/strain distributions of the trochanteric Gamma nail (TGN) fixation within the healed, trochanteric and subtrochanteric femoral fractures by means of a finite element method. The effect of three muscle groups, the abductors (ABD), the vastus lateralis (VL) and the iliotibial band (ITB), were investigated. The analytical results showed that addition of lateral muscle forces, iliotibial band and vastus lateralis, produced compensation of forces and reduction of bending moments in the bone and in the trochanteric Gamma nail especially in the lateral aspect. The iliotibial band produced a higher impact as compared to the vastus lateralis. Therefore in the finite element analysis of the proximal femur with the trochanteric Gamma nail fracture fixation should include the lateral muscle forces to simulate load condition with maximal physiological relevance to the closed nailing technique.

  15. The choice of locking plate in the treatment of peri-implant femoral fracture eight years after trans-trochanteric rotational osteotomy: A case report.

    PubMed

    Utsunomiya, Takeshi; Yamamoto, Takuaki; Motomura, Goro; Karasuyama, Kazuyuki; Sonoda, Kazuhiko; Kubo, Yusuke; Hatanaka, Hiroyuki; Iwamoto, Yukihide

    2016-01-01

    Transtrochanteric anterior rotational osteotomy of the femoral head (TRO) was developed as a joint preserving surgery for osteonecrosis of the femoral head. To the best of our knowledge, peri-implant fractures after femoral osteotomy have rarely been reported. We report a 58-year-old female who suffered a peri-implant femoral shaft fracture following a fall from a stepladder eight years after TRO. Fracture union was achieved six months after a preferred proximal femoral locking plate. The entry point of the ante-grade femoral nail would have been very close to the new position of the nutrient artery of the femoral head occasioned by the TRO and to avoid injury, we chose proximal femoral locking plate. It is important to consider the new position of the nutrient artery of the femoral head in the surgical planning of peri-implant fracture after TRO. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  16. Radiation exposure to the surgeon during closed interlocking intramedullary nailing

    SciTech Connect

    Levin, P.E.; Schoen, R.W. Jr.; Browner, B.D.

    1987-06-01

    During interlocking intramedullary nailing of twenty-five femoral and five tibial fractures, the primary surgeon wore both a universal film badge on the collar of the lead apron and a thermoluminescent dosimeter ring on the dominant hand to quantify the radiation that he or she received. When distal interlocking was performed, the first ring was removed and a second ring was used so that a separate recording could be made for this portion of the procedure. At the conclusion of the study, all of the recorded doses of radiation were averaged. The average amount of radiation to the head and neck during the entire procedure was 7.0 millirems of deep exposure and 8.0 millirems of shallow exposure. The average dose of radiation to the dominant hand during insertion of the intramedullary nail and the proximal interlocking screw was 13.0 millirems, while the average amount during insertion of the distal interlocking nail was 12.0 millirems. Both of these averages are well within the government guidelines for allowable exposure to radiation during one-quarter (three months) of a year. Precautions that are to be observed during this procedure are recommended.

  17. Revisiting Pneumatic Nail Gun Trigger Recommendations.

    PubMed

    Albers, James; Lowe, Brian; Lipscomb, Hester; Hudock, Stephen; Dement, John; Evanoff, Bradley; Fullen, Mark; Gillen, Matt; Kaskutas, Vicki; Nolan, James; Patterson, Dennis; Platner, James; Pompeii, Lisa; Schoenfisch, Ashley

    2015-03-01

    Use of a pneumatic nail gun with a sequential actuation trigger (SAT) significantly diminishes the risk for acute traumatic injury compared to use of a contact actuation trigger (CAT) nail gun. A theoretically-based increased risk of work-related musculoskeletal disorders from use of a SAT nail gun, relative to CAT, appears unlikely and remains unproven. Based on current knowledge, the use of CAT nail guns cannot be justified as a safe alternative to SAT nail guns. This letter provides a perspective of ergonomists and occupational safety researchers recommending the use of the sequential actuation trigger for all nail gun tasks in the construction industry.

  18. Revisiting Pneumatic Nail Gun Trigger Recommendations

    PubMed Central

    Albers, James; Lipscomb, Hester; Hudock, Stephen; Dement, John; Evanoff, Bradley; Fullen, Mark; Gillen, Matt; Kaskutas, Vicki; Nolan, James; Patterson, Dennis; Platner, James; Pompeii, Lisa; Schoenfisch, Ashley

    2015-01-01

    Summary Use of a pneumatic nail gun with a sequential actuation trigger (SAT) significantly diminishes the risk for acute traumatic injury compared to use of a contact actuation trigger (CAT) nail gun. A theoretically-based increased risk of work-related musculoskeletal disorders from use of a SAT nail gun, relative to CAT, appears unlikely and remains unproven. Based on current knowledge, the use of CAT nail guns cannot be justified as a safe alternative to SAT nail guns. This letter provides a perspective of ergonomists and occupational safety researchers recommending the use of the sequential actuation trigger for all nail gun tasks in the construction industry. PMID:26366020

  19. The stability of a hip fracture determines the fatigue of an intramedullary nail.

    PubMed

    Eberle, S; Bauer, C; Gerber, C; von Oldenburg, G; Augat, P

    2010-01-01

    The purpose of this study was to address the question of how the stability of a proximal hip fracture determines the fatigue and failure mechanism of an intramedullary implant. To answer this question, mechanical experiments and finite element simulations with two different loading scenarios were conducted. The two load scenarios differed in the mechanical support of the fracture by an artificial bone sleeve, representing the femoral head and neck. The experiments confirmed that an intramedullary nail fails at a lower load in an unstable fracture situation in the proximal femur than in a stable fracture. The nails with an unstable support failed at a load 28 per cent lower than the nails with a stable support by the femoral neck. Hence, the mechanical support of a fracture is crucial to the fatigue failure of an implant. The simulation showed why the fatigue fracture of the nail starts at the aperture of the lag screw. It is the location of the highest von Mises stress, which is the failure criterion for ductile materials.

  20. Physics of nail conditions: why do ingrown nails always happen in the big toes?

    PubMed

    Rauch, Cyril; Cherkaoui-Rbati, Mohammed

    2014-10-16

    Although surgical treatment of nail conditions can be traced back centuries to the writings of Paul Aegineta (625-690 AC), little is known about the physical laws governing nail growth. Such a poor understanding together with the increasing number of nail salons in the high street should raise legitimate concerns regarding the different procedures applied to nails. An understanding of the physics of nail growth is therefore essential to engage with human medicine and to understand the aetiology of nail conditions. In this context, a theory of nail plate adhesion, including a physical description of nail growth can be used to determine the transverse and longitudinal curvatures of the nail plate that are so important in the physical diagnosis of some nail conditions. As a result physics sheds light on: (a) why/how nails/hooves adhere strongly, yet grow smoothly; (b) why hoof/claw/nail growth rates are similar across species; (c) potential nail damage incurred by poor trimming; (d) the connection between three previously unrelated nail conditions, i.e. spoon-shaped, pincer and ingrown nails and; last but not least, (e) why ingrown nails occur preferentially in the big toes.

  1. Sport related proximal femoral fractures: a retrospective review of 31 cases treated in an eight year period

    PubMed Central

    Habernek, H.; Schmid, L.; Frauenschuh, E.

    2000-01-01

    In an eight year period, 31 patients with proximal femoral fractures resulting from sports accidents were treated by implantation of either a Gamma nail or a dynamic hip screw. Return to work or sports and the time to bone healing did not differ very much between the treatments. Gamma nailing was clearly the best with regard to stability and time to full mobilisation (4.5 days), but required 39 minutes to perform compared with insertion of a dynamic hip screw (27 minutes). The incidence of complications and malalignments did not differ very much between the two, although, when Gamma nailing was first used in the authors' clinic, more intraoperative complications occurred than with the dynamic hip screw. Stable pertrochanteric fractures may be treated with a dynamic hip screw. Unstable pertrochanteric or subtrochanteric fractures are treated with a Gamma nail at the authors' institution. Key Words: femur; fracture; Gamma nail; dynamic hip screw; skiing; mountain biking PMID:10690452

  2. Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures.

    PubMed

    Parker, M J; Handoll, H H

    2002-01-01

    Cephalocondylic intramedullary nails which are inserted proximally to distally (cephalocondylic) have been used for the surgical treatment of extracapsular hip fractures. To compare all cephalocondylic intramedullary nails with extramedullary implants for the surgical treatment of extracapsular hip fractures in adults. This is the third substantive update of our original review which compared the Gamma nail with the sliding hip screw (SHS). We searched the Cochrane Musculoskeletal Injuries Group trials register, MEDLINE, select orthopaedic journals and conference proceedings, and reference lists of relevant articles. We contacted trialists, colleagues and implant manufacturers. Date of the most recent search: August 2002. All randomised and quasi-randomised trials comparing cephalocondylic nails with extramedullary implants for extracapsular hip fractures. Both reviewers independently assessed trial quality and extracted data. Additional information was sought from all trialists. Wherever appropriate and possible, results were pooled. Seventeen trials comparing the Gamma nail with the SHS were included, with data available for 2472 patients. The Gamma nail was associated with an increased risk of operative and later fracture of the femur and an increased re-operation rate. There were no major differences in the incidence of wound infection, mortality or medical complications between implants. Data were inadequate for other outcomes. Five trials involving 623 patients compared the intramedullary hip screw (IMHS) with the SHS. Fracture fixation complications were more common in the IMHS group: all cases of operative and later fracture of the femur occurred in this group. Results for post-operative complications, mortality and functional outcomes were similar in the two groups. One study of 206 patients with a trochanteric fracture showed no advantages for proximal femoral nail (PFN) compared with the SHS. One trial of 60 patients reported favourable preliminary

  3. Electromagnetic Navigation in Distal Locking of Long Diaphyseal Interlocking Intramedullary Nailing.

    PubMed

    Zhou, Zhentao; Zhou, Xiaozhong; Shan, Bingchen; Zhou, Haibin; Lu, Zhengfeng; Dong, Qirong

    2016-12-01

    To describe the applications and effects of electromagnetic navigation (EN) technology in distal locking for the treatment of long diaphyseal fracture (LDF) with interlocking intramedullary nailing (IIN). An interventional study. The Second Affiliated Hospital of Soochow University, China, from March 2013 to July 2014. Patients who underwent IIN-LDF were selected. Twenty-four (50%) of whom were operated under EN guidance (group A) and the other 24 (50%) under conventional targeting guidance (group B). The distal locking time and X-ray irradiation time of the two groups were compared. Each group included 16 (33.3%) cases of femoral fracture and 8 (16.7%) cases of tibial fracture. The success rate of distal locking in group A was higher than that in group B (95.8% vs. 83.3%, p=0.045). There were statistically significant differences in the distal locking time and X-ray irradiation time of femoral intramedullary nailing between the two groups (p=0.027 and p=0.001, respectively). There were no statistically significant differences in the distal locking time and X-ray irradiation time of tibial intramedullary nailing between the two groups (p=0.347 and p=0.056, respectively). EN-IN was advantageous as it enabled easy targeting, significantly reduced intraoperative fluoroscopy and operation time and small trauma and had other advantages when used for treating LDFs, especially femoral diaphyseal fractures.

  4. Nail psoriasis: a review of the literature*

    PubMed Central

    Schons, Karen Regina Rosso; Knob, Cristiane Faccin; Murussi, Nádia; Beber, André Avelino Costa; Neumaier, Walter; Monticielo, Odirlei André

    2014-01-01

    Nails are considered epidermal appendages, and as such, are commonly affected in patients with psoriasis, 80% of whom are likely to develop nail psoriasis as a result of their condition. Two patterns of nail disorders have been shown to be caused by psoriasis. Nail matrix involvement can result in features such as leukonychia, pitting (punctures or cupuliform depressions), red spots in the lunula and crumbling. Nail bed involvement, on the other hand, can cause onycholysis, salmon or oil-drop patches, subungual hyperkeratosis and splinter hemorrhages. Nail disease causes aesthetic and functional impairment, and is indicative of more severe forms of psoriasis as well as of joint involvement. The treatment for nail psoriasis involves behavioral interventions, topical medications, or systemic therapy in case of extensive skin or joint involvement. This article presents a review of the main features of nail psoriasis, its clinical presentation, diagnostic and assessment methods, clinical repercussions, and of its available treatment options. PMID:24770509

  5. Nail psoriasis: a review of the literature.

    PubMed

    Schons, Karen Regina Rosso; Knob, Cristiane Faccin; Murussi, Nádia; Beber, André Avelino Costa; Neumaier, Walter; Monticielo, Odirlei André

    2014-01-01

    Nails are considered epidermal appendages, and as such, are commonly affected in patients with psoriasis, 80% of whom are likely to develop nail psoriasis as a result of their condition. Two patterns of nail disorders have been shown to be caused by psoriasis. Nail matrix involvement can result in features such as leukonychia, pitting (punctures or cupuliform depressions), red spots in the lunula and crumbling. Nail bed involvement, on the other hand, can cause onycholysis, salmon or oil-drop patches, subungual hyperkeratosis and splinter hemorrhages. Nail disease causes aesthetic and functional impairment, and is indicative of more severe forms of psoriasis as well as of joint involvement. The treatment for nail psoriasis involves behavioral interventions, topical medications, or systemic therapy in case of extensive skin or joint involvement. This article presents a review of the main features of nail psoriasis, its clinical presentation, diagnostic and assessment methods, clinical repercussions, and of its available treatment options.

  6. Nail fragility syndrome and its treatment.

    PubMed

    Baran, R; Schoon, D

    2004-07-01

    For reasons of clarity, definitions are offered for strength, hardness, flexibility, brittleness and toughness of the nails. Six clinical types of nail fragility are delineated: longitudinal furrows and splitting (onychorrhexis), single longitudinal splitting, multiple crenellated splitting, lamellar splitting (onychoschizia), transverse splitting and nail friability. Changes may be observed in the keratin structure of fragile nails. Nail brittleness is usually 'environmental' in origin, but sometimes may be part of a nail dystrophy. Household daily chores are particularly damaging. Among the acquired general causes, hypochromic anaemia and sideropaenia, arthritic deformities of the distal joints, peripheral vascular impairment and endocrinopathies are the best known. Useful therapeutic approaches are updated. They entail protection with plastic gloves worn over light cotton glove linings, the use of nail hardeners composed of two main types of products: a modified nail varnish that functions as a base coat or a hardener, such as dimethyl urea, which overcomes the objections related to formaldehyde; a systemic drug, biotine, is still useful.

  7. Understanding the formidable nail barrier: A review of the nail microstructure, composition and diseases.

    PubMed

    Baswan, Sudhir; Kasting, Gerald B; Li, S Kevin; Wickett, Randy; Adams, Brian; Eurich, Sean; Schamper, Ryan

    2017-05-01

    The topical treatment of nail fungal infections has been a focal point of nail research in the past few decades as it offers a much safer and focused alternative to conventional oral therapy. Although the current focus remains on exploring the ways of enhancing permeation through the formidable nail barrier, the understanding of the nail microstructure and composition is far from complete. This article reviews our current understanding of the nail microstructure, composition and diseases. A few of the parameters affecting the nail permeability and potential causes of the recurrence of fungal nail infection are also discussed. © 2017 Blackwell Verlag GmbH.

  8. A new cemented femoral stem: a prospective study of the Stryker accolade C with 2- to 5-year follow-up.

    PubMed

    Ajmal, Muhammad; Ranawat, Amar S; Ranawat, Chitranjan S

    2008-01-01

    This prospective study evaluates the short-term results of a recently released cemented femoral stem design in primary cemented and hybrid total hip arthroplasty (THA). There were 100 all-cemented and 100 hybrid THAs in the 2-year study group. Good to excellent results were obtained in 96%. There was one reoperation for recurrent dislocation in each cohort (1%) and one single-staged reoperation for sepsis in the cemented cohort. There were 47 THA available for 5-year follow-up. Good to excellent results were maintained in 98%. One additional patient had a revision because of late recurrent dislocation. This study has demonstrated excellent early results and safety with this cemented femoral stem. The features include a dual-wedge geometry with a 0.88-microm Ra surface roughness, proximal macro-normalizations, distal anti-rotation grooves, and an optimized head-and-neck ratio approaching 4:1 using a standard 28-mm head.

  9. Intramedullary leg lengthening with a motorized nail

    PubMed Central

    2011-01-01

    Background and purpose In the last decade, intramedullary limb lengthening has become a viable alternative to traditional external systems. We retrospectively analyzed the use of an intramedullary motorized nail (Fitbone) in a consecutive series of 32 patients. Patients and methods During the period September 2006 to December 2008, 32 consecutive patients with a median age of 17 (IQR: 15–19) years were treated with a fully implantable, motorized intramedullary lengthening device (Fitbone). The median leg length discrepancy was 35 (IQR: 30–44) mm at the femur (n = 21) and 28 (IQR: 25–30) mm at the tibia (n = 11). Results Leg lengthening was successful in 30 of 32 cases, with no residual relevant discrepancy (± 5 mm). No intraoperative complications were observed. The consolidation index was significantly different (p = 0.04) between femoral lengthening (mean 35 days/cm) and tibial lengthening (mean 48 days/cm) but did not depend on age older/younger than 16 or previous operations at the affected site. 3 problems, 3 obstacles, and 4 complications (3 minor, 1 major) were encountered in 8 patients, 5 of which were implant-associated. Interpretation This technique even allows correction in patients with multiplanar deformities. Compared to external devices, intramedullary systems provide comfort and reduce complication rates, give improved cosmetic results, and lead to fast rehabilitation since percutaneous, transmuscular fixation is prevented. This results in reasonable overall treatment costs despite the relatively high costs of implants. PMID:21561309

  10. Slipped capital femoral epiphysis

    MedlinePlus

    ... page: //medlineplus.gov/ency/article/000972.htm Slipped capital femoral epiphysis To use the sharing features on this page, please enable JavaScript. A slipped capital femoral epiphysis is a separation of the ball ...

  11. Radiological characteristics of the knee joint in nail patella syndrome.

    PubMed

    Tigchelaar, S; Rooy, J de; Hannink, G; Koëter, S; van Kampen, A; Bongers, E

    2016-04-01

    Nail patella syndrome (NPS) is a skeletal dysplasia with patellofemoral dysfunction as a key symptom. We present the first in-depth radiological evaluation of the knee in a large series of NPS patients and describe the typical malformations. Conventional radiological examination of 95 skeletally mature patients with NPS was performed. Patellar morphology was classified according to the Wiberg classification as modified by Baumgartl and Ficat criteria, and trochlear shape was classified according to the Dejour classification. Patellar aplasia was present in 4/90 (4%), and patellar hypoplasia in 77/90 (86%) of patients. The prevailing patellar shapes were type III, type IV and Hunter's cap. No patellar shape genotype-phenotype association could be found. The malformations of the distal femur comprised shortening of the lateral femoral condyle in 46 out of 84 patients (55%), with a prominent anterior surface of the lateral femoral condyle in 47 out of 84 patients (56%) and a flat anterior surface of the medial femoral condyle in 78 out of 85 patients (92%). The trochlea was type A1 according to the Dejour classification in 79 out of 85 patients (93%). An easily recognisable characteristic quartet of malformations consisting of patellar aplasiaor hypoplasia and the malformations of the distal femur was found in 22 out of 81 patients (27%), with the majority displaying at least three malformations. The distinct malformations of the knee in nail patella syndrome are easily recognisable on conventional radiographs and lead to the correct interpretation of the aberrant morphology which is essential in the treatment of these patellofemoral disorders. ©2016 The British Editorial Society of Bone & Joint Surgery.

  12. Nail abnormalities in patients with vitiligo.

    PubMed

    Topal, Ilteris Oguz; Gungor, Sule; Kocaturk, Ozgur Emek; Duman, Hatice; Durmuscan, Mustafa

    2016-01-01

    Vitiligo is an acquired pigmentary skin disorder affecting 0.1-4% of the general population. The nails may be affected in patients with an autoimmune disease such as psoriasis, and in those with alopecia areata. It has been suggested that nail abnormalities should be apparent in vitiligo patients. We sought to document the frequency and clinical presentation of nail abnormalities in vitiligo patients compared to healthy volunteers. We also examined the correlations between nail abnormalities and various clinical parameters. This study included 100 vitiligo patients and 100 healthy subjects. Full medical histories were collected from the subjects, who underwent thorough general and nail examinations. All nail changes were noted. In the event of clinical suspicion of a fungal infection, additional mycological investigations were performed. Nail abnormalities were more prevalent in the patients (78%) than in the controls (55%) (p=0.001). Longitudinal ridging was the most common finding (42%), followed by (in descending order): leukonychia, an absent lunula, onycholysis, nail bed pallor, onychomycosis, splinter hemorrhage and nail plate thinning. The frequency of longitudinal ridging was significantly higher in patients than in controls (p<0.001). Nail abnormalities were more prevalent in vitiligo patients than in controls. Systematic examination of the nails in such patients is useful because nail abnormalities are frequent. However, the causes of such abnormalities require further study. Longitudinal ridging and leukonychia were the most common abnormalities observed in this study.

  13. Nail abnormalities in patients with vitiligo*

    PubMed Central

    Topal, Ilteris Oguz; Gungor, Sule; Kocaturk, Ozgur Emek; Duman, Hatice; Durmuscan, Mustafa

    2016-01-01

    Background Vitiligo is an acquired pigmentary skin disorder affecting 0.1-4% of the general population. The nails may be affected in patients with an autoimmune disease such as psoriasis, and in those with alopecia areata. It has been suggested that nail abnormalities should be apparent in vitiligo patients. Objective We sought to document the frequency and clinical presentation of nail abnormalities in vitiligo patients compared to healthy volunteers. We also examined the correlations between nail abnormalities and various clinical parameters. Methods This study included 100 vitiligo patients and 100 healthy subjects. Full medical histories were collected from the subjects, who underwent thorough general and nail examinations. All nail changes were noted. In the event of clinical suspicion of a fungal infection, additional mycological investigations were performed. Results Nail abnormalities were more prevalent in the patients (78%) than in the controls (55%) (p=0.001). Longitudinal ridging was the most common finding (42%), followed by (in descending order): leukonychia, an absent lunula, onycholysis, nail bed pallor, onychomycosis, splinter hemorrhage and nail plate thinning. The frequency of longitudinal ridging was significantly higher in patients than in controls (p<0.001). Conclusions Nail abnormalities were more prevalent in vitiligo patients than in controls. Systematic examination of the nails in such patients is useful because nail abnormalities are frequent. However, the causes of such abnormalities require further study. Longitudinal ridging and leukonychia were the most common abnormalities observed in this study. PMID:27579738

  14. Reducing intraoperative duration and ionising radiation exposure during the insertion of distal locking screws of intramedullary nails: a small-scale study comparing the current fluoroscopic method against radiation-free, electromagnetic navigation.

    PubMed

    Grimwood, Darren; Harvey-Lloyd, Jane

    2016-12-01

    Intramedullary nailing is the standard surgical treatment for mid-diaphyseal fractures of long bones; however, it is also a high radiation dose procedure. Distal locking is regularly cited as a demanding element of the procedure, and there remains a reliance on X-ray fluoroscopy to locate the distal holes. A recently developed electromagnetic navigation (EMN) system allows radiation-free distal locking, with a virtual on-screen image. To compare operative duration, fluoroscopy time and radiation dose when using EMN over fluoroscopy, for the distal locking of intramedullary nails. Consecutive patients with mid-diaphyseal fractures of the tibia and femur, treatable with intramedullary nails, were prospectively enrolled during a 9-month period. The sample consisted of 29 individuals, 19 under fluoroscopic guidance and 10 utilising EMN. Participants were allocated depending on the type of intramedullary nail used and surgeon's preference. These were further divided into tibial and femoral subcategories, relative to the fracture site. EMN reduced fluoroscopy time by 49 (p = 0.038) and 28 s during tibial and femoral nailings, respectively. Radiation dose was reduced by 18 cGy/cm(2) (p = 0.046) during tibial and 181 cGy/cm(2) during femoral nailings when utilising EMN. Operative duration was 11 min slower during tibial nailings using EMN, but 38 min faster in respect of femoral nailings. This study has evidenced statistically significant reductions in both fluoroscopy time and radiation dose when using EMN for the distal locking of intramedullary nails. It is expected that overall operative duration would also decrease in line with similar studies, with increased usage and a larger sample.

  15. Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures.

    PubMed

    Parker, M J; Handoll, H H

    2002-01-01

    . Results for post-operative complications, mortality and functional outcomes were similar in the two groups. Two under-reported trials tested the proximal femoral nail (PFN). The results of one study of 206 patients with a trochanteric fracture showed no advantages for the PFN compared with the SHS. The other study, involving 39 patients, comparing the PFN with the dynamic condylar plate for treating more distal and uncommon trochanteric fractures gave better intra-operative and fracture fixation results for the PFN. One trial of 60 patients reported favourable preliminary results for an experimental mini-invasive static intramedullary nail compared with the SHS. Further evidence is required before any conclusions can be drawn on the relative merits of either the Kuntscher-Y nail or the mini-invasive static intramedullary nail in comparison with the SHS. Given the lower complication rate of the SHS in comparison with intramedullary nails, it appears that for trochanteric fractures the SHS is superior. Further studies will be required to determine if different types of intramedullary nail produce the same results, or if intramedullary nails have advantages for selected fracture types, for example, reversed fracture lines and subtrochanteric fractures. From the evidence available, IMHS appears to have the same problems as the Gamma nail, but other theoretical advantages of the IHMS cannot be ruled out.

  16. Femoral shaft medialisation and neck-shaft angle in unstable pertrochanteric femoral fractures.

    PubMed

    Pajarinen, J; Lindahl, J; Savolainen, V; Michelsson, O; Hirvensalo, E

    2004-12-01

    We analysed the time-dependent mean changes in the femoral neck length, neck-shaft angle and hip offset in a randomised study comprising 48 patients who were treated with the dynamic hip screw (DHS) or the proximal femoral nail (PFN) for an unstable intertrochanteric femoral fracture. As a consequence of fracture compression, the mean post-operative neck length was significantly shorter in patients treated with the DHS. During the first 6 weeks after the operation, a mean decrease of 4.6 degrees was observed in the neck-shaft angle, but there was not a significant difference between the treatment groups. The radiographic measures remained virtually unaffected during the interval from 6 weeks to 4 months in both groups. When the operated hip was compared to the opposite hip, patients who had received the DHS showed significantly greater medialisation of the femoral shaft at 4 months than those treated with the PFN. We thus recommend that unstable intertrochanteric fractures should be initially reduced in a slight valgus position in order to achieve an outcome after healing that is as normal as possible. As a result of differences in operative technique and implant stability, the PFN may be superior to the DHS in retaining the anatomical relations in the hip region in unstable intertrochanteric fractures.

  17. How to submit a nail specimen.

    PubMed

    Reinig, Erica; Rich, Phoebe; Thompson, Curtis T

    2015-04-01

    The scarcity of specific submission protocols for nail unit biopsies presents many challenges for appropriate specimen processing. Many nail biopsies are received fragmented or without orientation, often resulting in less-than-ideal tissue embedding and poor histologic sections, which are difficult to interpret. Methods are described for proper nail matrix/bed biopsy and plate submission that incorporate aspects of previous submission protocols and include inking the biopsy specimen along with submitting the tissue on a drawing of the nail. Also described is a technique for maintaining adherence of nail plate to glass slides, a chronic challenge in the laboratory.

  18. Consensus on melanonychia nail plate dermoscopy*

    PubMed Central

    Chiacchio, Nilton Di; de Farias, Débora Cadore; Piraccini, Bianca Maria; Hirata, Sergio Henrique; Richert, Bertrand; Zaiac, Martin; Daniel, Ralph; Fanti, Pier Alessandro; Andre, Josette; Ruben, Beth S; Fleckman, Philip; Rich, Phoebe; Haneke, Eckart; Chang, Patricia; Cherit, Judith Dominguez; Scher, Richard; Tosti, Antonella

    2013-01-01

    This statement, focused on melanonychia and nail plate dermoscopy, is intended to guide medical professionals working with melanonychia and to assist choosing appropriate management for melanonychia patients. The International Study Group on Melanonychia was founded in 2007 and currently has 30 members, including nail experts and dermatopathologists with special expertise in nails. The need for common definitions of nail plate dermoscopy was addressed during the Second Meeting of this Group held in February 2008. Prior to this meeting and to date (2010) there have been no evidence-based guidelines on the use of dermoscopy in the management of nail pigmentation. PMID:23739699

  19. [Distal femoral periprosthetic fractures: classification and therapy].

    PubMed

    Tomás, T; Nachtnebl, L; Otiepka, P

    2010-06-01

    Periprosthetic fracture is one of the most serious complication of total knee arthroplasty. In our retrospective clinical study we designed our classification with rules for treatment of those fractures. During the last thirty years we treated 53 distal femoral periprosthetic fractures in our orthopaedic department. In our clinical study we reviewed our group of distal femoral periprosthetic fractures with on the basis of X-ray findings, the treatment method used and treatment outcomes. According to our findings we divided distal femoral periprosthetic fractures into six groups: Type I Nondisplaced fractures, 5.7%; treatment failure rate, 33%. Type II a Fractures with lateral comminution (the most often type of fractures), 37.7%; treatment failure rate, 20%. Type II b Fractures with medial comminution, 7.5%; treatment failure rate, 60%. Type II c Fractures above TKA (the second most often type), 34%; treatment failure rate, 18%. Type II d Comminuted fractures, 5.7%; treatment failure rate, 18%. Type IIIFractures with loosening of TKA, 9.4%; treatment failure rate, 20%. For the treatment of fractures we used various methods according to the type of fracture: Plate osteosynthesis in 32 cases, with failure in seven. Three failures in IIa group due to incorrect osteosynthesis with condylar plate, treated by reosteosteosynthesis with same implant. One in IIb group treated primarily with cement plomb, after second failure treated with revision total knee arthroplasty. Two failures in IIc group, treated by reosteosynthesis with spongioplasty using the same implant. One failure in III group solved with revision TKA. Intramedullary nail in nine cases , with failure in two. One failure in IIb group treated by reosteosynthesis with condylar plate and cement plombage. One in IIc group due to infection, solved with extraction of material and second stage revision TKA. Conservative treatment in three cases,with failure in two. One in I group treated with condylar plate. One in

  20. Closed Intramedullary Derotational Osteotomy and Hip Arthroscopy for Cam Femoroacetabular Impingement From Femoral Retroversion

    PubMed Central

    Matsuda, Dean K.; Gupta, Nikhil; Martin, Hal D.

    2014-01-01

    Femoral retroversion is an uncommon cause of cam femoroacetabular impingement that may require surgical treatment beyond arthroscopic or open femoroplasty. We present the case of a young adult with bilateral severe femoral retroversion in whom such treatment failed. We discuss the rationale, surgical technique, and outcome of this patient, who underwent bilateral closed intramedullary derotational proximal femoral osteotomies and interlocked nailing with adjunctive pre- and post-osteotomy hip arthroscopies. Clinical improvement with normal foot progression angles, radiographic union, and resolution of bilateral cam femoroacetabular impingement from femoral retroversion was achieved. This surgery permits rapid institution of weight-bearing ambulation and an early rehabilitative program. Femoral retroversion may be an underappreciated and insufficiently treated cause of cam femoroacetabular impingement that may be readily detected and successfully remedied with this less invasive procedure. PMID:24749047

  1. Expandable self-locking nail in the management of closed diaphyseal fractures of femur and tibia.

    PubMed

    Kapoor, Sudhir K; Kataria, Himanshu; Boruah, Tankeswar; Patra, Satya R; Chaudhry, Aashish; Kapoor, Saurabh

    2009-07-01

    Intramedullary fixation is the treatment of choice for closed diaphyseal fractures of femur and tibia. The axial and rotational stability of conventional interlocking nails depends primarily on locking screws. This method uses increased operating time and increased radiation exposure. An intramedullary implant that can minimize these disadvantages is obviously better. Expandable intramedullary nail does not rely on interlocking screws and achieves axial and rotational stability on hydraulic expansion of the nail. We analyzed 32 simple fractures of shaft of femur and tibia treated by self-locking expandable nail. Intramedullary fixation was done by using self-locking, expandable nail in 32 patients of closed diaphyseal fractures of tibia (n = 10) and femur (n = 22). The various modes of injury were road traffic accidents (n = 21), fall from height (n = 8), simple fall (n = 2), and pathological fracture (n = 1). Among femoral diaphyseal fractures 16 were males and six females, average age being 33 yrs (range, 18- 62 yrs). Seventeen patients had AO type A (A1 (n = 3), A2 (n = 4), A3 (n = 10)) and 5 patients had AO type B (B1 (n = 2), B2 (n = 2), B3 (n = 1)) fractures. Eight patients having tibial diaphyseal fractures were males and two were females; average age was 29.2 (range, 18- 55 yrs). Seven were AO type A (A1 (n = 2), A2 (n = 3), A3 (n = 2)) and three were AO type B (B1 (n = 1), B2 (n = 1), and B3 (n = 1)). We performed closed (n = 27) or open reduction (n = 5) and internal fixation with expandable nail to stabilize these fractures. The total radiation exposure during surgery was less as no locking screws were required. Early mobilisation and weight-bearing was started depending on fracture personality and evidences of healing. Absence of localised tenderness and pain on walking was considered clinical criteria for union, radiographic criteria of union being continuity in at least in three cortices in both AP and lateral views. Patients were followed for at

  2. Expandable self-locking nail in the management of closed diaphyseal fractures of femur and tibia

    PubMed Central

    Kapoor, Sudhir K; Kataria, Himanshu; Boruah, Tankeswar; Patra, Satya R; Chaudhry, Aashish; Kapoor, Saurabh

    2009-01-01

    Background: Intramedullary fixation is the treatment of choice for closed diaphyseal fractures of femur and tibia. The axial and rotational stability of conventional interlocking nails depends primarily on locking screws. This method uses increased operating time and increased radiation exposure. An intramedullary implant that can minimize these disadvantages is obviously better. Expandable intramedullary nail does not rely on interlocking screws and achieves axial and rotational stability on hydraulic expansion of the nail. We analyzed 32 simple fractures of shaft of femur and tibia treated by self-locking expandable nail. Materials and Methods: Intramedullary fixation was done by using self-locking, expandable nail in 32 patients of closed diaphyseal fractures of tibia (n = 10) and femur (n = 22). The various modes of injury were road traffic accidents (n = 21), fall from height (n = 8), simple fall (n = 2), and pathological fracture (n = 1). Among femoral diaphyseal fractures 16 were males and six females, average age being 33 yrs (range, 18- 62 yrs). Seventeen patients had AO type A (A1 (n = 3), A2 (n = 4), A3 (n = 10)) and 5 patients had AO type B (B1 (n = 2), B2 (n = 2), B3 (n = 1)) fractures. Eight patients having tibial diaphyseal fractures were males and two were females; average age was 29.2 (range, 18- 55 yrs). Seven were AO type A (A1 (n = 2), A2 (n = 3), A3 (n = 2)) and three were AO type B (B1 (n = 1), B2 (n = 1), and B3 (n = 1)). We performed closed (n = 27) or open reduction (n = 5) and internal fixation with expandable nail to stabilize these fractures. The total radiation exposure during surgery was less as no locking screws were required. Early mobilisation and weight-bearing was started depending on fracture personality and evidences of healing. Absence of localised tenderness and pain on walking was considered clinical criteria for union, radiographic criteria of union being continuity in at least in three cortices in both AP and lateral views

  3. Nail Psoriasis: The Journey So Far

    PubMed Central

    Dogra, Alka; Arora, Amanjot Kaur

    2014-01-01

    Nail involvement is an extremely common feature of psoriasis and affects approximately 10-78% of psoriasis patients with 5-10% of patients having isolated nail psoriasis. However, it is often an overlooked feature in the management of nail psoriasis, despite the significant burden it places on the patients as a result of functional impairment of manual dexterity, pain, and psychological stress. Affected nail plates often thicken and crumble, and because they are very visible, patients tend to avoid normal day-to-day activities and social interactions. Importantly, 70-80% of patients with psoriatic arthritis have nail psoriasis. In this overview, we review the clinical manifestations of psoriasis affecting the nails, the common differential diagnosis of nail psoriasis, Nail Psoriasis Severity Index and the various diagnostic aids for diagnosing nail psoriasis especially, the cases with isolated nail involvement. We have also discussed the available treatment options, including the topical, physical, systemic, and biological modalities, in great detail in order to equip the present day dermatologist in dealing with a big clinical challenge, that is, management of nail psoriasis. PMID:25071247

  4. Iontophoretic drug delivery across the nail.

    PubMed

    Delgado-Charro, Maria Begoña

    2012-01-01

    Topical drug delivery to treat nail diseases such as onychomycosis and psoriasis is receiving increasing attention. Topical nail delivery is challenged by the complicated structure of the nail and the low permeability of most drugs across the nail plate. Considerable effort has been directed at developing methods to promote drug permeation across the nail plate. Iontophoresis efficiently enhances molecular transport across the skin and the eye and is now being tested for its potential in ungual delivery. This review covers the basic mechanisms of transport (electro-osmosis and -migration) and their relative contribution to nail iontophoresis as well as the key factors governing nail permselectivity and ionic transport numbers. Methodological issues concerning research in this area are summarized. The data available in vivo on nail iontophoresis of terbinafine specifically are reviewed in separate sections. Our understanding of nail iontophoresis has improved considerably since 2007; most decisively, the feasibility of nail iontophoresis in vivo has been clearly demonstrated. Future work is required to establish the adequate implementation of the technique so that its clinical efficacy to treat onychomycosis and nail psoriasis can be unequivocally determined.

  5. [The use of nails to diagnosis diseases].

    PubMed

    Baran, Robert

    2014-11-01

    For those interested in nails, a fairly good knowledge of the anatomy of the nail unit is indispensable. But nothing will replace a careful, clinical examination of the nail apparatus. The shape of the nail, surface abnormalities and coloration, with or without a magnifying glass, may well provide a medical diagnosis not only in dermatology but also for medicine in general. Pits on the surface of the nail plate may be enough to diagnose psoriasis on a limited area of scalp dandruff. Even partial detachment of the nail apparatus might lead to the suspicion of psoriatic arthritis. A triangular lunula is associated with the absence of patellas. Finally, no pulmonary examination of a smoker is complete without looking for clubbing. It is high time to pay tribute to the nail.

  6. Ilizarov distraction osteogenesis over the preexisting nail for treatment of nonunited femurs with significant shortening.

    PubMed

    Azzam, Wael; El-Sayed, Mohamed

    2016-04-01

    Nonunion of the femur with significant shortening with retained intramedullary nail (IMN) is a challenging orthopedic problem. We investigated whether the application of Ilizarov distraction osteogenesis over the preexisting nail can simultaneously achieve union and correct shortening. Thirteen patients with femoral diaphyseal nonunion associated with significant shortening with retained IMN were retrospectively reviewed. All patients were treated by distraction osteogenesis using a circular external fixator over the preexisting nail. The fixator was used to compress or distract the nonunion site and to gradually distract a separate osteotomy to restore limb length. The osteotomy was done percutaneously using the Gigli saw with the nail in situ. The applied surgical technique was bifocal compression distraction in 11 cases, bifocal distraction in one case, and monofocal distraction in one case. Bone healing was achieved in 11 cases (84.6 %) at both the nonunion and the lengthening sites. The mean length gained was 4 cm (range, 3-6 cm). The mean time to fracture union was 4.9 months (range, 4-6 months). The mean knee flexion improved from 86.5° (range, 40°-135°) preoperatively to 109.6° (range, 60°-125°) at final follow-up (p < 0.05). The mean limb-length discrepancy improved from 4.7 cm (range, 3-7.5) preoperatively to 0.7 cm (range, 0-3) at final follow-up (p < 0.001). Ten out of 13 patients had a total of 14 complications, with a mean of 1.1 complications per patient. Distraction osteogenesis over the preexisting nail can be a good alternative to treat difficult femoral diaphyseal nonunions associated with significant shortening.

  7. Outcome of Titanium Elastic Intramedullary Nail in the Treatment of Shaft of Femur Fracture in Children.

    PubMed

    Khan, J A; Singh, G P; Pandey, A

    2015-01-01

    Background Femoral-shaft fractures are among the most common fractures of the lower extremity in children. There are several different options for treating femoral-shaft fractures in children. Elastic stable intramedullary nailing (ESIN) has become the standard treatment for fractures of shaft of femur in children for reasons including mini-invasive surgery, no need for casting, early mobilization and discharge as well as growing concerns toward cost-effectiveness. Objective To demonstrate the effectiveness of intramedullary fixation of fracture shaft of femur in skeletally immature children using the titanium elastic intramedullary nails. Method Forty children who underwent fixation with titanium intramedullary nails because of fracture of shaft of femur (Winquist and Hansen type 1 and 2) were reviewed. There were 60% male and 40% female patients and mean follow-up was six months. Time of union, deformity at fracture site, limb length discrepancy, knee range of motion and complications were assessed. Result Average age of the patients was 5.17 years (range 3 to 10). All patients achieved complete healing at a mean 12.8 weeks (range 10 to 20 weeks). Average limb length discrepancy was -0.16 cm (range -1.0 to 1.1 cm) average knee range of motion was 137.55 degrees (range 118 to 152 degrees). Complications were recorded in 13 (31.7%) patients and included: Five malunion which did not show any deformity or functional impairment and eight superficial wound infections which were healed after removal of nail. All patients were active as their pre injury levels at six months follow up. Conclusion Elastic stable intramedullary nailing is the method of choice for the simple pediatrics fracture shaft of femur, as it is minimally invasive and shows good functional and cosmetic results. It allows short hospital stay and quick recovery from pain and is cast-free.

  8. Comparative anatomy of mouse and human nail units.

    PubMed

    Fleckman, Philip; Jaeger, Karin; Silva, Kathleen A; Sundberg, John P

    2013-03-01

    Recent studies of mice with hair defects have resulted in major contributions to the understanding of hair disorders. To use mouse models as a tool to study nail diseases, a basic understanding of the similarities and differences between the human and mouse nail unit is required. In this study we compare the human and mouse nail unit at the macroscopic and microscopic level and use immunohistochemistry to determine the keratin expression patterns in the mouse nail unit. Both species have a proximal nail fold, cuticle, nail matrix, nail bed, nail plate, and hyponychium. Distinguishing features are the shape of the nail and the presence of an extended hyponychium in the mouse. Expression patterns of most keratins are similar. These findings indicate that the mouse nail unit shares major characteristics with the human nail unit and overall represents a very similar structure, useful for the investigation of nail diseases and nail biology.

  9. A modified intramedullary nail interlocking design yields improved stability for fatigue cycling in a canine femur fracture model.

    PubMed

    Garlock, Adam N; Donovan, Jim; LeCronier, David J; Houghtaling, John; Burton, Stephen; Atkinson, Patrick J

    2012-06-01

    Intramedullary nailing has evolved to become the standard of care for most diaphyseal femoral and tibial fractures, as well as an expanding number of metaphyseal fractures. Owing to the unstable nature of some fractures, the intramedullary device may be subjected to significant stresses owing to a lack of solid cortical contact after nailing. In such cases, excessive interfragmentary motion (due to construct toggle) has been shown to occur. Such motion increases the likelihood of a non- or delayed-union. In the current study, two versions of a modified, angle stable interlocking design were subjected to fatigue testing in a segmental defect fracture model representing a canine femur. As a control, a third group of constructs were stabilized with a traditional nail that allowed a small amount of toggle. All constructs were subjected to 50,000 fatigue cycles representing 12 weeks of cage activity at physiologic levels of combined axial-torsional loading. Torsional testing pre- and post-fatigue revealed 4.6 +/- 1.3 degrees of toggle in the traditional nail and no toggle with the angle stable nail designs. The stable nails were also significantly stiffer in axial compression and torsion before and after cycling. These data indicate that the enhanced stability of the modified interlocking designs can be maintained throughout fatigue cycling in a challenging fracture model.

  10. Femoral bowing plane adaptation to femoral anteversion

    PubMed Central

    Akman, Alp; Demirkan, Fahir; Sabir, Nuran; Oto, Murat; Yorukoglu, Cagdas; Kiter, Esat

    2017-01-01

    Background: Femoral bowing plane (FBP) is the unattended subject in the literature. More over the femoral shaft with its bowing is neglected in established anteversion determination methods. There is limited information about the relationship between FBP and anteversion. Thus we focused on this subject and hypothesized that there could be an adaptation of FBP to anteversion. Materials and Methods: FBP is determined on three-dimensional solid models derived from the left femoral computerized tomography data of 47 patients which were taken before for another reason and comparatively evaluated with anteversion. There were 20 women and 27 men. The mean age of patients was 56 years (range 21–84 years). Results: The anteversion values were found as the angle between a distal condylar axis (DCA) and femoral neck anteversion axis (FNAA) along an imaginary longitudinal femoral axis (LFA) in the true cranio-caudal view. The FBP was determined as a plane that passes through the centre-points of three pre-determinated sections on the femoral shaft. The angles between DCA, FNAA and FBP were comparatively evaluated. The independent samples t-test was used for statistical analysis. At the end, it was found that FBP lies nearly perpendicular to the anteversion axis for the mean of our sample which is around 89° in females and 93° in males (range 78–102°). On the other hand, FBP does not lie close to the sagittal femoral plane (SFP); instead, there is an average 12.5° external rotation relative to the SFP. FBP is correlated well with anteversion in terms of FBP inclination from SFP and femoral torsion (i.e., angle between FBP and femoral neck anteversion axis (P < 0.001; r = 0.680 and r = −0.682, respectively). Combined correlation is perfect (R2 = 1) as the FBP, SFP, and posterior femoral plane forms a triangle in the cranio-caudal view. Conclusions: We found that FBP adapts to anteversion. As FBP lies close to perpendicularity for the mean, femoral component positioning

  11. Drug reactions affecting the nail unit: diagnosis and management.

    PubMed

    Piraccini, Bianca Maria; Iorizzo, Matilde

    2007-04-01

    Several drugs may be responsible for the development of nail abnormalities, but only a few classes are consistently associated with nail symptoms. Drug-induced nail abnormalities result from toxicity to the matrix, the nail bed, the periungual tissues, or the digit blood vessels. Pharmacologic agents that most frequently produce nail abnormalities include retinoids, indinavir, and cancer chemotherapeutic agents.

  12. Immunohistochemical study of specialized nail mesenchyme containing onychofibroblasts in transverse sections of the nail unit.

    PubMed

    Lee, Dong-Youn; Yang, Jun-Mo; Mun, Goo-Hyun; Jang, Kee-Taek; Cho, Kwang-Hyun

    2011-05-01

    In the frozen longitudinal section of the nail unit, CD10 was previously found in nail mesenchymal cells beneath nail matrix, and we proposed calling the nail mesenchymal cells onychofibroblasts. In this study, to further characterize nail mesenchyme containing onychofibroblasts, we examined the expression of several mesenchymal markers immunohistochemically in transverse paraffin sections of the nail unit. CD10 was strongly expressed in the nail mesenchyme containing onychofibroblasts beneath the nail matrix. However, CD10 was not observed in dermal fibroblasts and surrounding extracellular matrix of the lateral nail fold (LNF), except around blood vessels and eccrine structures. In addition, versican was expressed diffusely in the nail mesenchyme containing onychofibroblasts in contrast to the dermis of LNF. Fibrillin, which is a major component of elastic fiber in the dermis, was expressed very weakly on the nail mesenchyme below the nail matrix but was expressed strongly in the dermis of LNF. These findings support the existence of specialized nail mesenchyme containing onychofibroblasts that is distinguished from the dermis of LNF.

  13. Femoral impaction grafting

    PubMed Central

    Scanelli, John A; Brown, Thomas E

    2013-01-01

    Femoral impaction grafting is a reconstruction option applicable to both simple and complex femoral component revisions. It is one of the preferred techniques for reconstructing large femoral defects when the isthmus is non-supportive. The available level of evidence is primarily derived from case series, which shows a mean survivorship of 90.5%, with revision or re-operation as the end-point, with an average follow-up of 11 years. The rate of femoral fracture requiring re-operation or revision of the component varies between several large case series, ranging from 2.5% to 9%, with an average of 5.4%. PMID:23362469

  14. Itraconazole penetrates the nail via the nail matrix and the nail bed--an investigation in onychomycosis.

    PubMed

    Matthieu, L; De Doncker, P; Cauwenbergh, G; Woestenborghs, R; van de Velde, V; Janssen, P A; Dockx, P

    1991-09-01

    Nail-matrix kinetics were studied in 21 patients (19 with onychomycosis, two with tinea corporis) as soon as taking itraconazole (Sporanox) 100 mg daily for up to 7 months. Itraconazole was detected in the distal nail as soon as 1 month after the start of therapy (42 ng/g in fingernails and 16 ng/g in toenails). During the course of treatment, this concentration rose and reached a mean of 160 ng/g in fingernail clippings and 197 ng/g in toenail clippings. Moreover, in fingernails of 12 out of 21 patients and in toenails of six out of 20 patients, itraconazole was detected in the distal nail clippings before full outgrowth of the fastest-growing nail. In most patients, itraconazole was detected in the distal nail clippings earlier than would be expected if the drug were incorporated only via the nail matrix, indicating that in addition to the nail matrix, a second route of penetration into the nail exists, i.e. the nail bed.

  15. Radiation-free Insertion of Distal Interlocking Screw in Tibial and Femur Nailing: A Simple Technique

    PubMed Central

    Soni, Ritesh Kumar; Mehta, Surender Mohan; Awasthi, Bhanu; Singh, Janith Lal; Kumar, Amit; Thakur, Lokesh; Tripathy, Sujit Kumar

    2012-01-01

    Background: Distal interlocking screw insertion in intramedullary nailing of long-bone fracture is a challenging task for orthopedic surgeons. It is difficult particularly when the surgeon is in his learning stage or when image intensifier is not available. We describe a radiation-free technique of distal interlocking screw insertion which is easy and practicable. Materials and Methods: In this technique, a same length nail is placed over the skin (outer nail) and through its distal-most screw hole, a 3.2 mm drill bit is inserted to drill the distal locking screw hole of the intramedullary nail (inner nail). With a small skin incision over the distal screw holes, the distal-most screw hole is identified; the bone window overlying the screw hole is widened with an awl and a locking bolt is inserted with a washer under direct visualization. The other distal interlocking screw is simply drilled by matching the other three holes of the outer and inner nails. We have operated 86 patients (39 femoral shaft fracture and 47 tibial shaft fracture) in 1 year where this technique was used. There were 41 open fracture and 45 closed fracture. Results: Within 6 months of follow-up, bony union was achieved in 36 of 39 femur fractures and 45 of 47 tibial fractures. No unwanted complications were observed during the postoperative period and in follow-up. Conclusion: This method of radiation-free distal interlocking screw insertion is simple and can be used in third world country where image intensifier facility is not available. However, surgeons are encouraged to use image intensifier facility where the facility is available. PMID:23066456

  16. Nail-gun injury of the cervical spine: simple technique for removal of a barbed nail.

    PubMed

    Nathoo, Narendra; Sarkar, Atom; Varma, Gandhi; Mendel, Ehud

    2011-07-01

    Although nail-gun injuries are a common form of penetrating low-velocity injury, impalement with barbed nails has been underreported to date. Barbed nails are designed to resist dislodgment once embedded, and any attempt at removal may splay open the barbs along the path of entry, with the potential for significant soft-tissue and neurovascular injury. A 25-year-old man sustained a nail impalement of the cervical spine from accidental discharge of a nail gun. The patient was noted to be fully conscious with no neurological deficits. Cervical Zone 2 impalement was noted, with only the head of the nail visible. Angiography revealed the nail lying just anterior to the right vertebral artery (VA), with compression of the vessel. Preoperatively, analysis of a similar nail revealed that orientation of the head determined position of the barbs. A deep neck dissection was then performed to the lateral aspect of the C-3 body, using the nail as a guide. Prior to removal, the nail was turned 180° to change the position of the barbs, to prevent injury to the VA. Nail removal was uneventful. The authors present a simple technique for treatment of a nail-gun injury with a barbed nail. Prior to removal, radiographic analysis of the impaled nail must be performed to determine the presence of barbs. If possible, the surgeon should request a similar nail for analysis prior to surgery. Last, the treating surgeon must have knowledge of the barbs' position at all times during nail removal, to prevent damage to critical structures.

  17. Genetics Home Reference: nonsyndromic congenital nail disorder 10

    MedlinePlus

    ... congenital nail disorder 10 nonsyndromic congenital nail disorder 10 Enable Javascript to view the expand/collapse boxes. ... All Close All Description Nonsyndromic congenital nail disorder 10 is a condition that affects the fingernails and ...

  18. [Black nails caused by Proteus mirabilis].

    PubMed

    Qadripur, S A; Schauder, S; Schwartz, P

    2001-07-01

    Black nails caused by Proteus mirabilis were seen in a motor mechanic and in a petrol pump attendant. Proteus mirabilis is a gram-negative bacillus that generates hydrogen sulfide. This compound reacts with traces of metals in the nail plate such as zinc, nickel, cobalt, iron, manganese, tin, copper and lead. Metal sulfides blacken the nail plate. The protracted course of the discoloration over months corresponds to the slow reactions of metals with hydrogen sulfide. The disappearance of the blackening after topical treatment with chinosol, tincture of iodine and chloramphenicol solution supports the etiologic connection between black nails and Proteus mirabilis. Wet and dirty work encourages the colonisation of Proteus mirabilis between nail fold and nail plate.

  19. Yellow nails, lymphedema and chronic cough: Yellow nail syndrome in an eight-year-old girl

    PubMed Central

    Siddiq, Ishita; Hughes, Daniel

    2012-01-01

    Yellow nail syndrome is a rare disease and reported mainly in adults. A case of yellow nail syndrome involving an eight-year-old girl with associated discoloured yellowish nails on the fingers and toes, lymphedema and chronic cough, and sputum production is reported. PMID:22332131

  20. Congenital onychoheterotopia involving multiple toe nails.

    PubMed

    Yadav, Savita; Khullar, Geeti; Dogra, Sunil

    2013-01-01

    Onychoheterotopia is an uncommon condition in which nail tissue is found beyond the common nail unit of the digits of the hands and feet, most often on the fifth digit of the hand. It represents an extra and independent nail that can be present either congenitally, or more commonly, acquired following trauma. The exact pathogenesis of the congenital type is undetermined. We report a 25-year-old male with multiple congenital ectopic nails of the toes since birth, which has not been reported before.

  1. Investigation of Human Nail Microstructure with Ultrasound

    NASA Astrophysics Data System (ADS)

    Maeva, A. R.; Bakulin, E. Y.; Denisova, L. A.; Maev, R. Gr.

    Investigation of a human fingernail and the extraction of the data on its microstructure and elastic properties is important in three main aspects. First of all, various diseases of the nail can be differentiated more precisely; second of all, it is possible to non-invasively track during time the effects of a cosmetic product upon the nail; third of all, because various processes in the organism have a strong influence upon the nail plate growth, the monitoring of the nail morphology and its mechanical properties may be used as additional information for the diagnosis of a number of medical disorders, such as systemic sclerosis, psoriasis, chronic hand eczema, anemia etc. The aim of the present study was to carry out a detailed ultrasound investigation in the high-frequency range (25-50 MHz) of a human nail including micro-anatomical structure imaging and ultrasound velocity evaluation, using B-scans obtained with a scanning acoustic microscope. On the images, exact topology of the nail, nail matrix and the underlying bone have been revealed. Additionally, a certain type of inclined internal layering along the nails of some individuals has been found, which was not reported in previous ultrasonic studies of the nail.

  2. Functional analysis and treatment of nail biting.

    PubMed

    Dufrene, Brad A; Steuart Watson, T; Kazmerski, Jennifer S

    2008-11-01

    This study applied functional analysis methodology to nail biting exhibited by a 24-year-old female graduate student. Results from the brief functional analysis indicated variability in nail biting across assessment conditions. Functional analysis data were then used to guide treatment development and implementation. Treatment included a simplified habit reversal package that was modified based on results of the functional analysis. Following treatment implementation, nail biting decreased as evidenced by consistent nail growth and participant self-recorded data. Results are discussed in terms of treatment utility of functional analysis methodology for novel populations and response topographies.

  3. Yellow nail syndrome: a review.

    PubMed

    Vignes, Stéphane; Baran, Robert

    2017-02-27

    Yellow nail syndrome (YNS; OMIM 153300, ORPHA662) is a very rare disorder that almost always occurs after 50 years of age but a juvenile or familial form has also been observed. YNS is diagnosed based on a triad associating yellow nail discoloration, pulmonary manifestations (chronic cough, bronchiectasia, pleural effusion) and lower limb lymphedema. Chronic sinusitis is frequently associated with the triad. YNS etiology remains unknown but a role of lymphatic impairment is usually evoked. YNS is more frequently isolated but may be associated in rare cases with autoimmune diseases, other clinical manifestations implicating lymphatic functions or cancer and, hence, is also considered a paraneoplastic syndrome. YNS management is symptomatic and not codified. YNS can resolve spontaneously. Oral vitamin E alone or even better when associated with triazole antifungals may achieve partial or total disappearance of nail discoloration. Pleural effusion can be treated surgically, with decortication/pleurectomy or pleurodesis. Antibiotic prophylaxis is prescribed for bronchiectasia with chronic sputum production. Lymphedema treatment is based on low-stretch bandages and the wearing of elastic compression garments combined with skin care, exercises and, as needed, manual lymph drainage.

  4. Vascular Features of Nail Psoriasis Using Dynamic Optical Coherence Tomography

    PubMed Central

    Aldahan, Adam S.; Chen, Lucy L.; Fertig, Raymond M.; Holmes, Jon; Shah, Vidhi V.; Mlacker, Stephanie; Hsu, Vincent M.; Nouri, Keyvan; Tosti, Antonella

    2017-01-01

    Background Nail psoriasis is a painful and disfiguring nail disease that often leads to invasive biopsies. Dermoscopy of the hyponychium can be useful in the diagnosis showing twisted coiled vessels. Structural features of nail psoriasis have been described with optical coherence tomography (OCT). Objectives To investigate vascular features of nail psoriasis using dynamic OCT. Methods This was an observational, prospective, controlled study in which psoriasis patients with psoriatic nail changes and healthy control patients underwent OCT imaging of the distal nail plate and proximal nail fold. Vertical and horizontal OCT images were analyzed to describe structural and vascular features and to quantify blood flow at depth. Results Sixteen psoriatic nails and 16 control nails were included. Psoriatic nails had significantly increased blood flow in the proximal nail fold at depths of 0.72 mm (p = 0.035) and 0.76 mm (p = 0.027). Nail thickness was significantly greater in psoriatic nails compared to control nails (p = 0.0016). Compared to control nails, psoriatic nails had dilated, disorganized blood vessels superficially in the proximal nail fold. Limitations The main limitation of our study is the relatively small sample size. Conclusions OCT can identify structural and vascular features specific to nail psoriasis. PMID:28232916

  5. Rotary self-locking intramedullary nail for long tubular bone fractures.

    PubMed

    Huang, Zhong-lian; Yang, Hai-long; Xu, Jian-kun; Xia, Xue; Wang, Xin-jia; Song, Jian-xin; Hu, Jun

    2013-10-01

    Intramedullary nails had been widely used in the treatment of long-bone fractures because of less interference of fractures and center bearing biomechanical advantage. However, it had been also found many shortcomings such as broken nails, delayed healing and was modified in order to achieve better efficacy and reduce complications. The aim of the present study is to compare the efficacy of rotary self-locking intramedullary nails (RSIN) with that of interlocking intramedullary nails (IIN) in the treatment of long-bone fractures. A retrospective study investigated 129 cases with long-bone fractures (36 with femoral fracture, 81 with tibial fracture, and 12 with humeral fracture). The fractures were fixed using either an RSIN or IIN. All patients underwent followup for 12-30 months. All patients in both groups achieved a clinical fracture healing standard and the postoperative affected limb muscle strength and joint function were well restored. The RSIN group required a shorter operative time and the fracture healed faster. There was no significant difference in the hospital stay, intraoperative blood loss or postoperative complications between the two groups. RSIN is used to treat long-bone fractures. Its healing efficacy is equivalent to the IIN. Moreover, the RSIN method is simpler and causes less tissue damage than the IIN, therefore having the advantage of accelerated healing.

  6. Influence of nail prominence and insertion point on anterior knee pain after tibial intramedullary nailing.

    PubMed

    Chen, Chun-Yu; Lin, Kai-Cheng; Yang, Shan-Wei; Tarng, Yih-Wen; Hsu, Chien-Jen; Renn, Jenn-Huei

    2014-03-01

    Chronic anterior knee pain is the most common complication after tibial nail insertion. Its etiology remains unknown, and multifactorial sources have been suggested. The authors believe that nail prominence and the insertion point of the nail are important in the development of anterior knee pain. The purpose of this retrospective study was to evaluate the roles of the insertion point and nail prominence in anterior knee pain after tibial intramedullary nailing using a transtendinous approach and a common nail type. A total of 108 patients with tibial shaft fractures underwent reamed intramedullary nailing using a transtendinous approach between 2006 and 2009. Mean follow-up was 26.8±5.0 months. A visual analog scale (0-100) was used to estimate anterior knee pain severity while patients performed 7 activities retrospectively. Radiographic assessments, including nail prominence and insertion point, were performed. Sixty (55.6%) patients experienced knee pain (group P) and 48 (44.4%) did not (group N). Significant differences were not found between the groups with respect to demographics, nail diameters, or fracture classifications. Less superior and more anterior nail prominences in radiographic assessments were significantly associated with anterior knee pain. When the insertion point was over the bottom half of the anterior cortex, the influence of anterior nail prominence was more obvious. Nail removal resulted in diminished pain during the 7 assessed activities. Nail insertion should be over the bottom half of the anterior cortex, with minimal anterior nail prominence. If anterior knee pain occurs, removal of the nail should be considered.

  7. Cosmetically Induced Disorders of the Nail with Update on Contemporary Nail Manicures

    PubMed Central

    Tosti, Antonella

    2016-01-01

    The nail carries a significant cosmetic impact and plays an integral role in the multi-billion dollar salon industry. This review focuses on nail disorders that are induced by nail cosmetics via procedures, equipment, or materials that are intended to beautify or adorn the nail. The authors give specific attention to clinical presentations that are common, novel, and underreported, but may be misdiagnosed easily by the competent dermatologist. They also provide an update on the controversies surrounding contemporary nail cosmetic procedures, such as acrylic and gel manicures. PMID:27462387

  8. Nail tic disorders: Manifestations, pathogenesis and management.

    PubMed

    Singal, Archana; Daulatabad, Deepashree

    2017-01-01

    Nail tic disorders are classic examples of overlap between the domains of dermatology and psychiatry. They are examples of body-focused repetitive behaviors in which there is an irresistible urge or impulse to perform a certain behavior. The behavior is reinforced as it results in some degree of relief and pleasure. Nail tic disorders are common, yet poorly studied and understood. The literature on nail tic disorders is relatively scarce. Common nail tics include nail biting or onychophagia, onychotillomania and the habit tic deformity. Some uncommon and rare nail tic disorders are onychoteiromania, onychotemnomania, onychodaknomania and bidet nails. Onychophagia is chronic nail biting behavior which usually starts during childhood. It is often regarded as a tension reducing measure. Onychotillomania is recurrent picking and manicuring of the fingernails and/or toenails. In severe cases, it may lead to onychoatrophy due to irreversible scarring of the nail matrix. Very often, they occur in psychologically normal children but may sometimes be associated with anxiety. In severe cases, onychotillomania may be an expression of obsessive-compulsive disorders. Management of nail tic disorders is challenging. Frequent applications of distasteful topical preparations on the nail and periungual skin can discourage patients from biting and chewing their fingernails. Habit-tic deformity can be helped by bandaging the digit daily with permeable adhesive tape. Fluoxetine in high doses can be helpful in interrupting these compulsive disorders in adults. For a complete diagnosis and accurate management, it is imperative to assess the patient's mental health and simultaneously treat the underlying psychiatric comorbidity, if any.

  9. Total Hip Arthroplasty for Implant Rupture after Surgery for Atypical Subtrochanteric Femoral Fracture

    PubMed Central

    Ozaki, Yu; Ochi, Hironori; Watari, Taiji; Matsumoto, Mikio; Kaneko, Kazuo

    2016-01-01

    Treatment methods for delayed union and nonunion of atypical femoral fracture are still controversial. Moreover, no treatment method has been established for implant rupture caused by delayed union and nonunion. We encountered a 74-year-old female in whom nonunion-induced implant rupture occurred after treatment of atypical subtrochanteric femoral fracture with internal fixation using a long femoral nail. It was unlikely that sufficient fixation could be obtained by repeating osteosynthesis alone. Moreover, the patient was elderly and early weight-bearing activity was essential for early recovery of ADL. Based on these reasons, we selected one-stage surgery with total hip arthroplasty and osteosynthesis with inverted condylar locking plate as salvage procedures. Bone union was achieved at 6 months after surgery. This case illustrated that osteosynthesis-combined one-staged total hip arthroplasty could be considered as one of the options for nonunion-induced implant rupture of atypical femoral subtrochanteric fracture. PMID:27818818

  10. Mycobacteria in nail salon whirlpool footbaths, California.

    PubMed

    Vugia, Duc J; Jang, Yvonne; Zizek, Candi; Ely, Janet; Winthrop, Kevin L; Desmond, Edward

    2005-04-01

    In 2000, an outbreak of Mycobacterium fortuitum furunculosis affected customers using whirlpool footbaths at a nail salon. We swabbed 30 footbaths in 18 nail salons from 5 California counties and found mycobacteria in 29 (97%); M. fortuitum was the most common. Mycobacteria may pose an infectious risk for pedicure customers.

  11. Mycobacteria in Nail Salon Whirlpool Footbaths, California

    PubMed Central

    Jang, Yvonne; Zizek, Candi; Ely, Janet; Winthrop, Kevin L.; Desmond, Edward

    2005-01-01

    In 2000, an outbreak of Mycobacterium fortuitum furunculosis affected customers using whirlpool footbaths at a nail salon. We swabbed 30 footbaths in 18 nail salons from 5 California counties and found mycobacteria in 29 (97%); M. fortuitum was the most common. Mycobacteria may pose an infectious risk for pedicure customers. PMID:15829204

  12. Functional Analysis and Treatment of Nail Biting

    ERIC Educational Resources Information Center

    Dufrene, Brad A.; Watson, T. Steuart; Kazmerski, Jennifer S.

    2008-01-01

    This study applied functional analysis methodology to nail biting exhibited by a 24-year-old female graduate student. Results from the brief functional analysis indicated variability in nail biting across assessment conditions. Functional analysis data were then used to guide treatment development and implementation. Treatment included a…

  13. Microstructure of Horseshoe Nails Using Neutron Diffraction

    NASA Astrophysics Data System (ADS)

    Goossens, D. J.; Studer, A. J.; Stachurski, Z. H.

    2010-04-01

    Neutron diffraction allows nondestructive testing of the bulk microstructure of mechanical components. The microstructures of horseshoe nails made through three different processes have been explored as a function of position along the nail. Despite all nails being made of similar plain low-carbon steel and being process annealed after manufacture, the microstructures are far from the same. Nails made from strip, using a cold forging stamping process, show narrower diffraction peaks indicating a narrower distribution of lattice parameters and also show diffraction peak intensity ratios closer to those expected for unstrained steel. Thus, the distribution of the orientation of grains in these nails is closer to that of undistorted steel compared to nails made through the other two processes considered—one a drawing from wire and the other a combination of rolling and cold forging. The blades of the drawn nails showed little preferred orientation but the converse was true in the heads. Differing patterns of preferred orientation suggest that the various manufacturing approaches result in substantially different mechanical advantages for the three types of nails, a result in accord with mechanical testing.

  14. Functional Analysis and Treatment of Nail Biting

    ERIC Educational Resources Information Center

    Dufrene, Brad A.; Watson, T. Steuart; Kazmerski, Jennifer S.

    2008-01-01

    This study applied functional analysis methodology to nail biting exhibited by a 24-year-old female graduate student. Results from the brief functional analysis indicated variability in nail biting across assessment conditions. Functional analysis data were then used to guide treatment development and implementation. Treatment included a…

  15. Surgical treatment of femoral bending deformity in a patient with vitamin D-resistant rickets.

    PubMed

    Platzer, Patrick; Thalhammer, Gerhild; Vecsei, Vilmos; Wozasek, Gerald E

    2005-10-01

    Surgical treatment of patients with vitamin D-resistant rickets is reserved for management of severe deformities or pathological fractures of the lower limbs. This case report describes the operative management of a child with vitamin D-resistant rickets suffering from a pathological fracture and a bending deformity of the right femoral bone. A modified technique of fragmentation and realignment by intramedullary fixation was performed using an unreamed humerus nail. We corrected the anatomical proximal femoral shaft angle (aMPFA) from 68 degrees to 84 degrees and achieved three more centimetres of femoral length. The same procedure was performed on the left femur and corrected the aMPFA from 108 degrees to 89 degrees and gained 2.5 more centimetres of femoral length. Thus the legs were almost equal in length. We preferred the modified technique of multiple osteotomies and intramedullary fixation by nailing (originally described by Sofield and Millar) because the correction of angulation and rotation of the femoral shaft in one step appeared to be much easier than with plate fixation. Moreover, this method seems to reduce the number of refractures and enables the patients to approach the normal activities of growing children.

  16. Nonoperative treatment of slipped capital femoral epiphysis: a scientific study

    PubMed Central

    2011-01-01

    Background Treatment of the Slipped Capital Femoral Epiphysis remains a cause of concern due to the fact that the true knowledge of the etiopathogeny is unknown, as well as one of its major complications: chondrolysis. The conservative treatment remains controversial; it has been overlooked in the studies and subjected to intense criticism. The purpose of this study is to investigate the results of treatment on the hip of patients displaying slipped capital femoral epiphysis, using the plaster cast immobilization method and its link to chondrolysis. Methods The research was performed based on the study of the following variables: symptomatology, and the degree of slipping. A hip spica cast and bilateral short/long leg casts in abduction, internal rotation with anti-rotational bars were used for immobilizing the patient's hip for twelve weeks. Statistical analysis was accomplished by Wilcoxon's marked position test and by the Fisher accuracy test at a 5% level. Results A satisfactory result was obtained in the acute group, 70.5%; 94%; in the chronic group (chronic + acute on chronic). Regarding the degree of the slipping, a satisfactory result was obtained in 90.5% of hips tested with a mild slip; in 76% with moderate slip and 73% in the severe slip. The statistical result revealed that a significant improvement was found for flexion (p = 0.0001), abduction (p = 0.0001), internal rotation (p = 0.0001) and external rotation (p = 0.02). Chondrolysis was present in 11.3% of the hips tested. One case of pseudoarthrosis with aseptic capital necrosis was presented. There was no significant variation between age and chondrolysis (p = 1.00).Significant variation between gender/non-white patients versus chondrolysis (p = 0.031) and (p = 0.037), respectively was verified. No causal association between plaster cast and chondrolysis was observed (p = 0.60). In regard to the symptomatology group and the slip degree versus chondrolysis, the p value was not statistically

  17. The 2 clinical subbands of the distal nail unit and the nail isthmus. Anatomical explanation and new physiological observations in relation to the nail growth.

    PubMed

    Perrin, Christophe

    2008-06-01

    The distal region of the nail unit, which marks the transition of the nail bed to the hyponychium, is known clinically as the onychodermal band (ODB). For several authors, the ODB is described as 2 subbands of tonal values: slightly milky and pink from proximal to distal. However, its 2 subbands show individual variation and are often scarcely visible. It has been stated that the proximal subband, that is, the white band of Pinkus, corresponds histologically to the attachment of the compact orthokeratotic layer of the hyponychium to the nail plate. In 2 studies, I have individualized a transitional zone between the nail bed and the hyponychium: the nail isthmus. In these previous studies, the ODB was not visible. The purpose of this article is to analyze the anatomo-clinical correlations between the nail isthmus and the ODB and to highlight some new physiological information concerning the nail growth. A case showing clearly the 2 clinical subbands of ODB was investigated. In addition, all the longitudinal sections of the 5 normal nail unit specimens, used in the 2 previous studies, were reviewed to analyze the ventral surface of the nail plate in longitudinal planes. The nail isthmus can be described synthetically by 2 features: (1) a stair-like appearance of the epithelium of the distal nail bed with a marked depression of the epithelium below the inferior surface of the nail plate (2) a specialized mode of attachment of its horny layer to nail plate via a horizontal mode of differentiation. The white band of Pinkus corresponded histologically to the nail isthmus. Its white color was caused by alteration in light diffraction in the thin compartment of pale parakeratotic corneocytes squeezed between the nail plate and the epithelium of the nail isthmus. The pink middle band corresponded to the 2 horny layers surmounting the epidermis of the hyponychium: the compact horny layer of the hyponychium and the thin pale "tongue-like" parakeratotic extension of the nail

  18. Application of Hansen Solubility Parameters to predict drug-nail interactions, which can assist the design of nail medicines.

    PubMed

    Hossin, B; Rizi, K; Murdan, S

    2016-05-01

    We hypothesised that Hansen Solubility Parameters (HSPs) can be used to predict drug-nail affinities. Our aims were to: (i) determine the HSPs (δD, δP, δH) of the nail plate, the hoof membrane (a model for the nail plate), and of the drugs terbinafine HCl, amorolfine HCl, ciclopirox olamine and efinaconazole, by measuring their swelling/solubility in organic liquids, (ii) predict nail-drug interactions by comparing drug and nail HSPs, and (iii) evaluate the accuracy of these predictions using literature reports of experimentally-determined affinities of these drugs for keratin, the main constituent of the nail plate and hoof. Many solvents caused no change in the mass of nail plates, a few solvents deswelled the nail, while others swelled the nail to varying extents. Fingernail and toenail HSPs were almost the same, while hoof HSPs were similar, except for a slightly lower δP. High nail-terbinafine HCl, nail-amorolfine HCl and nail-ciclopirox olamine affinities, and low nail-efinaconazole affinities were then predicted, and found to accurately match experimental reports of these drugs' affinities to keratin. We therefore propose that drug and nail Hansen Solubility Parameters may be used to predict drug-nail interactions, and that these results can assist in the design of drugs for the treatment of nail diseases, such as onychomycosis and psoriasis. To our knowledge, this is the first report of the application of HSPs in ungual research.

  19. Octyl-2-Cyanoacrylate adhesive for rapid nail plate restoration.

    PubMed

    Hallock, G G; Lutz, D A

    2000-09-01

    Following nail bed repair, returning the nail plate as a conforming stent or splint is a common technique. Especially when split, the nail plate fragments can very readily be pieced together and bonded to the nail bed using the tissue adhesive Octyl-2-Cyanoacrylate. This new formulation can expedite this maneuver, and has shown no signs of histotoxicity or adverse effect on nail plate regeneration.

  20. Intra-articular risks of suprapatellar nailing.

    PubMed

    Beltran, Michael J; Collinge, Cory A; Patzkowski, Jeanne C; Masini, Brendan D; Blease, Robert E; Hsu, Joseph R

    2012-12-01

    To determine the risks to local anatomy near the starting point for tibial nailing during suprapatellar nailing, 15 fresh-frozen hemipelvis specimens were nailed using a suprapatellar technique. After nail passage, the menisci and articular surfaces, anterior cruciate ligament (ACL) insertion, intermeniscal ligament, and fat pad were assessed for injury. The distance from the entry portal to the menisci, articular surfaces, and ACL insertion was determined. Medial meniscus injury occurred in 1 (6.7%) specimen and medial articular injury in 2 (13%). Nails passed through the fat pad in all specimens; intermeniscal ligament injury occurred in 3 (20%) specimens. The ACL insertion and lateral structures were not injured in any specimen. The distance from the entry portal margin to the lateral and medial menisci was 6.46±2.47 mm and 4.74±3.17 mm, respectively. The distances to the lateral and medial articular margins measured 10.33±3.62 mm and 6.54±3.57 mm, respectively. The distance to the ACL insertion averaged 5.80±3.94 mm. Suprapatellar nailing is associated with a risk of injury to anterior knee structures comparable to other nailing techniques. Additional clinical studies are warranted to further define the role of this technique in the management of tibial fractures.

  1. Ultrasound-mediated nail drug delivery system.

    PubMed

    Abadi, Danielle; Zderic, Vesna

    2011-12-01

    A novel ultrasound-mediated drug delivery system has been developed for treatment of a nail fungal disorder (onychomycosis) by improving delivery to the nail bed using ultrasound to increase the permeability of the nail. The slip-in device consists of ultrasound transducers and drug delivery compartments above each toenail. The device is connected to a computer, where a software interface allows users to select their preferred course of treatment. In in vitro testing, canine nails were exposed to 3 energy levels (acoustic power of 1.2 W and exposure durations of 30, 60, and 120 seconds). A stereo -microscope was used to determine how much of a drug-mimicking compound was delivered through the nail layers by measuring brightness on the cross section of each nail tested at each condition, where brightness level decreases coincide with increases in permeability. Each of the 3 energy levels tested showed statistical significance when compared to the control (P < .05) with a permeability factor of 1.3 after 30 seconds of exposure, 1.3 after 60 seconds, and 1.5 after 120 seconds, where a permeability factor of 1 shows no increase in permeability. Current treatments for onychomycosis include systemic, topical, and surgical. Even when used all together, these treatments typically take a long time to result in nail healing, thus making this ultrasound-mediated device a promising alternative.

  2. Femoral fractures in children, is early interventional treatment beneficial?

    PubMed

    Sturdee, S W; Templeton, P A; Dahabreh, Z; Cullen, E; Giannoudis, P V

    2007-08-01

    A protocol of early intervention (flexible intramedullary nails, early hip spica, and external fixation) was started in 1999 and during a 3-year period there were 25 children who sustained a femoral shaft fracture (early intervention group). These were prospectively reviewed with a minimum follow up of 24 months (Range 24-35 months). A historical control group of 41 children was used. These children were injured between February 1996 and February 1999 and were retrospectively reviewed. They had traditional in patient treatments with either Gallows or Thomas splint traction (traditional treatment group). Over the 6-year period from 1996 to 2002 there were a total of 66 femoral shaft fractures in the study that presented to our hospital. The mean length of hospital stay was 29 nights in the traditional group and 10 nights in the early intervention group. This difference is significant (p<0.001). The malunion rate was slightly higher in the early active group at radiological union but most of these remodelled over the 2 years of follow up. The protocol of early intervention used in our institution, of flexible nails, early hip spica or external fixation depended on the age of the child, and has resulted in a shorter hospital stay for the children. This has benefits for the child, the family and the hospital.

  3. Microscopic examination of normal nail clippings.

    PubMed

    Werner, Betina; Antunes, Andre

    2013-01-01

    Nail clipping analysis for diagnosing causes of onychodystrophy other than onychomycosis is investigated to a very small extent. In order to achieve acceptance as a diagnostic method for any kind of nail abnormalities, normal microscopic parameters have to be established first. In most reported cases, nail plates were fixed in formalin with processing of the specimens with routine automated histotechnique. Fifteen pairs of normal nails were studied. One nail fragment was placed in a container with formalin, and the other was kept dry in a proper receptacle. Fixed specimens were submitted to standard automated tissue processing (formalin group) and dry specimens were directly embedded in paraffin (dry group). Several microscopic parameters were analyzed. Nail plate thickness ranged from 0.25 to 0.50 mm (mean 0.36 mm) and subungual region from 0 to 0.31 mm (mean 0.11 mm). Forty-one percent of cases presented onychokaryosis, and hypereosinophilic nuclear shadows were detected in 63%, statistically more frequent in the dry group (p=0.002). Parakeratosis was present in 86% of nails varying from 1 to 13 layers (mean 5.6). None of the nails presented fungi, neutrophils, and blood or serum collections. Bacteria were seen in 60% of specimens. Both groups yielded adequate microscopic preparations for analysis with no statistical difference in the dryness or hardness of specimens or difficulty in cutting the paraffin blocks (p=1). These microscopic findings of a normal population can be used as parameters for evaluating any cause of onychodystrophy. The dry method is faster and cheaper and yields adequate slide preparations for microscopic analysis of nail clippings.

  4. Open Intramedullary Nailing for Segmental Long Bone Fractures: An Effective Alternative in a Resource-restricted Environment.

    PubMed

    Babalola, Olasunkanmi M; Ibraheem, Gbadebo Hakeem; Ahmed, Bola A; Olawepo, Ayokunle; Agaja, Samuel B; Adeniyi, Adebowale

    2016-01-01

    Closed, locked intramedullary nailing has been accepted as the gold standard in the care of femoral fractures, with reported union rates as high as 98-100%. Closed, locked intramedullary nailing often requires expensive equipment which is a challenge in developing countries. Segmental long bone fractures are often a result of high-energy trauma and hence often associated with a lot of injuries to the surrounding soft tissues. This consequently results in higher rates of delayed or nonunion. This study was proposed to review the outcome of management of segmental fractures with locked intramedullary nails, using an open method of reduction. A retrospective analysis was made of data obtained from all segmental long bone fractures treated with intramedullary nailing over a 1-year period. Records were retrieved from the folders of patients operated on from January 2011 to December 2011. Patients were followed up for a minimum of 1 year after the surgery. We managed a total of 12 segmental long bone fractures in 11 patients. Eight of the 12 fractures were femoral fractures and 10 of the fractures were closed fractures. All but one fracture (91.7%) achieved union within 4 months with no major complications. Open method of locked intramedullary nailing achieves satisfactory results when used for the management of long bone fractures. The method can be used for segmental fractures of the humerus, femur, and tibia, with high union rates. This is particularly useful in low-income societies where the use of intraoperative imaging may be unavailable or unaffordable. It gives patients in such societies, a chance for comparable outcomes in terms of union rates as well as avoidance of major complications. Larger prospective studies will be necessary to conclusively validate the efficacy of this fixation method in this environment.

  5. Suprapatellar nailing of tibial fractures: surgical hints.

    PubMed

    Brink, Ole

    2016-01-01

    Intramedullary nailing of the tibia with suprapatellar entry and semi-extended positioning makes it technically easier to nail the proximal and distal fractures. The purpose of this article was to describe a simple method for suprapatellar nailing (SPN). A step-by-step run through of the surgical technique is described, including positioning of the patient. There are as yet only a few clinical studies that illustrate the complications with this method, and there has been no increased frequency of intraarticular damage. Within the body of the manuscript, information is included about intraarticular damage and comments with references about anterior knee pain.

  6. Suprapatellar nailing of tibial fractures: surgical hints

    PubMed Central

    2016-01-01

    Intramedullary nailing of the tibia with suprapatellar entry and semi-extended positioning makes it technically easier to nail the proximal and distal fractures. The purpose of this article was to describe a simple method for suprapatellar nailing (SPN). A step-by-step run through of the surgical technique is described, including positioning of the patient. There are as yet only a few clinical studies that illustrate the complications with this method, and there has been no increased frequency of intraarticular damage. Within the body of the manuscript, information is included about intraarticular damage and comments with references about anterior knee pain. PMID:27340503

  7. Nail picking disorder (onychotillomania): a case report.

    PubMed

    Snorrason, Ivar; Woods, Douglas W

    2014-03-01

    Nail picking disorder (onychotillomania) is characterized by excessive picking or pulling at one's own finger- or toenails. This condition has received scant research attention and may be related to other body focused repetitive behaviors such as pathological nail biting, skin picking and hair pulling. We present a case of a male client with a chronic and severe nail picking habit treated with acceptance-enhanced behavior therapy. The client showed clinical characteristics similar to other body focused repetitive behaviors and responded moderately well to the treatment. Copyright © 2013 Elsevier Ltd. All rights reserved.

  8. The 'PDA nail': traumatic nail dystrophy in habitual users of personal digital assistants.

    PubMed

    Olszewska, Malgorzata; Wu, John Z; Slowinska, Monika; Rudnicka, Lidia

    2009-01-01

    All-in-one devices with mobile phone, web browser, and organizer are now owned by over 6 million people and their popularity is increasing. These devices are often called personal digital assistants (PDAs) or 'BlackBerry(R)' devices, after a popular brand name of these appliances. The use of PDAs is associated with exposure of distal thumbs and nails to repeated pressure with a frequency of up to a few thousand times per hour and several tens of thousands of times per day. We describe two cases of traumatic thumb nail dystrophy associated with using a PDA keyboard for several hours per day. Both patients developed median nail plate dystrophy after 4-8 months of habitual PDA use. One patient also developed thumb nail psoriasis and paronychia. All symptoms resolved a few months after discontinuing PDA use. Analysis of nail biomechanics, performed by using a finite element fingertip model, showed that maximal stress reaches approximately 3 MPa and appears near the root on the internal surface of the nail, while it reaches approximately 2 MPa and appears around one-third from the root on the outside surface. In conclusion, biomechanical stress resulting from overuse of PDAs may result in various types of nail dystrophy. We suggest the general term 'PDA nails' for these nail abnormalities.

  9. Long-term functional implications of the iatrogenic rotational malalignment of healed diaphyseal femur fractures following intramedullary nailing.

    PubMed

    Gugala, Zbigniew; Qaisi, Yaqdan T; Hipp, John A; Lindsey, Ronald W

    2011-03-01

    The long-term functional implications for patients with iatrogenic femoral malrotation following femoral intramedullary nail fixation remain unclear. This study examined the extent and direction of rotational alignment of the femur treated with intramedullary nail fixation and its long-term functional effects on patients' standing, walking, and subjective outcome. Rotational alignment was measured using a CT-based protocol. Foot alignment while standing or walking was determined bilaterally using a pressure mat. Subjective functional outcome was assessed using a questionnaire. Sixteen patients (5F, 11 M; age: mean 44.3 years, range 24-75 years) with a healed femur fracture were included. Femur alignment demonstrated internal rotation in five patients (mean 6°; range 2-13°), and external rotation in 11 (mean 18°; range 3-32°). Static foot rotation demonstrated neutral rotation in two patients, internal rotation in four (mean 13°; range 5-22°), and external rotation in 10 (mean 15°; range 5-24°). Dynamic foot rotation demonstrated neutral rotation in two patients, internal rotation in two (mean 11°; range 4-26°), and external rotation in 12 (mean 11°; range 3-22°). There was a trend for increasing dynamic malrotation with femoral rotation (r(2)=0.27; p=0.055). In half the patients, dynamic foot rotation correlated with the extent of femoral malrotation. There was no association (p=0.6) between overall patient satisfaction (10 fully satisfied; 5 partially satisfied; and 1 dissatisfied) and foot alignment. Patients can compensate for even significant femoral malrotation and tolerate it well. External femoral malrotation appears to be better compensated/tolerated than internal malrotation. Copyright © 2010 Elsevier Ltd. All rights reserved.

  10. How to Safely Use Nail Care Products

    MedlinePlus

    ... Ingredients and Warnings Cosmetic ingredients (except most color additives) and products, including nail products, do not need ... Animal & Veterinary Children's Health Cosmetics Dietary Supplements Drugs Food Medical Devices Nutrition Radiation-Emitting Products Tobacco Products ...

  11. Nail apparatus melanoma: a diagnostic opportunity*

    PubMed Central

    Carreño, Ana Maria; Nakajima, Sílvia Rocha; Pennini, Silmara N.; Candido, Renato; Schettini, Antonio Pedro Mendes

    2013-01-01

    Malignant Melanoma is a high mortality neoplasm. The involvement of the nail apparatus is rare, with only 2 out of 3 patients seeking medical attention as the result of recent nail melanocytic lesions. This results in late diagnosis and a prognosis worse than cutaneous melanoma. We report a female, presenting with ulcerative lesions with clinical and laboratory features compatible with leishmaniasis. On return after treatment initiation a longitudinal melanonychia was observed on her first right finger. Biopsy of the nail matrix was performed. Histopathology was compatible with melanoma in situ. Longitudinal melanonychia is not a specific sign for melanoma and it is important that the dermatologist should identify the suspect lesions correctly. The incidental diagnosis of nail melanoma in situ in our case significantly impacted the patient's survival. PMID:23739714

  12. [Osteosynthesis of hip and femoral shaft fractures using the PFN-long].

    PubMed

    Pavelka, T; Houcek, P; Linhart, M; Matejka, J

    2007-04-01

    A group of 79 patients with ipsilateral fractures of the hip and femoral shaft treated with the use of a long proximal femoral nail (PFN-long) was retrospectively evaluated. From January 1998 to February 2005, 79 patients were treated surgically. The group included 42 men and 37 women at an average age of 56.6 years. In 47 patients (37 men and 10 women; average age, 38 years; range, 18-72 years) the fractures were due to a high-energy trauma. In the remaining 32 patients (six men and 25 women; average age, 77.6 years), the cause of fracture was a low-energy trauma, most frequently an ordinary fall. The fractures were categorized according to the Dousa, Bartonícek and Krbec classification. Type IV fractures, i. e., subtrochanteric fractures involving the whole upper half of the femur, were most frequent. The Synthes PFN-long is based on the PFN and partly also UFN implants. The nail is matched to femoral shaft antecurvation, and femoral neck screws have a 10 degrees anteversion. The nail is cannulated, is 10 mm thick and is available in three lengths with a distal dynamic opening. The results are based on the evaluation of 65 patients followed up for at least 12 months. At 12 months bone union was achieved in all patients; in 38 patients (58 %) it occurred by 6 months and in 59 patients (91 %) by 9 months. The outcomes were excellent in 42 (64 %), good in 18 (28 %) and satisfactory in 5 patients (8 %). Thirteen intra-operative complications (27 %) in nine patients were recorded, with the necessity of repeat surgery in four cases. Two problems were involved: incomplete reduction (nine fractures) and incorrect implant insertion (four fractures). Early complications included hematoma in the wound in five cases and one infected wound.A late complication was delayed union in two cases. The management of ipsilateral fractures of the hip and femoral shaft is still associated with a high percentage of complications, mostly due to reduction being difficult. The PFN-long is

  13. Nail changes in casted and braced clubfoot: A preliminary study.

    PubMed

    Agarwal, Anil; Kumar, Anubrat; Khanna, Deepshikha; Shaharyar, Abbas; Bhat, Mohd Shafi; Mishra, Madhusudan

    2016-12-01

    The study aimed at finding whether there are any nail changes specific to treatment in clubfoot. Sixty new, 26 undergoing serial corrective casting, and 247 clubfoot patients using foot abduction braces were prospectively studied. The casted and braced group formed the basis of the study to observe nail changes, if any. The new patients and opposite normal foot (in unilateral casted cases) were taken as controls. Acute paronychia, ingrown toe nail, onychoshizia, onychorrhexis, nail plate concavity, latent onychomadesis, and distal onycholysis were observed in feet undergoing corrective casting and bracing. Micronychia, malalignment and thinning of nail plate were the observed congenital nail anomalies. Nail changes in clubfeet are not infrequent. Certain nail changes might be etiologically linked to casting and bracing. Some of nail changes might require urgent medical care. Copyright © 2015 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

  14. [Slipped capital femoral epiphysis].

    PubMed

    Klein, C; Haraux, E; Leroux, J; Gouron, R

    2017-03-01

    Slipped capital femoral epiphysis (SFCE) is a disorder of the hip, characterized by a displacement of the capital femoral epiphysis from the metaphysic through the femoral growth plate. The epiphysis slips posteriorly and inferiorly. SCFE occurs during puberty and metabolic and epidemiologic risk factors, such as obesity are frequently found. Most chronic slips are diagnosed late. Sagittal hip X-rays show epiphysis slip. In case of untreated SCFE, a slip progression arises with an acute slip risk. Treatment is indicated to prevent slip worsening. The clinical and radiological classification is useful to guide treatment and it is predictive of the prognosis. In situ fixation of stable and moderately displaced SCFE with cannulated screws gives excellent results. Major complications are chondrolysis and osteonecrosis and the major sequelae are femoroacetabular impingement and early arthritis.

  15. Utility of Gel Nails in Improving the Appearance of Cosmetically Disfigured Nails: Experience with 25 Cases

    PubMed Central

    Nanda, Soni; Grover, Chander

    2014-01-01

    Background: Gel nails are a commonly used cosmetic procedure, though their use by dermatologists has not been evaluated. These can be used to improve the appearance of cosmetically disfigured nails where other treatment options have failed; the condition is self-limiting or irreversible; or to camouflage the dystrophy until healing. Materials and Methods: A prospective, uncontrolled, open-label study on 25 participants presenting with cosmetically disfigured nails was undertaken. Mycologically negative, consenting patients with various nail plate surface abnormalities like trachyonychia (n =8); superficial pitting (n =6); onychorrhexis (n =4); superficial pitting with onychoschizia (n =3); Beau's lines (n =3) and pterygium (n =1) were included. The patients received gel nail application using Ranara gel nail kit®. Extra care was taken to avoid any damage to cuticle. Standard pre- and post-treatment photographs were taken to assess improvement. Patient satisfaction score (1-10); Global assessment score of improvement (no improvement to excellent improvement) and any side effects reported were recorded. Results: The average age of treated patients was 30.44±11.39 years (range 18-60 years). A total of 69 nails were treated (average of 2.76 per patient). Post-procedure, the average patient satisfaction score was 9.08 ± 0.86 (range 7-10). The Global assessment showed excellent improvement (40% cases); good improvement (56% cases) and mild improvement in the single case of pterygium treated. Conclusions: The use of Gel nails in patients with cosmetically disfiguring nail plate surface abnormalities (like trachyonychia, onychoschizia, pitting, etc.) was found to produce good to excellent improvement in most of the cases. The patient satisfaction with the procedure was rated as high. This, coupled with absence of side effects, make gel nails a valuable tool in improving cosmesis and satisfaction among patients presenting with nail plate surface abnormalities. Further

  16. Heat profiles of laser-irradiated nails.

    PubMed

    Paasch, Uwe; Nenoff, Pietro; Seitz, Anna-Theresa; Wagner, Justinus A; Kendler, Michael; Simon, Jan C; Grunewald, Sonja

    2014-01-01

    Onychomycosis is a worldwide problem with no tendency for self-healing, and existing systemic treatments achieve disease-free nails in only 35 to 76% of cases. Recently, treatment of nail fungus with a near-infrared laser has been introduced. It is assumed that fungal eradication is mediated by local heat. To investigate if laser treatment has the potential to eradicate fungal hyphae and arthrospores, laser heat application and propagation needs to be studied in detail. This study aimed to measure nail temperatures using real-time videothermography during laser irradiation. Treatment was performed using 808- and 980-nm linear scanning diode lasers developed for hair removal, enabling contact-free homogeneous irradiation of a human nail plate in one pass. Average and peak temperatures increased pass by pass, while the laser beam moved along the nail plates. The achieved mean peak temperatures (808 nm: 74.1 to 112.4°C, 980 nm: 45.8 to 53.5°C), as well as the elevation of average temperatures (808 nm: 29.5 to 38.2°C, 980 nm: 27.1 to 32.6°C) were associated with pain that was equivalent to that of hair removal procedures and was not significantly different for various wavelengths. The linear scanning laser devices provide the benefits of contact-free homogeneous heating of the human nail while ensuring adequate temperature rises.

  17. Heat profiles of laser-irradiated nails

    NASA Astrophysics Data System (ADS)

    Paasch, Uwe; Nenoff, Pietro; Seitz, Anna-Theresa; Wagner, Justinus A.; Kendler, Michael; Simon, Jan C.; Grunewald, Sonja

    2014-01-01

    Onychomycosis is a worldwide problem with no tendency for self-healing, and existing systemic treatments achieve disease-free nails in only 35 to 76% of cases. Recently, treatment of nail fungus with a near-infrared laser has been introduced. It is assumed that fungal eradication is mediated by local heat. To investigate if laser treatment has the potential to eradicate fungal hyphae and arthrospores, laser heat application and propagation needs to be studied in detail. This study aimed to measure nail temperatures using real-time videothermography during laser irradiation. Treatment was performed using 808- and 980-nm linear scanning diode lasers developed for hair removal, enabling contact-free homogeneous irradiation of a human nail plate in one pass. Average and peak temperatures increased pass by pass, while the laser beam moved along the nail plates. The achieved mean peak temperatures (808 nm: 74.1 to 112.4°C, 980 nm: 45.8 to 53.5°C), as well as the elevation of average temperatures (808 nm: 29.5 to 38.2°C, 980 nm: 27.1 to 32.6°C) were associated with pain that was equivalent to that of hair removal procedures and was not significantly different for various wavelengths. The linear scanning laser devices provide the benefits of contact-free homogeneous heating of the human nail while ensuring adequate temperature rises.

  18. Lateral drug diffusion in human nails.

    PubMed

    Palliyil, Biji B; Li, Cong; Owaisat, Suzan; Lebo, David B

    2014-12-01

    The main objective of the current work is to demonstrate the process of passive lateral diffusion in the human nail plate and its effect on the passive transungual permeation of antifungal drug ciclopirox olamine (CPO). A water soluble dye, methyl red sodium salt (MR) was used to visualize the process of lateral diffusion using a novel suspended nail experiment. The decline in concentration of CPO correlates with that of concentration of MR from the proximal to the distal end of the nail in suspended nail study. Three toenails each were trimmed to 5 mm × 5 mm (25 mm(2)), 7 mm × 7 mm (49 mm(2)), and 9 mm × 9 mm (81 mm(2)) to study the extent and effect of lateral diffusion of the CPO on its in vitro transungual permeation. The permeation flux of CPO decreased as the surface area of the toenail increased. There was a positive correlation between the concentrations of CPO and MR in the area of application and in the peripheral area of the toenails of the three surface areas, confirming the findings in the suspended nail experiment. Profound lateral diffusion of CPO was demonstrated and shown to reduce the in vitro passive transungual drug permeation and prolong the lag-time in human toenails. The study data implies that during passive in vitro transungual permeation experiments, the peripheral nail around the area of drug application has to be kept to a minimum, in order to get reliable data which mimics the in vivo situation.

  19. Biomechanical investigation of a novel ratcheting arthrodesis nail.

    PubMed

    McCormick, Jeremy J; Li, Xinning; Weiss, Douglas R; Billiar, Kristen L; Wixted, John J

    2010-10-14

    Knee or tibiotalocalcaneal arthrodesis is a salvage procedure, often with unacceptable rates of nonunion. Basic science of fracture healing suggests that compression across a fusion site may decrease nonunion. A novel ratcheting arthrodesis nail designed to improve dynamic compression is mechanically tested in comparison to existing nails. A novel ratcheting nail was designed and mechanically tested in comparison to a solid nail and a threaded nail using sawbones models (Pacific Research Laboratories, Inc.). Intramedullary nails (IM) were implanted with a load cell (Futek LTH 500) between fusion surfaces. Constructs were then placed into a servo-hydraulic test frame (Model 858 Mini-bionix, MTS Systems) for application of 3 mm and 6 mm dynamic axial displacement (n = 3/group). Load to failure was also measured. Mean percent of initial load after 3-mm and 6-mm displacement was 190.4% and 186.0% for the solid nail, 80.7% and 63.0% for the threaded nail, and 286.4% and 829.0% for the ratcheting nail, respectively. Stress-shielding (as percentage of maximum load per test) after 3-mm and 6-mm displacement averaged 34.8% and 28.7% (solid nail), 40.3% and 40.9% (threaded nail), and 18.5% and 11.5% (ratcheting nail), respectively. In the 6-mm trials, statistically significant increase in initial load and decrease in stress-shielding for the ratcheting vs. solid nail (p = 0.029, p = 0.001) and vs. threaded nail (p = 0.012, p = 0.002) was observed. Load to failure for the ratcheting nail; 599.0 lbs, threaded nail; 508.8 lbs, and solid nail; 688.1 lbs. With significantly increase of compressive load while decreasing stress-shielding at 6-mm of dynamic displacement, the ratcheting mechanism in IM nails may clinically improve rates of fusion.

  20. Biomechanical investigation of a novel ratcheting arthrodesis nail

    PubMed Central

    2010-01-01

    Background Knee or tibiotalocalcaneal arthrodesis is a salvage procedure, often with unacceptable rates of nonunion. Basic science of fracture healing suggests that compression across a fusion site may decrease nonunion. A novel ratcheting arthrodesis nail designed to improve dynamic compression is mechanically tested in comparison to existing nails. Methods A novel ratcheting nail was designed and mechanically tested in comparison to a solid nail and a threaded nail using sawbones models (Pacific Research Laboratories, Inc.). Intramedullary nails (IM) were implanted with a load cell (Futek LTH 500) between fusion surfaces. Constructs were then placed into a servo-hydraulic test frame (Model 858 Mini-bionix, MTS Systems) for application of 3 mm and 6 mm dynamic axial displacement (n = 3/group). Load to failure was also measured. Results Mean percent of initial load after 3-mm and 6-mm displacement was 190.4% and 186.0% for the solid nail, 80.7% and 63.0% for the threaded nail, and 286.4% and 829.0% for the ratcheting nail, respectively. Stress-shielding (as percentage of maximum load per test) after 3-mm and 6-mm displacement averaged 34.8% and 28.7% (solid nail), 40.3% and 40.9% (threaded nail), and 18.5% and 11.5% (ratcheting nail), respectively. In the 6-mm trials, statistically significant increase in initial load and decrease in stress-shielding for the ratcheting vs. solid nail (p = 0.029, p = 0.001) and vs. threaded nail (p = 0.012, p = 0.002) was observed. Load to failure for the ratcheting nail; 599.0 lbs, threaded nail; 508.8 lbs, and solid nail; 688.1 lbs. Conclusion With significantly increase of compressive load while decreasing stress-shielding at 6-mm of dynamic displacement, the ratcheting mechanism in IM nails may clinically improve rates of fusion. PMID:20942976

  1. Transungual delivery of terbinafine by iontophoresis in onychomycotic nails.

    PubMed

    Nair, Anroop B; Vaka, Siva Ram Kiran; Murthy, S Narasimha

    2011-10-01

    Trans-nail permeability is limited due to the innate nature of the nail plate and the recent investigations indicated the potential of iontophoresis in enhancing the transungual drug delivery in normal nails. However, the onychomycotic nails differ from the normal nails with respect to the anatomical and biological features. The current study investigated the effect of iontophoresis (0.5 mA/cm(2) for 1 h) on the transungual delivery of terbinafine in onychomycotic finger and toe nails. The presence of fungi in the onychomycotic nails was diagnosed by potassium hydroxide (KOH) microscopy. Passive and iontophoretic delivery of terbinafine across the infected nail was studied in Franz diffusion cell. Further, the release profile of terbinafine from the drug-loaded nails was investigated by agar diffusion method. KOH microscopy confirmed the presence of fungi in all the nails used. The amount of drug permeated across the nail plate was enhanced significantly during iontophoresis over passive delivery, that is, by 21-fold in case of finger and 37-fold in case of toe nails. Further, the total drug load in the onychomycotic nail was enhanced by ~12-fold (in both finger and toe nails) due to iontophoresis. Release of terbinafine from the iontophoresis-loaded nails into agar plates exhibited two phases, a rapid phase followed by a steady release, which extended >2 months. This study concluded that the drug delivery in onychomycotic nails did not differ significantly when compared with normal nails, although the extent of drug permeation and drug load differs between finger and toe nails.

  2. Elastic stable intramedullary nailing for pediatric long bone fractures: experience with 175 fractures.

    PubMed

    Furlan, D; Pogorelić, Z; Biočić, M; Jurić, I; Budimir, D; Todorić, J; Šušnjar, T; Todorić, D; Meštrović, J; Milunović, K P

    2011-01-01

    To demonstrate the effectiveness of intramedullary fixation of displaced long bones shaft fractures in skeletally immature children using the elastic stable intramedullary nails. The case records of 173 children who underwent fixation with titanium intramedulary nails because of long bones fractures were reviewed. The average age of the patients was 11.7 years, and mean follow-up was 41.3 months. There were 55 humeral, 42 forearm, 42 femoral and 36 tibial fractures. Subjective satisfaction was assessed. All patients achieved complete healing at a mean of 7.5 weeks. Complications were recorded in 11 (6.3%) patients and included: one neuropraxia, six entry site skin irritations, two protrusions of the wires through the skin and two skin infections at the entry site. In a subjective measure of outcome at follow-up, 89% of patients were very satisfied and 11% satisfied; no patients reported their outcome as not satisfied. The implants were removed at a median time of six months from the index operation. Elastic Stable Intra-medullary Nailing is the method of choice for the pediatrics patients, because it is minimaly invasive and shows very good functional and cosmetic results. It allows an early functional and cast-free follow-up with a quick pain reduction.

  3. Secondary effects of femoral instrumentation on pulmonary physiology in a standardised sheep model: what is the effect of lung contusion and reaming?

    PubMed

    Hildebrand, Frank; Giannoudis, Peter; van Griensven, Martijn; Chawda, Majur; Probst, Christian; Harms, Oliver; Harwood, Paul; Otto, Karl; Fehr, M; Krettek, Christian; Pape, Hans-Christoph

    2005-04-01

    Intramedullary nailing is the treatment of choice for patients with femoral shaft fractures. However, there is an ongoing debate in multiple trauma patients with associated lung contusion when primary or secondary definitive stabilisation of the long bone fracture should be performed, as nailing is thought to play an important role in the pathogenesis of adult respiratory distress syndrome (ARDS). In a standardised sheep model, this study aimed to quantify the development of acute pulmonary endothelial changes, to assess the activation of polymorphonuclear leucocytes (PMNL) and to observe the effects on the coagulation system associated with the reamed nailing procedure. Furthermore, the effect of coexisting lung contusion in an experimental model was evaluated. The animals were randomly assigned to one of four different groups (6 animals/group). In control groups, only a sham operation (thoracotomy) was performed, whereas in study groups, lung contusion was induced prior to femoral stabilisation either by external fixation or reamed femoral nailing. Using bronchoalveolar lavage (BAL) pulmonary permeability changes were quantified and PMNL activation was assessed by chemiluminescence. Additionally PMNL diapedesis and interstitial lung oedema were determined by histological analysis. All animals were sacrificed 4 h after the start of the femoral instrumentation. Without an associated lung injury, instrumentation of the femoral canal with the reamed nailing technique induced a transient increase in pulmonary permeability. In the face of an induced lung contusion, reamed femoral nailing resulted in significant increases in PMNL activation, pulmonary permeability and interstitial lung oedema, compared with external fixation. Without pulmonary contusion, reaming of the femoral canal was associated with a transient increase in pulmonary permeability. This was exacerbated in the presence of lung contusion along with increased PMNL activation. External fixation did not

  4. Treatment of open proximal femoral fractures sustained in combat.

    PubMed

    Mack, Andrew W; Freedman, Brett A; Groth, Adam T; Kirk, Kevin L; Keeling, John J; Andersen, Romney C

    2013-02-06

    Open proximal femoral fractures are rare injuries that often result from wartime high-energy causes. Limited data exist regarding the treatment and complications of these injuries. We retrospectively reviewed the records of combat casualties treated at two institutions between March 2003 and March 2008. The casualty patient databases, medical records, radiographs, and laboratory data were reviewed to determine time to union, complication rates, and patient outcomes. Forty-one patients (thirty-nine men and two women) with a mean age of 25.7 years were identified as receiving treatment for open proximal femoral fractures. The mechanisms of injury for these forty-one patients were blast (twenty-nine patients [71%]), gunshot wound (eight patients [20%]), motor vehicle crash (three patients [7%]), and helicopter crash (one patient [2%]). There were thirty Type-IIIA, six Type-IIIB, and five Type-IIIC open fractures. The predominant method of definitive fixation was a cephalomedullary or reconstruction nail in thirty-four patients (83%). Thirty-nine patients had at least two years of follow-up data available for assessment of complications and radiographic union. The mean time to union was 5.1 months (range, 2.8 to 16.0 months). Complications requiring reoperation occurred in twenty-two (56%) of thirty-nine patients. Wound infection (twelve patients [31%]) and symptomatic heterotopic ossification (ten patients [26%]) were the most common complications. Cephalomedullary nail fixation of open Type-III wartime subtrochanteric and pertrochanteric femoral fractures can be reliably used to effect fracture union in a timely manner. The most frequent complications of treatment are wound infection and symptomatic heterotopic ossification.

  5. Tibia-based referencing for standard proximal tibial radiographs during intramedullary nailing.

    PubMed

    Bible, Jesse E; Choxi, Ankeet A; Dhulipala, Sravan C; Evans, Jason M; Mir, Hassan R

    2013-11-01

    Limited information exists to define standard tibial radiographs. The purpose of this study was to define new landmarks on the proximal tibia for standard anteroposterior and lateral radiographs. In 10 cadaveric knees, fibular head bisection was considered the anteroposterior image, and femoral condyle overlap the lateral image. In another 10 knees, a "twin peaks" anteroposterior view, showing the sharpest profile of the tibial spines, was used. The "flat plateau" lateral image was obtained by aligning the femoral condyles then applying a varus adjustment with overlap of the tibial plateaus. Medial peritendinous approaches were performed, and an entry reamer used to open the medullary canal. A priori analysis showed good to excellent intra-/inter-observer reliability with the new technique (intra-class correlation coefficient ICC 0.61-0.90). The "twin peaks" anteroposterior radiograph was externally rotated 2.7±2.1° compared to the standard radiograph with fibular head bisection. Portal position and incidence of damage to intra-articular structures did not significantly differ between groups (P>.05). The "twin peaks" anteroposterior view and "flat plateau" lateral view can safely be used for nail entry portal creation in the anatomic safe zone. Tibia-based radiographic referencing is useful for intramedullary nailing cases in which knee or proximal tibiofibular joint anatomy is altered.

  6. In vitro permeation of several drugs through the human nail plate: relationship between physicochemical properties and nail permeability of drugs.

    PubMed

    Kobayashi, Yoichi; Komatsu, Tsunehisa; Sumi, Machiko; Numajiri, Sachihiko; Miyamoto, Misao; Kobayashi, Daisuke; Sugibayashi, Kenji; Morimoto, Yasunori

    2004-03-01

    The objectives of the present study are to clarify the relationship between the physicochemical properties and the nail permeability of drugs through human nail plates. Homologous p-hydroxybenzoic acid esters were used to investigate the relationship between the octanol/water partition coefficient and the permeability coefficient of several drugs. The nail permeability was found to be independent of the lipophilicity of a penetrating drug. However, the nail permeability of several model drugs was found to markedly decrease as their molecular weights increased. The nail permeability of an ionic drug was found to be significantly lower than that of a non-ionic drug, and the nail permeability of these drugs markedly decreased as their molecular weights increased. The permeation of a model drug, 5-fluorouracil (5-FU), through healthy nail plates was also determined and compared with that through nail plates with fungal infections. The drug permeation through a nail plate decreased with an increase in nail plate thickness. Nail plates with fungal infections exhibited approximately the same 5-FU permeation as healthy nail plates. We suggest that the permeability of a drug is mainly influenced by its molecular weight and permeability through nails with fungal infection can be estimated from data on healthy nail permeability.

  7. Computer-aided design and custom-made guide in corrective osteotomy for complex femoral deformity.

    PubMed

    Chai, Wei; Xu, Meng; Zhang, Guo-qiang; Zhang, Li-hai; Gou, Wen-long; Ni, Ming; Chen, Ji-ying

    2013-06-01

    Preoperative planning of corrective osteotomy with traditional radiography has limitations in regards to determining the ideal osteotomy location and orientation in three-dimensional femoral deformities. Though a successful operation can be planned preoperatively, intraoperative contingencies might adhere to the procedural plan in the performance of operation. To efficiently perform a planned procedure, proposed is a design to implement three-dimensional reconstruction photography, based on computer-tomography (CT) scan. A custom-made guide was designed to navigate the osteotomy as planned, and additionally, a personalized intramedullary nail was used for fixation after osteotomy. Three-dimensional (3D) photography of deformed femur was established based on the CT dataset and transferred into 3D photography processing software for further planning. Osteotomy planes were designed and adjusted at deformity sites to correct the 3D deformities. The methodology of a custom-made osteotomy guide was introduced in femoral corrective osteotomy, for the first time, to navigate the operation as planned. After the virtual osteotomy and reduction of bone segments, the parameters of a custom-made intramedullary nail were measured for manufacturing. Findings Virtual operation in computer shows complete correction of the 3D deformity. The osteotomy guide, obtained by rapid-prototyping techniques, navigates mimicking surgery on rapid-prototyping model of the involved femur as planned. Internal fixation was achieved using the custom-made intramedullary nail. Interpretation three-dimensional visualization introduces an advantage in preoperative planning for corrective osteotomy of 3D femoral deformity, and the custom-made osteotomy guide is crucial to realize such a deliberate plan during the actual procedures. The internal fixator, such as an intramedullary nail, can be modified or personalized for fixation in unique cases.

  8. Nail position has an influence on anterior knee pain after tibial intramedullary nailing.

    PubMed

    Darabos, Nikica; Bajs, Ivana Dovzak; Rutić, Zeljko; Darabos, Anela; Poljak, Damir; Dobsa, Jasminka

    2011-09-01

    Our aim was to determine the possible relationship between anterior knee pain (AKP) and nail position marked as a distance from tip of nail to tibial plateau (NP) and to the tuberositas tibiae (NT). Nail position has an influence on anterior knee pain after tibial intramedullary nailing. We evaluated postoperative outcome results of 50 patients in the last 3 years with healed fractures initially treated with intramedullary (IM) reamed nails with 2 or 3 interlocking screws on both parts of the nail and with the use of medial paratendinous incision for nail entry portal. Patients marked a point on the visual analog scale (VAS) that corresponded to the level of postoperative AKP felt. Two groups of patients were formed on the basis of AKP (pain level was neglected): groups A and B, with and without pain, respectively. The difference between the two groups concerning NP measurements was statistically significant (p < 0.05), but not concerning NT measurements at the p < 0.05 level. Patients were classified by pain with high accuracy (98%) according to a classification tree. Symptoms of AKP did not appear if the tip of the nail position was more than 6.0 mm from the NP and more than 2.6 mm from the NT. However, for better evaluation of these results it will be necessary to examine a larger number of postoperative patients with AKP.

  9. Iontophoresis across the proximal nail fold to target drugs to the nail matrix.

    PubMed

    Manda, Prashanth; Sammeta, Srinivasa M; Repka, Michael A; Murthy, S Narasimha

    2012-07-01

    The main objective of the present study was to investigate the plausibility of iontophoretic delivery of drugs to the nail matrix via proximal nail fold. The in vitro drug transport studies were performed in Franz diffusion cells across folded epidermis, which is used as a model for the proximal nail fold. The amount of drug transported into the receiver compartment following iontophoresis for 3 h at 0.5 mA/cm(2) was 150-fold higher than the control (0.008 ± 0.002 μg/cm(2)). The amount of drug present in the skin after iontophoresis (0.45 ± 0.12 μg/mg) was approximately fivefold higher as compared with that of the control (0.08 ± 0.01 μg/mg). Iontophoresis of terbinafine across the proximal nail fold was assessed using excised cadaver toe model as well. A custom-designed foam-pad-type patch system was used for iontophoresis in cadaver toes. The amount of the drug delivered into the nail matrix following iontophoresis for 3 h was significantly higher than the minimum inhibition concentration of terbinafine. However, on the contrary, passive delivery for about 24 h did not result in any detectable drug levels in the nail matrix. Iontophoresis across the proximal nail fold could be developed as a potential method to target drugs to nail matrix. Copyright © 2012 Wiley Periodicals, Inc.

  10. [Anatomy, biology, physiology and basic pathology of the nail organ].

    PubMed

    Haneke, E

    2014-04-01

    The nail is the largest skin appendage. It grows continuously through life in a non-cyclical manner; its growth is not hormone-dependent. The nail of the middle finger of the dominant hand grows fastest with approximately 0.1 mm/day, whereas the big toe nail grows only 0.03-0.05 mm/d. The nails' size and shape vary characteristically from finger to finger and from toe to toe, for which the size and shape of the bone of the terminal phalanx is responsible. The nail apparatus consists of both epithelial and connective tissue components. The matrix epithelium is responsible for the production of the nail plate whereas the nail bed epithelium mediates firm attachment. The hyponychium is a specialized structure sealing the subungual space and allowing the nail plate to physiologically detach from the nail bed. The proximal nail fold covers most of the matrix. Its free end forms the cuticle which seals the nail pocket or cul-de-sac. The dermis of the matrix and nail bed is specialized with a morphogenetic potency. The proximal and lateral nail folds form a frame on three sides giving the nail stability and allowing it to grow out. The nail protects the distal phalanx, is an extremely versatile tool for defense and dexterity and increases the sensitivity of the tip of the finger. Nail apparatus, finger tip, tendons and ligaments of the distal interphalangeal joint form a functional unit and cannot be seen independently. The nail organ has only a certain number of reaction patterns that differ in many respects from hairy and palmoplantar skin.

  11. Drug delivery to the nail following topical application.

    PubMed

    Murdan, Sudaxshina

    2002-04-02

    The absorption of drugs into the nail unit, following topical application to the nail plate, is highly desirable to treat nail disorders, such as onychomycosis (fungal infections of the nail). Nail permeability is however quite low and limits topical therapy to early/mild disease states. In this paper, the recent research into ungual drug delivery is reviewed. The nail unit and the two most common diseases affecting the nail--onychomycosis and nail psoriasis--are briefly described to set the scene and to give an overview of the nature and scope of the problem. The factors, which affect drug uptake and permeation through the nail plate such as solute molecular size, hydrophilicity/hydrophobicity, charge, and the nature of the vehicle, are then discussed, followed by ways of enhancing drug transport into and through the nail plate. Finally, drug-containing nail lacquers which, like cosmetic varnish, are brushed onto the nail plates to form a film, and from which drug is released and penetrates into the nail, are reviewed.

  12. [Fracture Type and Injury-to-Surgery Interval as Risk Factors for Avascular Necrosis of the Femoral Head after Internal Fixation of Intracapsular Femoral Neck Fracture].

    PubMed

    Popelka, O; Skála-Rosenbaum, J; Bartoška, R; Waldauf, P; Krbec, M; Džupa, V

    2015-01-01

    The aim of the study was to investigate the occurrence of avascular necrosis (AVN) of the femoral head following the osteosynthesis of intracapsular fracture of the femoral neck in relation to the time interval between injury and surgery and the type of fracture. The data of patients with intracapsular fractures of the femoral neck surgically treated in the period from 2001 to 2011 were reviewed. Of 1555 patients treated for this fracture, 125 (7%) underwent osteosynthesis. The evaluated group included 115 patients who came for examination at one-year follow-up. There were 59 (52%) women and 56 (48%) men. Dynamic hip screw (DHS) osteosynthesis with an anti-rotation screw was performed in 103 patients and lag-screw osteosynthesis involving three parallel cannulated cancellous screws was employed in 12 patients. The patients were allocated to groups according to the injury-to-surgery interval and to sub-groups on the basis of the Garden classification of femoral fracture stage. In the group of 58 patients treated within 6 h of injury, AVN developed in 10 (17%). When the type of fracture was considered, 4% of the non-displaced fractures and 30% of the displaced fractures developed AVN. The patients with Garden stage I and II (non-displaced) fractures treated within 6 h of injury had a significantly lower risk of AVN development than those with Garden stage III or IV (displaced) fractures. The group treated between 6 and 24 post-injury hours comprised 21 patients, of whom four (19%) had AVN. In non-displaced and displaced fracture sub-groups, 25% of the patients in the former and 16% in the latter had AVN. The stage of displacement had no effect on AVN development. The two groups together (patients treated by 24 h) had a significantly lower AVN incidence than the patients treated after 24 h (p = 0.0025). In this group of 36 patients, 16 had AVN (44%) and the fracture stage made no significant difference (p = 0.6985; nondisplacement sub-group, 41%; displacement sub

  13. [Yellow nail syndrome: two pediatric case reports].

    PubMed

    Dessart, P; Deries, X; Guérin-Moreau, M; Troussier, F; Martin, L

    2014-10-01

    Yellow nail syndrome (YNS) is a combination of specific nail dystrophy (yellowish or green nails, transverse ridging, increased curvature with "a hump" and distal onycholysis), lymphoedema and respiratory tract involvement (mainly bronchial hyper-responsiveness, recurrent pneumonia, bronchiectasis and pleural effusion), with or without sinusitis. This rare condition is most often seen in middle age. We report two pediatric cases. A 9-year-old boy had 20 yellow nails and lymphedema of the lower and upper left limbs. He was born at 32 weeks of gestation. At birth, he had fetal hydrops with bilateral chylothorax. Since then, he presented bronchopulmonary dysplasia. In his first year of life, he had recurrent nasopharyngitis and serosal otitis. Lymphoscintigraphy was not performed. A 14-year-old boy had 10 yellow toenails and 2 yellow fingernails. He was born at 36 weeks of gestation with fetal hydrops. He had recurrent serosal otitis and asthma attacks. Lymphoscintigraphy showed lymphatic hypoplasia, especially of the left limbs. These two children have the classic triad of YNS, including yellow nails, lymphedema and respiratory tract involvement. Thirteen cases have been reported in children from birth to 10 years of age, three of whom were siblings, thus suggesting genetic predisposition. In most cases lymphoscintigraphy showed hypoplasia and/or ectasia of lymphatic vessels. These lymphatic abnormalities may be responsible for nail changes as seen in Turner's syndrome. The prognosis of YNS in adults may be serious because of the pulmonary tract involvement. However, it is not known in children. Yellow dystrophic nails in children may be associated with lymphedema and respiratory tract involvement, as in adults, and this condition should therefore be investigated in cases of YNS. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  14. Custom Knee Device for Knee Contractures After Internal Femoral Lengthening.

    PubMed

    Bhave, Anil; Shabtai, Lior; Ong, Peck-Hoon; Standard, Shawn C; Paley, Dror; Herzenberg, John E

    2015-07-01

    The development of knee flexion contractures is among the most common problems and complications associated with lengthening the femur with an internal device or external fixator. Conservative treatment strategies include physical therapy, serial casting, and low-load prolonged stretching with commercially available splinting systems. The authors developed an individually molded, low-cost custom knee device with polyester synthetic conformable casting material to treat knee flexion contractures. The goal of this study was to evaluate the results of treatment with a custom knee device and specialized physical therapy in patients who had knee flexion contracture during femoral lengthening with an intramedullary lengthening femoral nail. This retrospective study included 23 patients (27 limbs) who underwent femoral lengthening with an internal device for the treatment of limb length discrepancy. All patients had a knee flexion contracture raging from 10° to 90° during the lengthening process and were treated with a custom knee device and specialized physical therapy. The average flexion contracture before treatment was 36°. The mean amount of lengthening was 5.4 cm. After an average of 3.8 weeks of use of the custom knee device, only 2 of 27 limbs (7.5%) had not achieved complete resolution of the flexion contracture. The average final extension was 1.4°. Only 7 of 27 limbs (26%) required additional soft tissue release. The custom knee device is an inexpensive and effective method for treating knee flexion contracture after lengthening with an internal device.

  15. Routes of drug delivery into the nail apparatus: Implications for the efficacy of topical nail solutions in onychomycosis.

    PubMed

    Gupta, Aditya K; Simpson, Fiona C

    2016-01-01

    The route of antifungal drug entry into the nail plate and the underlying nail bed plays an important role in determining the efficacy of therapy. Oral antifungal agents reach the nail bed and nail plate by being ingested and achieving antifungal levels in the blood stream that are well in excess of the minimum inhibitory concentration. The reticular circulation at the distal end of the digit enables the drug to reach the nail bed, the proximal matrix and the lateral nail folds. The drug then diffuses into the proximal, ventral and lateral nail plate. The primary route of drug delivery for topical lacquers is transungual, with drug applied to the dorsal aspect of the nail plate and penetrating to the underlying nail bed. The new topical agents approved in the US for the treatment of onychomycosis are solutions with lower viscosity and increased nail penetration characteristics; therefore, these agents penetrate through the transungual route, but also through the space between the nail plate and the nail bed. This subungual route is an important method of drug delivery and is able to in part circumvent the thickness of the nail plate.

  16. 50. INTERIOR VIEW OF PACKING LINE WHERE ALL THE NAIL ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    50. INTERIOR VIEW OF PACKING LINE WHERE ALL THE NAIL BOXES ARE FORMED, FILLED WITH NAILS AND SEALED; NOTE THESE ARE FIFTY-POUND BOXES - LaBelle Iron Works, Thirtieth & Wood Streets, Wheeling, Ohio County, WV

  17. Nail disorders as signs of pediatric systemic disease.

    PubMed

    Shah, Kara N; Rubin, Adam I

    2012-09-01

    Herein, we describe some of the more common changes in the nail unit that can be seen in systemic diseases in children. Changes that can be seen are not limited to those discussed in the following pages. The presence of changes on multiple nails is suggestive of a systemic cause in an ill child. However, multiple nails can also be affected in primary inflammatory disorders and infections of the nail unit. When evaluating a pediatric patient with a nail disorder, it is important to perform a complete physical examination of the skin and oral mucosa, as other clues to the diagnosis of the nail problem may be found. A comprehensive family history is also important to uncover possible syndromic associations with nail disease or diseases that can manifest with nail changes.

  18. How Savvy Are You about Nail Care Safety?

    MedlinePlus

    ... Food and Drug Administration says nail polishes and removers are safe when used as intended. But under ... Health and Human Services. More Health News on Cosmetics Nail Diseases Recent Health News Related MedlinePlus Health ...

  19. Transonychial water loss in healthy and diseased nails.

    PubMed

    Krönauer, C; Gfesser, M; Ring, J; Abeck, D

    2001-01-01

    The objective of this study was to determine the transonychial water loss (TOWL) in both healthy and affected nails in different diseases and to compare it with the transepidermal water loss (TEWL). TOWL was measured by a new evaporimetric method: Plasticine was used to fix the protection cover of the evaporimeter probe to the nails. The TOWL behaved contrary to the TEWL. Affected nails in patients with atopic eczema (p <0.01), psoriasis (p<0.05) and onychomycosis (p<0.001) showed a significantly lower TOWL than did nails of healthy test subjects. The decrease in TOWL in diseased nails in comparison to healthy nails could be due to the formation of a stratum granulosum in atopic, psoriatic or fungus-affected nails, as this layer is normally absent in healthy nails.

  20. 42. INTERIOR VIEW OF THE NAIL HARDENER USED TO HARDEN ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    42. INTERIOR VIEW OF THE NAIL HARDENER USED TO HARDEN AND TEMPER THE NAILS; WEST TUBES IN FOREGRPUND AND DRAWBACK TUBE IN THE CENTER - LaBelle Iron Works, Thirtieth & Wood Streets, Wheeling, Ohio County, WV

  1. Nail psoriasis – what a rheumatologist should know about

    PubMed Central

    2017-01-01

    Psoriasis is a chronic recurrent inflammatory skin disease with prevalence of 1–3%. Nail psoriasis affects 10–90% of patients with plaque psoriasis. The aim of the article is to review the literature for the correlation between nail psoriasis and psoriatic arthritis (PsA) to provide rheumatologists a short review on features of nail psoriasis, methods of their assessment and possible clinical repercussions. The PubMed database was searched using the key words ‘nail psoriasis’ and ‘psoriatic arthritis’. Psoriasis involving the nail matrix shows up as changes such as pitting, Beau lines, leukonychia, red spots in the lunula, or nail plate crumbling. Nail bed psoriasis manifests as onycholysis, oil drops (or salmon patches), dyschromia, splinter hemorrhages, or subungual hyperkeratosis. Nail psoriasis and psoriatic lesions in the gluteal cleft and on the scalp usually accompany PsA, especially in adult men. PMID:28386142

  2. 6. DETAIL, NORTH (FRONT) DOORWAY, CROSS BATTENS AND NAILS, WITH ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    6. DETAIL, NORTH (FRONT) DOORWAY, CROSS BATTENS AND NAILS, WITH NAILS - Williams Place, Commissary, SC secondary Road 113, 3/4 mile North of SC secondary Road 235, Glenn Springs, Spartanburg County, SC

  3. Nail psoriasis - what a rheumatologist should know about.

    PubMed

    Nieradko-Iwanicka, Barbara

    2017-01-01

    Psoriasis is a chronic recurrent inflammatory skin disease with prevalence of 1-3%. Nail psoriasis affects 10-90% of patients with plaque psoriasis. The aim of the article is to review the literature for the correlation between nail psoriasis and psoriatic arthritis (PsA) to provide rheumatologists a short review on features of nail psoriasis, methods of their assessment and possible clinical repercussions. The PubMed database was searched using the key words 'nail psoriasis' and 'psoriatic arthritis'. Psoriasis involving the nail matrix shows up as changes such as pitting, Beau lines, leukonychia, red spots in the lunula, or nail plate crumbling. Nail bed psoriasis manifests as onycholysis, oil drops (or salmon patches), dyschromia, splinter hemorrhages, or subungual hyperkeratosis. Nail psoriasis and psoriatic lesions in the gluteal cleft and on the scalp usually accompany PsA, especially in adult men.

  4. Radiation exposure during intramedullary nailing.

    PubMed

    Hak, David J

    2017-06-01

    Surgeons should aim to keep radiation exposure "As Low As Reasonably Achievable (ALARA)" during intramedullary nailing and other minimally invasive surgical procedures. This requires understanding the principles of ionizing radiation and methods for minimizing exposure risk. The main source of radiation exposure to surgical personnel during fluoroscopy is from scattered radiation. Since radiation scatter is mainly directed towards the fluoroscopy source, the best configuration during surgery to reduce radiation dose to the surgeon is to position the fluoroscopic source below the operating room table and the image collector above the table. During cross table imaging, the surgeon should stand on the side with the image collector to minimize their exposure to radiation scatter. To reduce scattered radiation the patient must be placed as close to the image collector and as far away from the x-ray tube as possible. Standing farther away from the patient can exponentially reduce radiation exposure. The hands usually have the greatest dose exposure to radiation during surgical procedures, but they are far less radiosensitive than the eyes or thyroid. To minimize exposure to the hands, a surgeon should use the hands-off technique taking fluoroscopic images only when his or her hands are farthest from the radiographic field. Lead gowns, lead thyroid shields, and lead glasses, further reduces an individual's exposure to radiation. Copyright © 2017 Elsevier Ltd. All rights reserved.

  5. Fat embolism syndrome after nailing an isolated open tibial fracture in a stable patient: a case report

    PubMed Central

    2014-01-01

    Background Fat embolism syndrome is a potentially fatal complication of long bone fractures. It is usually seen in the context of polytrauma or a femoral fracture. There are few reports of fat embolism syndrome occurring after isolated long bone fractures other than those of the femur. Case presentation We describe a case of fat embolism syndrome in a 33-year-old Caucasian man. He was being seen for an isolated Gustilo’s grade II open tibial fracture. He was deemed clinically stable, so we proceeded to treat the fracture with intramedullary reamed nailing. He developed fat embolism syndrome intraoperatively and was treated successfully. Conclusion This case caused us to question the use of injury severity scoring for isolated long bone fractures. It suggests that parameters that have been described in the literature other than that the patient is apparently clinically stable should be used to establish the best time for nailing a long bone fracture, thereby improving patient safety. PMID:24731759

  6. Fat embolism syndrome after nailing an isolated open tibial fracture in a stable patient: a case report.

    PubMed

    Aparicio, Gustavo; Soler, Isabel; López-Durán, Luis

    2014-04-14

    Fat embolism syndrome is a potentially fatal complication of long bone fractures. It is usually seen in the context of polytrauma or a femoral fracture. There are few reports of fat embolism syndrome occurring after isolated long bone fractures other than those of the femur. We describe a case of fat embolism syndrome in a 33-year-old Caucasian man. He was being seen for an isolated Gustilo's grade II open tibial fracture. He was deemed clinically stable, so we proceeded to treat the fracture with intramedullary reamed nailing. He developed fat embolism syndrome intraoperatively and was treated successfully. This case caused us to question the use of injury severity scoring for isolated long bone fractures. It suggests that parameters that have been described in the literature other than that the patient is apparently clinically stable should be used to establish the best time for nailing a long bone fracture, thereby improving patient safety.

  7. Femoral shortening after surgical treatment of trochanteric fractures in nongeriatric patients.

    PubMed

    Platzer, Patrick; Thalhammer, Gerhild; Wozasek, Gerald E; Vécsei, Vilmos

    2008-04-01

    Femoral shortening is a well-known clinical finding after surgical treatment of per- and intertrochanteric fractures. Particularly, in geriatric patients with poor bone quality and unstable fracture types, secondary compression of these fractures often leads to length inequality of the lower limbs. In younger patients with good bone quality and mobilization with delayed weight bearing, limb length shortening is expected to be a rare complication. The purpose of this study was to analyze incidence and degree of femoral shortening in patients younger than 60 years of age after fixation of different types of per- and intertrochanteric fractures. In addition, we compared the results of two different implants, which were used for operative treatment. Ninety-five patients, younger than 60 years of age, were evaluated for femoral shortening after surgical treatment of per- and intertrochanteric fractures between 1997 and 2002. Follow-up examinations took place at an average of 3.2 years (2-5 years) after trauma. Fractures were classified by the AO/OTA system and divided into sub-types 31 A1, 31 A2, and 31 A3. Two different implants (dynamic hip screw and cephalomedullary nail) were used for operative treatment, mainly depending on type and stability of the fracture. Femoral shortening was analyzed by standardized lower extremity radiographs measuring the distance from the top of the femoral head to the center of a line drawn between the most distal part of the medial and lateral femoral condyles. Fifty-seven patients were treated by a cephalomedullary nail, 38 by dynamic hip screw. Femoral shortening was seen in 46 patients (48%) with a mean value of 11 mm. Twenty-two patients had a femoral inequality of less than 10 mm, 17 patients an inequality between 10 mm and 20 mm, and 7 patients a shortening of more than 20 mm. Statistical analysis revealed that fracture type and implant had a significant influence on the shortening: In patients with fracture types 31 A2 and A3

  8. Single incision pediatric flexible intramedullary tibial nailing.

    PubMed

    Coury, John G; Lum, Zachary C; O'Neill, Nicholas P; Gerardi, Joseph A

    2017-09-01

    There has been a trend towards flexible intramedullary nailing for unstable tibial shaft fractures in the pediatric population, traditionally, utilizing a 2-incision technique with passage of one nail medially and one nail laterally. Our study aims to compare a single incision approach for flexible nailing of unstable tibial shaft fractures in pediatric patients to the traditional 2-incision approach. Patients were selected for operative fixation if they had a length unstable tibial shaft fracture confirmed by fluoroscopy. Exclusion criteria included length stable tibial fractures that could undergo nonoperative treatment. Single incision technique utilized the medial incision only. Patients were monitored in the hospital for one postoperative day and followed up at 4 week, 8 week, and 12 week marks. Radiographic analysis was performed to evaluate for malunion or nonunion. Operative times, infection rates and complications were recorded and analyzed. All patients achieved complete fracture healing at the 12-week follow up. There were no delayed unions, nonunions or malunions in either treatment group. Single medial incision for tibial flexible nails had equivalent outcomes with no difference in primary healing rate, malunion or nonunion rate when compared to the dual incision technique.

  9. 78 FR 78382 - Steel Nails From China; Determination

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-26

    ... COMMISSION Steel Nails From China; Determination On the basis of the record \\1\\ developed in the subject five... order on steel nails from China would be likely to lead to continuation or recurrence of material injury... contained in USITC Publication 4442 (December 2013), entitled Steel Nails from China: Investigation No....

  10. Guidance on maintaining personal hygiene in nail care.

    PubMed

    Malkin, Bridget; Berridge, Pat

    Nail care is important in the maintenance of personal hygiene and is an essential aspect of patient care. Confusion about who should perform nail care for patients has resulted in poor practice and cycles of non-activity. This article provides guidance for nurses on performing routine nail care.

  11. Withdrawal Strength and Bending Yield Strength of Stainless Steel Nails

    Treesearch

    Douglas R. Rammer; Samuel L. Zelinka

    2015-01-01

    It has been well established that stainless steel nails have superior corrosion performance compared to carbon steel or galvanized nails in treated wood; however, their mechanical fastening behavior is unknown. In this paper, the performance of stainless steel nails is examined with respect to two important properties used in wood connection design: withdrawal strength...

  12. Unusual manifestation of the yellow nail syndrome - Case report*

    PubMed Central

    Papaiordanou, Francine; Epstein, Marina Gabrielle; Miyaoka, Mariana Yumi; Yang, Jeane Jeong Hoon; Pires, Mario Cezar

    2014-01-01

    The yellow nail syndrome is a rare disorder characterized by the classic triad of yellow and dystrophic nails, lymphedema and pleural effusion. We report in this paper a case of yellow nail syndrome, presenting the classic triad of the disease, associated with an unusual lymph accumulation in the abdomen region. PMID:24937826

  13. Portable x-ray fluorescence for the analysis of chromium in nail and nail clippings.

    PubMed

    Fleming, David E B; Ware, Chris S

    2017-03-01

    Assessment of chromium content in human nail or nail clippings could serve as an effective biomarker of chromium status. The feasibility of a new portable x-ray fluorescence (XRF) approach to chromium measurement was investigated through analysis of nail and nail clipping phantoms. Five measurements of 180s (real time) duration were first performed on six whole nail phantoms having chromium concentrations of 0, 2, 5, 10, 15, and 20µg/g. Using nail clippers, these phantoms were then converted to nail clippings, and assembled into different mass groups of 20, 40, 60, 80, and 100mg for additional measurements. The amplitude of the chromium Kα characteristic x-ray energy peak was examined as a function of phantom concentration for all measurement conditions to create a series of calibration lines. The minimum detection limit (MDL) for chromium was also calculated for each case. The chromium MDL determined from the whole nail intact phantoms was 0.88±0.03µg/g. For the clipping phantoms, the MDL ranged from 1.2 to 3.3µg/g, depending on the mass group analyzed. For the 40mg clipping group, the MDL was 1.2±0.1µg/g, and higher mass collections did not improve upon this result. This MDL is comparable to chromium concentration levels seen in various studies involving human nail clippings. Further improvements to the portable XRF technique would be required to detect chromium levels expected from the lower end of a typical population.

  14. [Retrograde nailing in a tibial fracture].

    PubMed

    Valls-Mellado, M; Martí-Garín, D; Fillat-Gomà, F; Marcano-Fernández, F A; González-Vargas, J A

    2014-01-01

    We describe a case of a severely comminuted type iiia open tibial fracture, with distal loss of bone stock (7 cm), total involvement of the tibial joint surface, and severe instability of the fibular-talar joint. The treatment performed consisted of thorough cleansing, placing a retrograde reamed calcaneal-talar-tibial nail with proximal and distal blockage, as well as a fibular-talar Kirschner nail. Primary closure of the skin was achieved. After 3 weeks, an autologous iliac crest bone graft was performed to fill the bone defect, and the endomedullary nail, which had protruded distally was reimpacted and dynamized distally. The bone defect was eventually consolidated after 16 weeks. Currently, the patient can walk without pain the tibial-astragal arthrodesis is consolidated. Copyright © 2013 SECOT. Published by Elsevier Espana. All rights reserved.

  15. Advances in Intramedullary Nailing: Suprapatellar Nailing of Tibial Shaft Fractures in the Semiextended Position.

    PubMed

    Zelle, Boris A; Boni, Guilherme; Hak, David J; Stahel, Philip F

    2015-12-01

    Reamed locked intramedullary nailing remains the standard treatment for displaced tibial shaft fractures. Supra-patellar tibial nailing in the semiextended position has been suggested as a safe and effective surgical technique that allows mitigating certain challenges of the standard subpatellar approach. Suprapatellar nailing seems to facilitate achieving and maintaining fracture reduction, particularly in proximal third tibia fractures. Preliminary investigations have suggested that this technique is associated with a low rate of complications, including a reduced incidence of postoperative anterior knee pain. Further clinical investigations are necessary to establish overall complication rates and long-term subjective outcomes.

  16. Basal cell carcinoma of the nail unit.

    PubMed

    Forman, Seth B; Ferringer, Tammie C; Garrett, Algin B

    2007-05-01

    We report a case of a 70-year-old white male with a basal cell carcinoma of the left thumb nail unit. Excision of the tumor via Mohs micrographic surgery was completed in 2 stages. The defect was repaired with a full thickness skin graft. Five months later the nail unit healed without complications. Prior to this report, 21 cases of basal cell carcinoma have been reported in the world literature. This case, as well as the prior reports, are reviewed with a focus on time to diagnosis, location, excisional technique, and method of repair.

  17. Are biologics useful for nail psoriasis?

    PubMed

    Antúnez-Lay, Andrea; Cabrolier, Jorge; Andino-Navarrete, Romina

    2016-01-11

    Apart from involving skin, psoriasis can compromise the nails and adjacent structures. Even though there are multiple therapeutic alternatives, there is great interest in biological therapy, but no consensus on its role exists. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified two systematic reviews including three randomized trials. We combined the evidence using meta-analysis and generated a summary of findings table following the GRADE approach. We concluded it is not clear whether biological therapy is superior to placebo in the treatment of nail psoriasis because the certainty of the evidence is very low.

  18. Controversies in the Treatment of Ingrown Nails

    PubMed Central

    Haneke, Eckart

    2012-01-01

    Ingrown toenails are one of the most frequent nail disorders of young persons. They may negatively influence daily activities, cause discomfort and pain. Since more than 1000 years, many different treatments have been proposed. Today, conservative and surgical methods are available, which, when carried out with expertise, are able to cure the disease. Packing, taping, gutter treatment, and nail braces are options for relatively mild cases whereas surgery is exclusively done by physicians. Phenolisation of the lateral matrix horn is now the safest, simplest, and most commonly performed method with the lowest recurrence rate. Wedge excisions can no longer be recommended PMID:22675345

  19. Dermatologic Manifestations of the Lower Extremity: Nail Surgery.

    PubMed

    Jellinek, Nathaniel J; Vélez, Nicole F

    2016-07-01

    Nail surgery is a fundamental component of podiatric surgery. Nail disorders are common and may cause significant morbidity and occasionally mortality. Diagnosis of inflammatory and infectious conditions, and of benign or malignant tumors, often requires a biopsy of the nail unit. Excisional surgery may also be curative for certain tumors. This article reviews key elements of nail anatomy, surgical preparation, local anesthesia, and methods to achieve and maintain a bloodless field. A familiarity with these concepts should allow clinicians to develop a surgical plan and approach when patients present with a nail disorder requiring biopsy or surgical treatment. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. A simple procedure with nail preservation for ingrowing toe-nails.

    PubMed Central

    Tweedie, J H; Ranger, I

    1985-01-01

    The numerous methods used for treating ingrowing toe-nails are testimony to the lack of a generally acceptable procedure with a low failure rate. A simple procedure with nail preservation is described, and the results of treatment assessed. The procedure consists of making a transposition flap of the nail wall after preliminary curettage of the granulation tissue in the nail groove. A total of 82 patients were treated by this method over a 3-year period, and the results in 63 patients were assessed between 18 months and 3 years after surgery. A total of 120 operations were carried out and 110 (92%) were successful. The treatment is effective, well tolerated, not technically difficult, and should be considered as an alternative to current methods of treatment. Images Fig. 3 PMID:4052211

  1. Does Tranexamic Acid Reduce Bleeding during Femoral Fracture Operation?

    PubMed

    Haghighi, Mohammad; Ettehad, Hossein; Mardani-Kivi, Mohsen; Mirbolook, Ahmadreza; Nabi, Bahram Naderi; Moghaddam, Roya; Sedighinejad, Abbas; Khanjanian, Gita

    2017-03-01

    Proximal Femoral shaft fractures are commonly associated with marked blood loss which can lead to postoperative acute anemia and some other complications. Tranexamic acid (TA) is an antifibrinolytic medication that reduces intra-and postoperative blood loss and transfusion requirements during some elective surgeries. The aim of this study is to evaluate the effect of intravenous Tranexamic acid (TA) on intraoperative blood loss and a subsequent need for transfusion in patients who were undergoing surgery for femoral shaft fractures in trauma setting. Thirty-eight ASA grade I-II patients undergoing proximal femoral shaft fracture surgery with intra medullary nailing were included in this double blind randomized controlled clinical trial. They were allocated into two groups. Group I, the intervention group with eighteen patients received 15 mg/kg (TA) via intravenous infusion before surgical incision. Patients in the placebo group received an identical volume of normal saline. Hemoglobin level was measured four hours before and after the surgeries. Postoperative blood loss and hemoglobin change as well as transfusion rates and volumes were compared between the two groups. Mean Percentage fall in hemoglobin after surgery were 1.75±0.84 and 2.04±1.9 in the study and placebo groups, respectively (P=0.570). Hemoglobin loss was higher in the placebo group. Transfusion rates was lower in TA group (5.6%) compared to the placebo group (30%) (P=0.06). No significant difference in The Allowable Blood Loss during the surgery was found between the two groups (P=0.894). Preoperative treatment with TA reduces postoperative blood loss and the need for blood transfusion during traumatic femoral fracture operation.

  2. Does Tranexamic Acid Reduce Bleeding during Femoral Fracture Operation?

    PubMed Central

    Haghighi, Mohammad; Ettehad, Hossein; Mardani-Kivi, Mohsen; Mirbolook, Ahmadreza; Nabi, Bahram Naderi; Moghaddam, Roya; Sedighinejad, Abbas; Khanjanian, Gita

    2017-01-01

    Background: Proximal Femoral shaft fractures are commonly associated with marked blood loss which can lead to postoperative acute anemia and some other complications. Tranexamic acid (TA) is an antifibrinolytic medication that reduces intra-and postoperative blood loss and transfusion requirements during some elective surgeries. The aim of this study is to evaluate the effect of intravenous Tranexamic acid (TA) on intraoperative blood loss and a subsequent need for transfusion in patients who were undergoing surgery for femoral shaft fractures in trauma setting. Methods: Thirty-eight ASA grade I-II patients undergoing proximal femoral shaft fracture surgery with intra medullary nailing were included in this double blind randomized controlled clinical trial. They were allocated into two groups. Group I, the intervention group with eighteen patients received 15 mg/kg (TA) via intravenous infusion before surgical incision. Patients in the placebo group received an identical volume of normal saline. Hemoglobin level was measured four hours before and after the surgeries. Postoperative blood loss and hemoglobin change as well as transfusion rates and volumes were compared between the two groups. Results: Mean Percentage fall in hemoglobin after surgery were 1.75±0.84 and 2.04±1.9 in the study and placebo groups, respectively (P=0.570). Hemoglobin loss was higher in the placebo group. Transfusion rates was lower in TA group (5.6%) compared to the placebo group (30%) (P=0.06). No significant difference in The Allowable Blood Loss during the surgery was found between the two groups (P=0.894). Conclusion: Preoperative treatment with TA reduces postoperative blood loss and the need for blood transfusion during traumatic femoral fracture operation. PMID:28497100

  3. Anatomic compatibility of femoral intramedullary implants: a cadaveric study.

    PubMed

    Biçer, Ömer Sunkar; Huri, Gazi; Tekin, Mustafa; Mirioğlu, Akif; Aydın, Ahmet; Tan, İsmet

    2016-01-01

    The purpose of this study was to describe the morphology of the proximal and diaphysis of femur, distribution of neck version, neck-shaft angles, and radius of anterior curvature in a Turkish population to compare with that of femoral intramedullary implants. Using 84 cadaveric femora, three-dimensional (3D) modeling was performed with a light scanner, data were transferred to Solidworks 2013 software (Solidworks, Waltham, MA, USA) to determine the variability in the femoral length (FL), neck version, neck-shaft angle (NSA), and anterior bow. Three independent observers' measurements were tested with a reliability analysis and then evaluated using Cronbach's alpha value, after which they were compared with the neck-shaft angles, and the radii of curvature (RAC) of intramedullary femoral nails, as stated on the official manufacturer websites. Mean FL, femoral neck anteversion (FNA), and NSA had ranges of 346.1-454.1 mm, -11.3-40.4°, and 105.9-149.0°, respectively, and RAC was between 1.0 and 1.2 m. The correlation coefficient and 95% confidence intervals (CI) were 0.89 (CI 0.849-0.928), 0.86 (CI 0.799-0.904), and 0.85 (95% CI 0.785-0.898) for FL, FNA, and NSA, respectively. FNA was <10° in 32 femora (37.6%) and >14° 38 (44.7%). NSA was between 130° and 135° in 40 femora (47.1%), and RAC ranged from 0.5 to 1.5 m in 76 femora (91.6%), <1 m in 38 (45.8%), and >1.5 m in 7 (8.4%). FNA and NSA show a wide distribution, mostly out of the range of intramedullary implants. There is a need for implants that are compatible with a range of NSAs and versions, so that they are suitable for use with a variety of morphologies.

  4. The effect of nail polish and acrylic nails on pulse oximetry reading using the Lifebox oximeter in Nigeria.

    PubMed

    Desalu, I; Diakparomre, O I; Salami, A O; Abiola, A O

    2013-12-01

    AIMS AND OBJECTIVES - Pulse oximetry is mandatory during anaesthesia, sedation and transfer of critically ill patients. The effect of nail polish and acrylic nails on the accuracy of saturation reading is inconsistent. The Lifebox pulse oximeter is reliable and recommended for low and middle income countries. We investigated its accuracy in the presence of 4 nail colours and acrylic nails SUBJECTS AND METHODS Fifty non-smoking volunteers had their fingers numbered from right to left (little finger of right hand =1 and little finger of left hand =10). Alternate fingers were nails painted with clear, red, brown and black nail polish and the 5th finger had acrylic nail applied. The corresponding finger on the other hand acted as control. The oxygen saturation was determined using the Lifebox pulse oximeter. Results All fingers (100%) with clear nail polish, red nail polish and acrylic nails recorded a saturation value. Each of the mean saturation value for clear nail polish, red nail polish and acrylic nails was not significantly different from the control mean (p= 0.378, 0.427 and 0.921). Only 12% and 64% of nails polished black and brown respectively recorded a saturation value. The mean SpO- for black and brown polish were significantly different from their control mean (p<0.001). CONCLUSION Black and brown polish resulted in a significant decrease in SpO with the Lifebox oximeter. Dark coloured nail polish should be removed prior to SpO2 determination to ensure that accurate readings can be obtained.

  5. In vitro human nail penetration and kinetics of panthenol.

    PubMed

    Hui, X; Hornby, S B; Wester, R C; Barbadillo, S; Appa, Y; Maibach, H

    2007-08-01

    The in vitro absorption of panthenol into and through the human nail was examined in this study. Panthenol, the alcohol form of pantothenic acid (vitamin B5), is believed to act as a humectant and improve the flexibility and strength of nails. A liquid nail treatment formulated with panthenol (2%) was compared to a solution of panthenol (2%) in water. Fingernail specimens were dosed daily for 7 days with either the nail treatment (non-lacquer film forming) formulation or aqueous solution with sampling performed every 24 h. Panthenol concentrations were determined in the dorsal surface, interior (by drilling and removal) and in the supporting bed under the human nail. Panthenol levels in the dorsal nail (R(2) = 0.87; P < 0.001), nail interior (R(2) = 0.94; P < 0.001) and nail supporting bed (R(2) = 0.79; P < 0.003) showed a significant linear increase with each day of dosing. Significantly more panthenol was delivered into the interior nail and supporting bed by a nail treatment formulation than from an aqueous solution. The film acts not only as a reservoir of panthenol, but also acts to increase the hydration of the nail and the thermodynamic activity of panthenol as well, thereby enhancing diffusion.

  6. 1st meeting on topical drug delivery to the nail.

    PubMed

    Murdan, Sudaxshina

    2007-07-01

    The first ever symposium dedicated solely to drug delivery to the nail following topical application was held on the 2nd April 2007, in London, UK, organised by Dr Clive Roper (Charles River Laboratories, Scotland) and Dr Sudaxshina Murdan (School of Pharmacy, University of London, UK), under the auspices of Skin Forum. The 1-day meeting was attended by approximately 35 delegates from industry, academia and hospitals, and provided a much-needed forum for the presentation and discussion of research and problems in this emerging field. Topical drug delivery is especially suitable for onychomycosis (fungal infections of the nail plate and/or nail bed) and nail psoriasis, which affect 2 - 13 and 1 - 3% of the general population, respectively, and make up the bulk of nail disorders. Topical therapy would avoid the adverse events and drug interactions of systemic antifungal agents and the pain of injection when antipsoriatic agents are injected into affected nail folds. However, successful topical therapy is extremely challenging due to the very low permeability of the nail plate. Five speakers spoke about various aspects of topical drug delivery to the nail, including review of the nail plate structure, function, diseases, their existing therapies (systemic and topical), limitations and global sales. The need for effective topical drug delivery to the nail to overcome the problems associated with present treatment, and the fact that there are few topical formulations available for the treatment of nail fungal infections and psoriasis, and the even fewer effective formulations, was highlighted.

  7. Onychomycosis: Potential of Nail Lacquers in Transungual Delivery of Antifungals

    PubMed Central

    Sharma, Hemlata; Pathak, Kamla

    2016-01-01

    Onychomycosis constitutes the most common fungal infection of the nail (skin beneath the nail bed) that affects the finger as well as toe nails. It is an infection that is initiated by yeasts, dermatophytes, and nondermatophyte molds. Nail lacquers are topical solutions intended only for use on fingernails as well as toenails and have been found to be useful in the treatment of onychomycosis. Thus, in the present review an attempt has been made to focus on the treatment aspects of onychomycosis and the ungual delivery of antifungals via nail lacquer. Several patents issued on nail lacquer till date have also been discussed. Penetration efficiency was assessed by several researchers across the human nail plate to investigate the potentiality of nail lacquer based formulations. Various clinical trials have also been conducted in order to evaluate the safety and efficacy of nail lacquers in delivering antifungal agents. Thus, it can be concluded that nail lacquer based preparations are efficacious and stable formulations. These possess tremendous potential for clinical topical application to the nail bed in the treatment of onychomycosis. PMID:27123362

  8. Prospective evaluation of femoral head viability following femoral neck fracture

    SciTech Connect

    Binkert, B.; Kroop, S.A.; Nepola, I.V.; Grantham, A.S.; Alderson, P.O.

    1984-01-01

    The bone scans of 33 patients (pts) with recent subcapital fractures (fx) of the femur were evaluated prospectively to determine their value in predicting femoral head visability. Each of the 33 pts (ll men, 22 women, age range 30-92) had a pre-operative bone scan within 72 hrs of the fx (23 pts within 24 hrs). Anterior and posterior planar views of both hips and pinhole views (50% of pts) were obtained 2 hrs after administration of Tc-99m HDP. The femoral head was classified as perfused if it showed the same activity as the opposite normal side or if it showed only slightly decreased activity. Femoral heads showing absent activity were classified as nonperfused. Overall, 20 of the 33 pts showed a photopenic femoral head on the side of the fx. Only 2 pts showed increased activity at hte site of the fx. Internal fixation of the fx was performed in 23 pts, 12 of whom had one or more follow-up scans. Five of these 12 pts showed absent femoral head activity on their initial scan, but 2 showed later reperfusion. The other 7 pts showed good perfusion initially, with only 1 later showing decreased femoral head activity. The other 10 pts (7 of whom had absent femoral head activity) had immediate resection of the femoral head and insertion of a Cathcart prosthesis. The results suggest that femoral head activity seen on a bone scan in the immediate post-fx period is not always a reliable indicator of femoral head viability. Decreased femoral head activity may reflect, in part, compromised perfusion secondary to post-traumatic edema, with or without anatomic disruption of the blood supply.

  9. Laparoscopic repair of femoral hernia

    PubMed Central

    Yang, Xue-Fei

    2016-01-01

    Laparoscopic repair of inguinal hernia is mini-invasive and has confirmed effects. Femoral hernia could be repaired through the laparoscopic procedures for inguinal hernia. These procedures have clear anatomic view in the operation and preoperatively undiagnosed femoral hernia could be confirmed and treated. Lower recurrence ratio was reported in laparoscopic procedures compared with open procedures for repair of femoral hernia. The technical details of laparoscopic repair of femoral hernia, especially the differences to laparoscopic repair of inguinal hernia are discussed in this article. PMID:27826574

  10. Treatment of Nail Psoriasis: Common Concepts and New Trends

    PubMed Central

    Oram, Yasemin; Akkaya, A. Deniz

    2013-01-01

    The lifetime incidence of nail involvement in psoriatic patients is estimated to be 80–90%, and the nails can be affected in 10% to 55% of psoriatic patients. Psoriasis may also solely involve the nails, without any other skin findings, in which the treatment can be more challenging. Nail psoriasis may lead to considerable impairment in quality of life due to aesthetic concerns and more importantly limitations in daily activities resulting from the associated pain, which may be overlooked by the physicians. Several topical and systemic treatment modalities, as well as radiation and light systems, have been used in the treatment of nail psoriasis. In the last decade, the introduction of biologic agents and the utilization of laser systems have brought a new insight into the treatment of nail psoriasis. This paper focuses on the recent advances, as well as the conventional methods, in treating nail psoriasis in adults and children, in reference to an extensive literature search. PMID:23762032

  11. Twenty-Nail Dystrophy and Darier's (Darier-White) Disease.

    PubMed

    Sehgal, Virendra N; Chatterjee, Kingshuk; Chaudhuri, Anita; Verma, Prashant; Sharma, Sonal

    2015-01-01

    A 35-year-old married man presented with progressive distortion of all the nails of the hands and toes for the past 30 years. Initially, his parents noticed yellowish discoloration and roughness of the thumb nail at the age of 5 years. Since then, the changes have been insidious to involve the other nails. Currently, the nails are lusterless, rough, ridged, and difficult to trim. In addition, the patient has had dark, dirty-looking raised eruptions over the skin, attended by generalized itching, corresponding to the onset of the nail lesions. His mother experienced similar disease. Examination of the nails was marked by alternating elevation and depression (ridging) and/or pitting, lack of luster, roughening, sandpaper texture, and splitting, along with muddy, grayish white discoloration. Dystrophy of the nails was prominent. The changes were bilateral and symmetrical, affecting all 10 fingers and 10 toes (Figure 1).

  12. Matrix based system of isotretinoin as nail lacquer to enhance transungal delivery across human nail plate.

    PubMed

    Joshi, Monika; Sharma, Vijay; Pathak, Kamla

    2015-01-15

    The project was aimed at development of isotretinoin nail lacquer and assessment of its penetration efficiency across human nail plate. Preliminary studies (hydration enhancement factor and SEM) aided the selection of thioglycolic acid as permeation and eugenol was selected as local anesthetic in the formulation. The nail lacquer was optimized by 3(2) factorial design and a total of nine formulations were prepared and screened. In vitro adhesion and ex vivo permeation (cumulative drug permeation per unit area (CDP/A) = 6.61 ± 0.57 mg/cm(2)) across bovine hoof guided the selection of F3 as optimized formulation that was improvised. Viscosity adjustments to improve handling characteristics were affected by incorporation of ethyl cellulose (6%; F3M1) that scaled the viscosity to 312.681 cp and insignificantly (p > 0.05) affected CDP/A (6.32 ± 0.45 mg/cm(2)). In comparison to marketed preparation (Retino-A cream) F3M1 afforded two fold increase in CDP/A. The permeation characteristics were defined by Higuchi model (r(2) = 0.964) and flux value of 176 μg/cm(2)/h. Confocal laser scanning microscopy, after 72 h of nail lacquer application, revealed extensive distribution of the fluorescent tracer across the human nail plate in comparison to control that was confined to the top layer. Conclusively, an efficacious and stable nail lacquer of isotretinoin was developed for potential clinical topical use to target the drug to nail bed in treatment of nail psoriasis. Copyright © 2014 Elsevier B.V. All rights reserved.

  13. Influence of the intramedullary nail preparation method on nail's mechanical properties and degradation rate.

    PubMed

    Morawska-Chochół, Anna; Chłopek, Jan; Szaraniec, Barbara; Domalik-Pyzik, Patrycja; Balacha, Ewa; Boguń, Maciej; Kucharski, Rafael

    2015-06-01

    When it comes to the treatment of long bone fractures, scientists are still investigating new materials for intramedullary nails and different manufacturing methods. Some of the most promising materials used in the field are resorbable polymers and their composites, especially since there is a wide range of potential manufacturing and processing methods. The aim of this work was to select the best manufacturing method and technological parameters to obtain multiphase, and multifunctional, biodegradable intramedullary nails. All composites were based on a poly(l-lactide) matrix. Either magnesium alloy wires or carbon and alginate fibres were introduced in order to reinforce the nails. The polylactide matrix was also modified with tricalcium phosphate and gentamicin sulfate. The composite nails were manufactured using three different methods: forming from solution, injection moulding and hot pressing. The effect of each method of manufacturing on mechanical properties and degradation rate of the nails was evaluated. The study showed that injection moulding provides higher uniformity and homogeneity of the particle-modified polylactide matrix, whereas hot pressing favours applying higher volume fractions of fibres and their better impregnation with the polymer matrix. Thus, it was concluded that the fabrication method should be individually selected dependently on the nail's desired phase composition. Copyright © 2015 Elsevier B.V. All rights reserved.

  14. Non-Melanoma-Associated Dyschromia of the Proximal Nail Fold

    PubMed Central

    Cohen, Philip R

    2016-01-01

    Subungual melanoma with pigmentation beneath the nail that extends to involve the proximal nail fold is referred to as Hutchinson’s sign. Black or brown subungual discoloration involving the proximal nail fold secondary to other etiologies has been referred to as pseudo-Hutchinson’s sign. Three patients with nail discoloration and concurrent dyschromia of the proximal nail fold are described: a female with a chronic subungual hematoma and pseudo-Hutchinson’s sign, a male with culture-confirmed Pseudomonas aeruginosa (P. aeruginosa) of the nail with green discoloration involving the proximal nail fold, and a male with an acute subungual hematoma with red-purple subungual discoloration affecting the proximal nail fold. PubMed was searched for the following: black, brown, chloronychia, discoloration, dyschromia, green, hematoma, Hutchinson’s sign, nail, nail fold, proximal, pseudo-Hutchinson’s sign, red, subungual melanoma, syndrome. The papers were reviewed and appropriate references evaluated. In conclusion, melanoma-associated black proximal nail fold pigmentation is referred to as Hutchinson’s sign, and non-melanoma-associated black pigmentation has been designated as pseudo-Hutchinson’s sign. Subungual nail plate discoloration extending to involve the proximal nail fold may be black, green, or red-purple in patients with melanocytic and non-melanocytic lesions, bacterial infection (Pseudomonas), and acute subungual hematoma, respectively. Instead of creating a new terminology, we suggest that non-black subungual discoloration (green or red-purple) extending to involve the proximal nail fold be referred to as pseudo pseudo-Hutchinson’s sign. PMID:28090415

  15. A Clinical Study of 35 Cases of Pincer Nails

    PubMed Central

    Lee, Jae In; Lee, Young Bok; Oh, Shin Tack; Cho, Baik Kee

    2011-01-01

    Background Pincer nail is a nail deformity characterized by transverse overcurvature of the nail plate. Pincer nail can affect a patient's quality of life due to its chronic, recurrent course; however, there have been no clinical studies on the pincer nail condition in Korean patients. Objective The purpose of this study was to characterize the clinical findings and treatment of pincer nail. In addition, possible etiological factors were considered, and treatment efficacy was evaluated. Methods The medical records and clinical photographs of 35 patients (12 males, 23 females) who were diagnosed with pincer nail between August 1, 2005 and July 31, 2009 were studied. Results Patient age ranged from 10 to 77 (52.09±17.26) years, and there was a predominance of female (23 out of 35 patients, F:M=2:1). The mean duration of the disorder was 7.45 years (range 0.25~40); 85% had pincer nail for at least 1 year. In addition, 40% had a history of previous treatment and recurrence. There were 82.8% patients with the common type of pincer nails. The most commonly involved nails were both great toenails. Among 35 patients, nail grinding was started in 30 patients, and 25 patients showed clinical improvement with nail grinding. The width index increased and the height index decreased after treatment. The mean follow up period was 8.42 months (range 1~27), and 7 patients showed recurrence after 8.8 months (range 2~20). Among 35 patients, 5 patients were treated with nail extraction with matricectomy, and the symptoms resolved immediately. The mean follow up period was 7.6 months (range 0~19), and recurrence was not observed. Onychomycosis was also present in 37.1% of patients, and itraconazole pulse therapy for 3 months was added. Conclusion The results of this study demonstrate the clinical features of pincer nail in Korean patients. The findings show that the common type of pincer nail was most common, and nail grinding as a conservative treatment greatly improved pincer nails

  16. Side Effects: Skin and Nail Changes

    Cancer.gov

    Cancer treatments can cause skin to become dry, itchy, red, or peel. Nails may become dark, yellow, or cracked. Learn about signs of skin problems that may need urgent medical care. Get a helpful list of questions to ask your doctor.

  17. Intramedullary Mg2Ag nails augment callus formation during fracture healing in mice.

    PubMed

    Jähn, Katharina; Saito, Hiroaki; Taipaleenmäki, Hanna; Gasser, Andreas; Hort, Norbert; Feyerabend, Frank; Schlüter, Hartmut; Rueger, Johannes M; Lehmann, Wolfgang; Willumeit-Römer, Regine; Hesse, Eric

    2016-05-01

    Intramedullary stabilization is frequently used to treat long bone fractures. Implants usually remain unless complications arise. Since implant removal can become technically very challenging with the potential to cause further tissue damage, biodegradable materials are emerging as alternative options. Magnesium (Mg)-based biodegradable implants have a controllable degradation rate and good tissue compatibility, which makes them attractive for musculoskeletal research. Here we report for the first time the implantation of intramedullary nails made of an Mg alloy containing 2% silver (Mg2Ag) into intact and fractured femora of mice. Prior in vitro analyses revealed an inhibitory effect of Mg2Ag degradation products on osteoclast differentiation and function with no impair of osteoblast function. In vivo, Mg2Ag implants degraded under non-fracture and fracture conditions within 210days and 133days, respectively. During fracture repair, osteoblast function and subsequent bone formation were enhanced, while osteoclast activity and bone resorption were decreased, leading to an augmented callus formation. We observed a widening of the femoral shaft under steady state and regenerating conditions, which was at least in part due to an uncoupled bone remodeling. However, Mg2Ag implants did not cause any systemic adverse effects. These data suggest that Mg2Ag implants might be promising for intramedullary fixation of long bone fractures, a novel concept that has to be further investigated in future studies. Biodegradable implants are promising alternatives to standard steel or titanium implants to avoid implant removal after fracture healing. We therefore developed an intramedullary nail using a novel biodegradable magnesium-silver-alloy (Mg2Ag) and investigated the in vitro and in vivo effects of the implants on bone remodeling under steady state and fracture healing conditions in mice. Our results demonstrate that intramedullary Mg2Ag nails degrade in vivo over time without

  18. Titanium Elastic Nailing for Pediatric Tibia Fractures: Do Older, Heavier Kids Do Worse?

    PubMed

    Goodbody, Christine M; Lee, Rushyuan J; Flynn, John M; Sankar, Wudbhav N

    2016-01-01

    Elastic nailing is a common method of fixation for tibial shaft fractures in skeletally immature individuals. Poor outcomes of titanium elastic nails for femoral shaft fractures have been associated with increasing patient age and weight, especially patients weighing >50 kg. Our objective is to determine if there is an upper weight or age limit to the safe and effective use of titanium elastic nails for tibial shaft fractures in the pediatric population. This is a retrospective cohort study of patients who underwent stabilization of a tibial shaft fracture with titanium elastic nails at a large tertiary-care pediatric trauma center. Data collected included patient demographics, injury characteristics, and radiographic data. Weight groups were stratified as ≥ or <50 kg, and age groups as 14 years or older or less than 14 years old. Malunion was defined as 10 degrees of angulation in either the sagittal or coronal plane. Union was defined as bridging of ≥3 cortices on orthogonal radiographs. A significant difference in time to union was considered to be 3 weeks. Ninety-five patients were included with a mean age of 12.1 years (range, 6 to 16 y) and a mean weight of 50.2 kg (range, 21 to 122 kg). Malunion rate was similar between weight cohorts: 13.3% (6/45) in the ≥50-kg group and 10% (5/50) in the <50-kg group (P=0.61). Malunion rate was similarly comparable between age groups: 17.6% (6/34) in the 14 years and older group and 8.2% (5/61) in the less than 14-year-old group (P=0.17). There was no statistically significant difference in time to union between weight or age cohorts. In sum, we did not find a significant difference in the rate of malunion or time to healing between younger and older patients or between lighter and heavier patients. The use of titanium elastic nails for tibial shaft fractures, unlike for other long bone fractures, seems not to be precluded in older and heavier patients. Level III.

  19. Short-term isotretinoin-induced elkonyxis and median nail dystrophy.

    PubMed

    Alli, Nuran; Dogan, Sibel

    2016-03-01

    Elkonyxis and median nail distrophy are very rare nail fold disorders due to the damage in nail matrix and proximal nail fold. Herein, we report a patient with both elkonyxis and median nail distrophy occured two months into a treatment course of isotretinoin that is to our knowledge for the first time.

  20. Mycotic femoral aneurysm.

    PubMed

    Wilson, Richard Scott; Bennett, Kenneth R

    2007-05-01

    After several weeks of fever and chills, a 31-year-old logger developed pain in his right thigh. Upon examination a tender, pulsating upper thigh mass was found with a long loud bruit arising from it. Severe aortic insufficiency was present; however, blood cultures were negative. An angiogram, captured blood with contrast spewing from the profunda femoral artery to fill a 5 x 10 cm sac. A false aneurysm was diagnosed and resected; numerous gram positive cocci were present in cut sections, but cultures from the cavity grew the gram negative bacteria Salmonella and Alcaligenes. After one month of intravenous ampicillin the aortic valve was replaced after being destroyed by endocarditis. Ampicillin was continued and recovery was uneventful. Mycotic aneurysms are commonly caused by Salmonella (10%), which was second only to Staphylococcus (30%). The femoral artery accounts for 38% of all mycotic aneurysms. They typically present with a pulsatile mass (52%), bruit (50%), and fever (48%). This diagnosis can be supported by leukocytosis (64-71%), positive blood cultures (50-85%), and a history of arterial trauma (51%) (injection drug use, intravascular procedure, or trauma) or endocarditis (10%).

  1. Coexistence of onychomycosis in psoriatic nails: a descriptive study.

    PubMed

    Natarajan, Vidhya; Nath, Amiya Kumar; Thappa, Devinder Mohan; Singh, Rakesh; Verma, Surendra Kumar

    2010-01-01

    Psoriatic nail changes predispose to onychomycosis because it becomes easier for fungi to penetrate an already compromised nail plate. Moreover, some of the psoriatic nail changes closely resemble onychomycosis. To investigate cases of nail psoriasis for any evidence of onychomycosis. Seventy-two patients with psoriasis were included in the study. The patients were selected from the psoriasis clinic and dermatology in-patient ward. Direct microscopic examination with 20% KOH and culture were carried out in all patients showing psoriatic nail changes. Histopathological examination with Periodic Acid-Schiff (PAS) stain was done in cases negative by KOH examination and culture. Nail changes were seen in 66.66% (48/72) of psoriasis patients. The most common fingernail changes observed were pitting, onycholysis and subungual hyperkeratosis, and the most common toenail changes were onycholysis and subungual hyperkeratosis. Nail changes were significantly more common in males. The duration of skin lesions of psoriasis and Psoriasis Area Severity Index scores were significantly higher in patients with nail changes. Out of 48 patients with psoriatic nail change, 23 (47.91%) had investigative evidence of onychomycosis. The fungal isolates on culture were non-dermatophytic molds in nine patients (18.75%) and yeast like fungi also in nine patients (18.75%). Coexistent onychomycosis in psoriatic nails does occur.

  2. Proximal femoral fracture surgery in a patient with osteopetrosis tarda: complications and treatment strategy

    PubMed Central

    Seyfettinoglu, Fırat; Tuhanioğlu, Ümit; Ogur, Hasan Ulas; Cicek, Hakan

    2016-01-01

    Osteopetrosis is a rare, inherited disease characterized by defects in osteoclastic function that results in defective bone resorption. When fractures are encountered, fixation is extremely difficult. Osteopetrosis patients have an increased predisposition to infection. If infection develops after a fracture, treatment is more difficult. In this paper, treatment is presented of a 49-year old female to whom proximal femoral nailing was applied for fixation of an osteopetrotic proximal femur fracture; and when it was unsuccessful, revision was made with a locked anatomic plate, which subsequently led to development of infection. PMID:27843357

  3. Transungual delivery of efinaconazole: its deposition in the nail of onychomycosis patients and in vitro fungicidal activity in human nails.

    PubMed

    Sakamoto, Misao; Sugimoto, Noriaki; Kawabata, Hideki; Yamakawa, Eiko; Kodera, Nobuyuki; Pillai, Radhakrishnan; Tatsumi, Yoshiyuki

    2014-11-01

    Effective transungual delivery of topical antifungal agents in onychomycosis has been hampered by poor nail permeation. To be effective they must have antifungal efficacy, and effectively permeate through the dense keratinized nail plate to the site of infection in the nail bed and nail matrix. The therapeutic efficacy of efinaconazole topical solution, 10% has been established in two phase 3 clinical trials in distal lateral subungual onychomycosis. To investigate the transungual delivery of efinaconazole in onychomycosis patients and its fungicidal activity in the toenail. Concentrations of efinaconazole were determined as part of a multi-center, open label study in forty onychomycosis patients following repeated application of efinaconazole topical solution, 5% and 10% to the toenails over 28 days, with a 2-week follow-up. Fungicidal activity against T. rubrum in the ventral layer of human nails was determined using an in vitro human nail infection model (ChubTur®). Efinaconazole concentrations in the nail were four orders of magnitude higher than MIC values of efinaconazole against dermatophytes. Further, nail drug concentrations were not influenced by the presence of disease or nail thickness, and maintained at high antifungal levels post-treatment. Efinaconazole was effective in reducing fungal viability, suggesting that sufficient amounts of efinaconazole were being delivered into the ventral layer of the nail plate.
    Effective transungual delivery of efinaconazole was demonstrated. The high efinaconazole concentrations in patient toenails and fungicidal activity in vitro potentially contribute to the clinical efficacy reported in phase 3 studies.

  4. Treatment of trochanteric fractures with the gamma3 nail - methodology and early results of a prospective consecutive monitored clinical case series.

    PubMed

    A C, Unger; E, Wilde; B, Kienast; C, Jürgens; A P, Schulz

    2014-01-01

    There is only sparse data on clinical results and complications of the third-generation Gamma nailing system (Gamma3, Stryker). Therefore, we started a large multi-centre case series in 2008. The aim of this paper is to present the study design and early results of a single arm of a prospective, consecutive, monitored, post-market follow-up evaluation of Gamma3 nails. From September 2009 to January 2012, 154 consecutive patients with an average age of 80 ± 1.43 years (50-99 years) and a trochanteric femoral fracture were included in the local arm of the trial. All patients that fulfilled the inclusion criteria were treated with a Gamma3 nail. Preoperative variables included age, gender, fracture classification, walking ability (Merle d'Aubigné score), daily activity level (retrospective Zuckerman score), ASA rating of operative risk, waiting time for operation, use of walker or crutches and body mass index (BMI). Skin-to-skin time, fluoroscopy time, blood loss, intraoperative complications and device information were recorded for each patient. Follow-up postoperative assessment was undertaken at 4, 12 and 24 months. Hip range of motion, pain around the hip and the tight, walking ability (Merle d'Aubigné score, Sahlgrenska mobility score) and management of daily life (Zuckerman score) were used to evaluate the outcome. The descriptive data of age, gender, BMI, ASA classification, fracture type and skin-to-skin time is similar to other studies. Median fluoroscopy time was 62 seconds (range: 4-225 seconds) and significantly shorter in closed reductions. No intraoperative implant-related complication was recorded. A cut-out of the leg-screw during assessment period occurred in 2.6% patients (n = 4). At the 12-month assessment two (1.8%) non-unions were identified and two patients (1.8%) had broken the femoral shaft below the 180 mm nail after a fall. Analysis of the scores showed significantly declined mobility and activity in daily life four months after operation

  5. [Three cases of removal of intrabronchial metal nails].

    PubMed

    Nohara, Jun; Lee, Synnum; Noguchi, Tetsuo; Sakaguchi, Yasuto; Kono, Tomoya; Terada, Yasuji

    2009-12-01

    We describe the successful extraction from an airway of foreign bodies metal nails in three cases. They were all carpenters, and often held nails between their lips. Case 1: a 72-year-old man had aspirated a nail three months earlier, but did not seek medical assistance at the time. A chest X-ray film and CT examination revealed a nail in the peripheral S7 region of the right lower lobe. The nail could not be extracted with forceps via bronchoscopy, so video-assisted thoracic surgery was performed. During surgery, the nail moved to the truncus intermedius, then it was extracted using bronchoscopy forceps. The extracted nail was rust-proof, and no rust was observed. Case 2 : a 76-year-old man visited our hospital with a history bloody sputum with a slightly dry cough for two months. A chest X-ray film showed a nail in the right hilum. Bronchoscopy revealed the nail covered with mucinous secretion in the right B7, and it was extracted by forceps. It was a rust-proof type nail, and no granulation tissue was observed in the bronchus. Case 3: a 74-year-old man visited our hospital because of dry cough for two months. A chest X-ray revealed a nail in the right hilus and bronchoscopy showed the nail was buried in reactive granulation tissue in the right middle lobe bronchus and could not be observed from the surface. Tranilast (n-[3,4-dimethoxycinnamoyl] anthranilic acid) at 300 mg/day and Methylprednisolone at 250 mg/day were prescribed for 4 days, followed by a reduction of the corticosteroid to 40 mg/day for 3 days. Seven days later, the granulation tissue and mucosal edema had diminished, and the nail was successfully extracted. The extracted nail was not rust-proof and had swollen with rust. These nails were found a few months after aspiration. The reason why these were not defected was possibly that the long and narrow shape did not obstruct the segmental bronchus and the symptoms can be less severe compared with other foreign bodies. The rust-proof nails were

  6. Early Clinical Experience with a Newly Designed Interlocking Nail System-Targon(®) Vet.

    PubMed

    Brückner, Michael; Unger, Martin; Spies, Markus

    2016-08-01

    To describe early clinical experience with a newly designed interlocking nail system (Targon(®) Vet) in diaphyseal fractures in cats and small dogs. Retrospective case series. Client-owned cats (n=49) and dogs (n=8). Fifty-seven consecutive cases (49 cats, 8 dogs) with 60 long bone fractures were included in the study. Follow-up radiographs were scheduled at 4 and 8 weeks and again 6 months postoperatively. The end point for each case was determined radiographically by a healed fracture. Complications were defined as minor or major. Clinical outcome was subjectively assessed by a full orthopedic examination and follow-up radiographs. Descriptive data are reported. Median age of cats was 18 months (range, 3-220 months) and of dogs was 28 months (range, 7-115 months). Median body weight was 3.7 kg (range, 1.67-8.41 kg) for cats and 8.15 kg (range, 2.68-13.6 kg) for dogs. Median radiographic follow-up was 16 weeks. All fractures with follow-up radiographs available (n=46) were healed with no infections reported. A total of 12 postoperative complications occurred: 3 minor (slippage of the locking screws) and 9 major (5 femoral-irritation of the sciatic nerve, stress protection, fracture because of a missed fissure, femoral neck fracture, intra-operative revision with a rod and plate; 4 tibial-3 with protrusion of the distal locking screw through the skin and 1 with in-growth of the intramedullary nail). Implantation of the Targon(®) Vet System was feasible in all cases. It provides an alternative system for diaphyseal fracture repair in cats and small dogs. © Copyright 2016 by The American College of Veterinary Surgeons.

  7. The management of leg-length discrepancy in Ollier's disease with a fully implantable lengthening nail.

    PubMed

    Baumgart, R; Bürklein, D; Hinterwimmer, S; Thaller, P; Mutschler, W

    2005-07-01

    Ollier's disease is characterised by severe deformity of the extremities and retarded growth because of multiple enchondromas. For correction of deformity, the Ilizarov method has been used although it has many complications. A 17-year-old boy with Ollier's disease had a limb-length discrepancy of 17.4 cm, with a valgus deformity of the right knee and recurvatum of the femur of 23 degrees . He had undergone three unsuccessful attempts to correct the deformities by using external fixators. We used a fully implantable, motorised, lengthening and correction nail (Fitbone) to achieve full correction of all the deformities without complications. We decided to carry out the procedure in three stages. First, we lengthened the femur by 3.6 cm and the tibia by 4 cm. We then exchanged the femoral nail for a longer implant and achieved a further 6 cm of length. This reduced the shortening to 3.8 cm. When the boy has finished secondary school we will adjust the remaining discrepancy.

  8. Comparative study between lateral decubitus and traction table for treatment of pertrochanteric fractures with cephalomedullary nails.

    PubMed

    Souza, Eric Fernando de; Hungria, José Octávio Soares; Rezende, Lucas Romano Sampaio; Bellan, Davi Gabriel; Borracini, Jonas Aparecido

    2017-01-01

    To perform a retrospective radiographic assessment of the reduction and implant position in the femoral head in patients with pertrochanteric fractures treated with cephalomedullary nailing in the lateral position versus traction table. Radiographs of patients with pertrochanteric fracture of the femur treated with cephalomedullary nailing in the lateral position and traction table were retrospectively evaluated. For the evaluation we used the anteroposterior radiographic view of the pelvis and the lateral view of the affected side. The cervicodiaphyseal angle, the tip-apex distance (TAD), and the spatial position of the cephalic component in the head were measured. Two patient groups were created, one group operated on the traction table and another group operated in the lateral position. Regarding the cervicodiaphyseal angle observed in the traction table group, the results of 11 patients (61.1%) were outside the acceptable parameters proposed in the present study. Both groups were equivalent regarding TAD and the position of the cephalic component in the head. A difference in the cervicodiaphyseal angle was observed; the group operated on the traction table had 11 patients (61.1%) whose measurements were outside the acceptable parameters.

  9. [Arthrodesis without bone fusion with an intramedullary modular nail for revision of infected total knee arthroplasty].

    PubMed

    Miralles-Muñoz, F A; Lizaur-Utrilla, A; Manrique-Lipa, C; López-Prats, F A

    2014-01-01

    To evaluate the outcome of knee fixation without bone fusion using an intramedullary modular nail and interposed cement. Retrospective study of 29 infected total knee arthroplasties with prospective data collection and a mean follow-up of 4.2 years (3-5). Complications included 2 recurrent infections, 1 peri-implant fracture, and 1 cortical erosion due to the tip of the femoral component. All of these were revised with successful results. The mean limb length discrepancy was 0.8 cm, with 24<1cm. Twenty-five patients reported no pain. The mean WOMAC-pain was 86.9, WOMAC-function 56.4, SF12-physical 45.1, and SF12-mental 53.7. Four patients needed a walking frame, and only two were dependent for daily activities. The Endo-Model Link nail is an effective method for knee fixation that restores the anatomical alignment of the limb with adequate leg length. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

  10. Genetics Home Reference: T-cell immunodeficiency, congenital alopecia, and nail dystrophy

    MedlinePlus

    ... alopecia, and nail dystrophy T-cell immunodeficiency, congenital alopecia, and nail dystrophy Printable PDF Open All Close ... expand/collapse boxes. Description T-cell immunodeficiency, congenital alopecia, and nail dystrophy is a type of severe ...

  11. [Biomechanical analysis of the medullary bone nail and its locking].

    PubMed

    Teubner, E

    1985-07-01

    By mechanical definition an intramedullary nail is not a nail but rather a bendable feather, subject to longitudinal tension and to a lesser degree to transverse pressure. Reaming the medullary canal is necessary for centralization of the nail as well as to increase the area of contact with the bone. However, this procedure is detrimental to the bone metabolism and reduces its elasticity against torsional forces. The dynamic locking nail-system is more biologic than conventional nailing and it reduces rotatory instability with the help of additional components, such as transverse screws. Only static locking allows true static weight bearing with crutches, but not dynamic mobilisation. Nails with conventional strength and in leaf of trefoil formation are superior to other designs. However, an improved angle in the proximal locking is suggested, as this would allow for a three to four times greater weight bearing.

  12. New developments in magnetic resonance imaging of the nail unit.

    PubMed

    Soscia, Ernesto; Sirignano, Cesare; Catalano, Onofrio; Atteno, Mariangela; Costa, Luisa; Caso, Francesco; Peluso, Rosario; Bruner, Vincenzo; Aquino, Maria Maddalena; Del Puente, Antonio; Salvatore, Marco; Scarpa, Raffaele

    2012-07-01

    The evolution of dedicated magnetic resonance imaging (MRI) musculoskeletal equipment allows new sequences and better images of the nail unit. The use of MRI has modified the imaging strategies used in treating inflammatory arthritis. In the case of psoriatic arthritis (PsA), the MRI study of the nail unit identifies nail involvement, which appears as an initial lesion for the induction of distal phalanx damage and consequently of distal interphalangeal joint arthritis. All patients with psoriasis, even in the absence of a clinically evident onychopathy, show characteristic MRI changes in the nail. This evidence could have a practical diagnostic value, because MRI study of the nail could document diagnosis in patients with undifferentiated spondyloarthropathies who have a barely evident psoriasis. We discuss the advantages and problems related to the use of low-field and high-field MRI in the study of the nail unit of patients with PsA.

  13. Computational comparison of reamed versus unreamed intramedullary tibial nails.

    PubMed

    Gómez-Benito, María José; Fornells, Pere; García-Aznar, José Manuel; Seral, Belén; Seral-Iñnigo, Fernando; Doblaré, Manuel

    2007-02-01

    We compared, via a computational model, the biomechanical performance of reamed versus unreamed intramedullary tibial nails to treat fractures in three different locations: proximal, mid-diaphyseal, and distal. Two finite element models were analyzed for the two nail types and the three kinds of fractures. Several biomechanical variables were determined: interfragmentary strains in the fracture site, von Mises stresses in nails and bolts, and strain distributions in the tibia and fibula. Although good mechanical stabilization was achieved in all the simulated fractures, the best results were obtained in the proximal fracture for the unreamed nail and in the mid-diaphyseal and distal fractures for the reamed nail. The interlocking bolts, in general, were subjected to higher stresses in the unreamed tibial nail than in the reamed one; thus the former stabilization technique is more likely to fail due to fatigue.

  14. Msx2 and Foxn1 regulate nail homeostasis.

    PubMed

    Cai, Jing; Ma, Liang

    2011-06-01

    Epithelial-mesenchymal interactions underlie the foundation for ectodermal appendage formation. Signal molecules such as BMPs and WNTs mediate crosstalk between the two tissue layers and coordinate both the induction and morphogenesis of ectodermal appendages. Here, we analyzed the function of two BMP downstream transcription factors, Msx2 and Foxn1, in nail differentiation. First, we show that Msx2 function is required during onychocyte (nail cell) terminal differentiation. Second, the Msx2/Foxn1/hair keratin pathway controlling hair differentiation is also conserved during onychocyte differentiation. Finally, the Msx2-/-; Foxn1-/- double-mutant nails exhibit a more severe phenotype than either single mutant including nail bed hyperplasia. Together, our data implicate important functions for Msx2 and Foxn1 in regulating differentiation of the keratogenous zone, proliferation of distal nail matrix cells, and organization of the nail bed.

  15. Relapse of Yellow Nail Syndrome with Pulmonary Lymphedema.

    PubMed

    Morimoto, Kozo; Saraya, Takeshi; Kurosaki, Atsuko; Yano, Ryozo; Sasaki, Yuka; Osawa, Takeshi; Kudoh, Shoji; Goto, Hajime

    2016-01-01

    Yellow nail syndrome (YNS) is a rare disorder characterized by the triad of yellow, thickened nails, lymphedema, and respiratory manifestations such as pleural effusions, bronchiectasis, and recurrent lower respiratory tract infections. We report a case of YNS showing pulmonary interlobular septal thickening on thoracic computed tomography, implying the presence of lymphatic edema. The patient showed both the remission and relapse of yellow nail with different lung treatments over a long clinical course.

  16. Retrograde tibial nail: anatomical implantation and surgical feasibility study.

    PubMed

    Kuhn, S; Appelmann, P; Pairon, P; Gruszka, D; Rommens, P M

    2015-01-01

    PURPOSE OF THE STUDY The treatment of distal tibial fractures requires a stable fixation while minimizing the secondary trauma to the soft tissues by the surgical approach and implant. The experimental Retrograde Tibial Nail is currently investigated as a minimally invasive alternative to plating and antegrade nailing. The purpose of this study was to evaluate the surgical feasibility in a cadaver model for all distal tibial fracture types generally considered treatable by nailing. MATERIAL AND METHODS Five different fracture types (AO/OTA 43-A1/A2/A3 and 43-C1/C2) were created on separate cadaveric limbs. In simple fractures (AO/OTA 43-A1/A2/A3) primary nailing was performed. In intraarticular fractures (AO/OTA 43-C1/2) reduction of the articular block and lag screw fixation was performed before nailing. Intraoperative complications, quality of reduction, fluoroscopy duration and operative time were evaluated. RESULTS Retrograde intramedullary nailing is feasible in simple fracture types by closed manual reduction and percutaneous reduction forceps. Retrograde nailing is possible in fractures with simple intraarticular involvement after primary lag screw fixation. The duration of surgery averaged 51.8 minutes (range 40-62 min). No major complications occurred during nailing. CONCLUSIONS The minimally invasive retrograde nail combines a minimally invasive local osteosynthesis with the ability to adequately fix extraarticular and simple intraarticular distal tibial fractures. The results suggests that retrograde tibia nailing is a promising new concept for the treatment of distal tibia fractures. Key words: minimally invasive surgery, tibia, metaphyseal fractures, intramedullary nailing, retrograde nailing.

  17. Drugs in nails: physiology, pharmacokinetics and forensic toxicology.

    PubMed

    Palmeri, A; Pichini, S; Pacifici, R; Zuccaro, P; Lopez, A

    2000-02-01

    In recent years, drug analysis in keratinised matrices, such as hair and nails, has received considerable attention because of several advantages over drug testing methodologies employing body fluids, such as urine or serum. For example, keratinic matrices, such as finger- and toenails, can accumulate drugs during long term exposure. Drugs are incorporated into nails by a double mechanism: (i) deposition into the root of the growing nail via the blood flow in the nail matrix; and (ii) incorporation via the nail bed during growth from the lunula to the beginning of the free margin. Together, these account for a wide retrospective window of drug detection. Nails can provide a good forensic matrix for the detection of drugs of abuse. Indeed, the international literature has reported the use of nail analysis in postmortem detection of drugs of abuse, drug testing in the workplace and drug screening to detect prenatal exposure, even though further studies are needed for correct interpretation of the data obtained. Another application of drug analysis in nails consists of the possibility of detecting the presence of an antimycotic at the site of action during antifungal therapy for patients with onychomycosis. When available, this evidence has permitted drug treatment of a shorter duration and reduced toxicity. However, so far the potential of drug monitoring in nails still lacks harmonisation and validation of analytical methodologies and a better comprehension of the possible correlation between drug concentrations in the matrix and period of exposure.

  18. Optimization of intramedullary nailing by numerical simulation of fracture healing.

    PubMed

    Wehner, Tim; Claes, Lutz; Ignatius, Anita; Simon, Ulrich

    2012-04-01

    Due to the annular gap between intramedullary (IM) nails and the endosteal surface, high interfragmentary movement can occur under loading. This could prolong the healing time, particularly for thin IM nails that are often used for unreamed IM nailing. The aims of our study were to determine the influence of the nail diameter on the healing time of human tibial shaft fractures and to investigate whether the healing time could be shortened by increasing the stiffness of the implant material. Therefore, a corroborated numerical model for simulating the fracture healing process in humans was used to simulate the healing process of human tibial fractures treated with IM nails. The calculated healing time (up to 71 weeks) was longest for transverse fractures treated with thin IM nails made of titanium. That the healing time was disproportionately long depended on the nail diameter, and could be greatly reduced by using a thicker nail or using steel instead of titanium. To avoid a prolonged healing time, the nail should be thick, and the annular gap should be as narrow as possible. Alternatively, using steel instead of titanium may also help to avoid a prolonged healing time.

  19. Radiographic findings in the nail-patella syndrome

    PubMed Central

    Louis, Thomas H.

    2015-01-01

    Nail-patella syndrome is a rare disorder characterized classically by the tetrad of nail hypoplasia or aplasia, aplastic or hypoplastic patellae, elbow dysplasia, and the presence of iliac horns. Iliac horns are considered pathognomonic, and the presence of hypoplastic or aplastic patellae in conjunction with nail abnormalities is a cardinal feature of diagnosis. Elbow dysplasia is present in most cases and can exhibit features typical of the syndrome. Herein we present the radiographic findings of the elbows, knees, and pelvis of a woman with nail-patella syndrome. PMID:26130880

  20. Yellow nail syndrome: does protein leakage play a role?

    PubMed

    D'Alessandro, A; Muzi, G; Monaco, A; Filiberto, S; Barboni, A; Abbritti, G

    2001-01-01

    Yellow nail syndrome is characterized by primary lymphoedema, recurrent pleural effusion and yellow discoloration of the nails. Although mechanical lymphatic obstruction is assumed to be the underlying pathology, it cannot explain the common finding of high albumin concentration in the pleural space. This paper describes a case of yellow nail syndrome presenting with the classical triad of lymphoedema, recurrent pleural effusion and yellow discoloration of the nails, associated with persistent hypoalbuminaemia and increased enteric loss of albumin. Based on the findings in this case and those in the literature, it is speculated that increased microvascular permeability may contribute to the pathogenesis of this syndrome.

  1. Insights into drug delivery across the nail plate barrier.

    PubMed

    Saner, Manish V; Kulkarni, Abhijeet D; Pardeshi, Chandrakantsing V

    2014-11-01

    Topical therapy is at the forefront in treating nail ailments (especially onychomycosis and nail psoriasis) due to its local effects, which circumvents systemic adverse events, improves patient compliance and reduces treatment cost. However, the success of topical therapy has been hindered due to poor penetration of topical therapeutics across densely keratinized nail plate barrier. For effective topical therapy across nail plate, ungual drug permeation must be enhanced. Present review is designed to provide an insight into prime aspects of transungual drug delivery viz. nail structure and physiology, various onychopathies, techniques of nail permeation enhancement and in vitro models for trans-nail drug permeation studies. Updated list of drug molecules studied across the nail plate and key commercial products have been furnished with sufficient depth. Patents pertinent to, and current clinical status of transungual drug delivery have also been comprehensively reviewed. This is the first systematic critique encompassing the detailed aspects of transungual drug delivery. In our opinion, transungual drug delivery is a promising avenue for researchers to develop novel formulations, augmenting pharmaceutical industries to commercialize the products for nail disorders.

  2. Unreamed intramedullary nailing in distal tibial fractures.

    PubMed

    Salem, Khaled Hamed

    2013-10-01

    Unreamed nailing has gained acceptance in the treatment of diaphyseal long bone fractures, especially in cases with polytrauma or high-energy injuries. Its application in distal tibial fractures, however, remains controversial. In this study, 101 distal tibial fractures treated using closed unreamed nailing were reviewed after a mean follow-up of 32 months. There were 59 type A und 42 type B fractures. The most common fracture pattern was the A1 spiral fracture (n = 40) followed by the B2 wedge fracture (n = 18). Intra-articular extension was encountered in 14 cases. One-fourth of the patients (n = 24) had open injuries. Forty-seven patients had additional injuries, and nearly one-third of them were polytraumatised. Union occurred after a mean time of 23.9 (range, 11-134) weeks. There were 13 cases of delayed union and seven non-unions; all healed eventually with additional surgery in only six fractures. Malunion was seen in 12 cases (five valgus, two varus and five external torsion), ten of which were associated with unplated fibular fractures. Three fractures (two open) were treated for deep infection. The most common complication seen was fatigue failure of the locking screws (27 cases). Unreamed nailing of distal tibial fractures is associated with a rather high rate of bone healing complications and locking screw failure. The decision for its use in the notoriously challenging fractures of this segment should be critically considered.

  3. Super U Technique for Ingrown Nails.

    PubMed

    Correa, J; Magliano, J; Agorio, C; Bazzano, C

    2017-06-01

    Ingrown nails are a common problem, seen mostly in young adults. Also known as onychcrypotisis, this condition typically affects the great toenail. Four stages have been defined according to the severity and duration of the condition, and treatment varies from conservative to surgical techniques depending on the stage. We present our experience with this condition, describing the characteristics of our population and surgical treatment, in particular the super U technique. This was a retrospective, descriptive study of patients with ingrown great toenail treated surgically using the super U technique. We also describe postoperative management. Ten patients with a mean age of 35.7 years underwent operation, 9 for unilateral ingrown great toenail and 1 for bilateral disease. Stage II ingrown nail was the most common. Half of the patients had been treated previously using other surgical techniques. The mean time to healing was 6 weeks. The only postoperative complication was infection in 1 patient. Mild to moderate postoperative pain persisted for a week. The majority of patients were satisfied with the cosmetic result. We believe the super U technique is very useful in stage II ingrown nail and in disease that has recurred after previous surgery, and is the treatment of choice in stage III or IV disease in which excessive hypertrophic tissue is found. Copyright © 2017 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.

  4. Prophylactic intramedullary nailing in monostotic fibrous dysplasia.

    PubMed

    Demiralp, Bahtiyar; Ozturk, Cagatay; Ozturan, Kutay; Sanisoglu, Yavuz S; Cicek, Ilker E; Erler, Kaan

    2008-06-01

    Fibrous dysplasia of bone is an enigma with no known cure. Treatment currently consists of curettage and bone-grafting in an attempt to eradicate the lesion and to prevent progressive deformity. This study presents the results of prophylactic intramedullary nailing in 10 patients with monostotic fibrous dysplasia, pain increasing with movement, and scintigraphically established activity. Ten patients with monostotic fibrous dysplasia in their upper or lower extremities treated between 2001 and 2003 were included in the study. Seven patients were male and 3 were female; their mean age was 26.9 years. The mean duration of follow-up was 33.5 months. Closed intramedullary nail without reaming was used in all cases. Bone grafting was not performed. Patients were allowed full weight bearing on the affected extremities on the second postoperative day. Mean VAS for functional pain was 5.33 +/- 0.65 preoperatively and 2.26 +/- 0.57 at final follow-up (p < 0.05). Radiographs showed no changes in lesion size, and the intramedullary fixation appeared to be stable. Prophylactic intramedullary nailing appeared to be beneficial in monostotic fibrous dysplasia with scintigraphically proven activity and functional pain. It also avoids problems that may occur following pathological fracture.

  5. Close association between metal allergy and nail lichen planus: detection of causative metals in nail lesions.

    PubMed

    Nishizawa, A; Satoh, T; Yokozeki, H

    2013-02-01

    Lichen planus (LP) is a common skin disorder of unknown aetiology that affects the skin, mucous membranes and nails. Although metal allergies have been implicated in the development of oral LP (OLP), the contribution of these allergies to nail LP (NLP) has yet to be studied in detail. To elucidate the link between metal allergy and NLP. We retrospectively analysed 115 LP patients with respect to the contribution of metals to either NLP or OLP. We also attempted to detect the specific metals involved in these nail lesions. Of the 79 patients that received a metal patch test (PT), 24 (30%) were positive for at least one of the metal compounds tested. Notably, the prevalence of positive reactions to metals in the NLP patients was significantly higher as compared with the OLP patients (59% vs. 27%, P < 0.05). Among the 10 PT-positive patients with NLP, improvement of the skin lesions was seen in six of the patients after removal of dental materials containing causative metals or systemic disodium cromoglycate therapy. On the other hand, only 3 of 16 PT-positive patients with OLP exhibited improvement after the removal of dental materials. Causative metals in the dental fillings/braces were detected in the involved nail tissues. This study suggests that metal allergies are more closely associated with NLP vs. OLP, and that deposited metals in the nail apparatus contribute to the development of lichenoid tissue reactions in the nail bed and matrix. © 2012 The Authors. Journal of the European Academy of Dermatology and Venereology © 2012 European Academy of Dermatology and Venereology.

  6. Femoral shaft osteotomy for obligate outward rotation due to SCFE.

    PubMed

    Stevens, Peter M; Anderson, Lucas; MacWilliams, Bruce A

    2017-04-01

    Slipped capital femoral epiphysis (SCFE) is an adolescent disease that leads to retroversion of the femoral neck and shaft, relative to the head. Observing that patients with SCFE must walk with an outward foot progression angle and externally rotate the leg in order to flex the hip, we have been performing a femoral shaft rotational osteotomy wherein we rotate the lower femur 45° inward, relative to the upper femur. By correcting retroversion, our goal is to improve functional hip and knee motion, thereby mitigating the effects of SCFE impingement. This is a retrospective review of five hips in four patients (two boys and two girls), average age 14.7 years (range 11 + 7-18 years) who underwent femoral midshaft rotational osteotomy for correction of acquired retroversion of the femur secondary to severe SCFE. We compared clinical findings at the outset to those at an average follow-up of 46 months (range 24-74 months). Pre- and post-gait analysis was performed in three patients. Two of the patients underwent elective arthroscopic osteochondroplasty to alleviate residual FAI: contralateral arthroscopy is pending in one. The first patient in this series received a hip arthroplasty, 62 months after his osteotomy, at age 23. Following midshaft osteotomy, all patients experienced improvement in comfort, gait and activities of daily living. With the patella neutral, they had improved range of hip flexion from an average preoperative flexion of <25° to a postoperative flexion of >90°. Two patients (both male) had delayed union and some loss of correction, secondary to broken interlocking screws; each healed with reamed, exchange nailing. The interlocking screws have since been redesigned and enlarged. Femoral shaft rotational osteotomy restores the functional range of hip motion, while correcting obligate out-toeing and improving knee kinematics. This procedure is technically straightforward, permitting progressive weight bearing, while avoiding the risk of AVN

  7. Electromagnetic navigation reduces surgical time and radiation exposure for proximal interlocking in retrograde femoral nailing.

    PubMed

    Somerson, Jeremy S; Rowley, David; Kennedy, Chad; Buttacavoli, Frank; Agarwal, Animesh

    2014-07-01

    To compare the time required for proximal locking screw placement between a standard freehand technique and the navigated technique, and to quantify the reduction in ionizing radiation exposure. A fresh frozen cadaver model was used for 48 proximal interlocking screw procedures. Each procedure consisted of insertion of 2 anteroposterior locking screws. Standard fluoroscopic technique was used for 24 procedures, and an electromagnetic navigation system was used for the remaining 24 procedures. Procedure duration was recorded using an electronic timer and radiation doses were documented. Mean total insertion time for both proximal interlocking screws was 405 ± 165.7 seconds with the freehand technique and 311 ± 78.3 seconds in the navigation group (P = 0.002). All procedures resulted in successful locking screw placement. Mean ionizing radiation exposure time for proximal locking was 29.5 ± 12.8 seconds. Proximal locking screw insertion using the navigation technique evaluated in this work was significantly faster than the standard fluoroscopic method. The navigated technique is effective and has the potential to prevent ionizing radiation exposure.

  8. In Vitro Nail Penetration of Tavaborole Topical Solution, 5%, Through Nail Polish on Ex Vivo Human Fingernails.

    PubMed

    Vlahovic, Tracey; MPharm, Tejal Merchant; Chanda, Sanjay; Zane, Lee T; Coronado, Dina

    2015-07-01

    Onychomycosis is a common infection of the toenails that causes nail thickening and discoloration. The physical appearance of the infected nail can diminish self-image and negatively impact quality of life. Patients may use nail polish to mask the appearance of infected nails. To evaluate the in vitro nail penetration properties of tavaborole topical solution, 5%, through nail polish using ex vivo, non-diseased human fingernails. In study 1, tavaborole penetration was evaluated over 20 days of dosing using the Franz finite dose technique and modified Franz diffusion cells. Nails received either 1 coat of over-the-counter (OTC) typical polish or were left unpolished (controls). In study 2, tavaborole penetration was measured over 14 days of dosing using the finite dose technique and vertical diffusion cells. Nails were polished with either 4 coats or 1 coat of salon typical polish or with 2 coats or 1 coat of OTC typical polish, or they were left unpolished. In study 1, the mean ± standard deviation (SD) cumulative tavaborole penetration at day 21 was numerically higher, though not statistically significant, through polished nails (3,526 ± 1,433 μg/cm(2))vs unpolished nails (2,661 ± 1,319 μg/cm(2)).In study 2, the mean cumulative tavaborole penetration was also numerically higher (statistical significance not assessed) through all nails that received polish vs unpolished nails. At day 15, mean ± SD cumulative tavaborole nail penetration was 1,179 ± 554 μg/cm(2) through 4 coats of salon typical polish, 1,227 ± 974 μg/cm(2) through 1 coat of salon typical polish, 1,493 ± 1,322 μg/cm(2) through 2 coats of OTC typical polish, 1,428 ± 841 μg/cm(2) through 1 coat of OTC typical polish, and 566 ± 318 μg/cm(2) through unpolished nails. Results from these in vitro studies demonstrated that tavaborole penetrated through human nails with up to 4 layers of nail polish.

  9. Role of mechanical forces in hand nail configuration asymmetry in hemiplegia: an analysis of four hundred thumb nails.

    PubMed

    Sano, H; Ogawa, R

    2013-01-01

    To assess the relationship between nail configuration and mechanical force, the nail morphology and pinch strengths of the paralyzed and non-paralyzed sides of patients with hemiplegia were measured. Study 1: Analysis of nail configuration. Both thumb nails of 100 subjects with hemiplegia and 100 healthy volunteers (400 thumb nails) were enrolled. The left and right thumb nails were compared in terms of configuration, namely the curve index (defined as nail height/width). Study 2: Measurement of pinch strength. In 10 subjects with hemiplegia and 10 healthy volunteers, the pinch strengths of both sides were compared. Study 1: In the subjects with hemiplegia, the palsy side had a significantly higher curve index than the non-palsy side (32.7 ± 8.3 vs. 24.4 ± 6.5%). The two sides of the healthy volunteers did not differ significantly in terms of the curve index. Study 2: In all hemiplegia cases, the non-palsy side had a higher pinch strength. The differences were statistically significant (4.40 ± 1.90 vs. 0.05 ± 0.16 kg). In the healthy volunteers, the dominant and non-dominant sides did not differ significantly. Mechanical forces may affect the nail configuration and could participate in the pathophysiology of nail deformities.

  10. Computer-assisted navigation in total knee arthroplasty without femoral hardware removal.

    PubMed

    Hernandez-Vaquero, D; Suarez-Vazquez, A; Iglesias-Fernandez, S

    2012-01-01

    The use of navigation applied to total knee arthroplasty in knees with femoral hardware retained has not been studied. We use navigation in six patients to implant a total knee arthroplasty while retaining the femoral hardware. The retained materials were screws in two cases, diaphyseal plates in another two, intramedullary nails in one and supracondylar tube/plate in another one. Preoperative knee scores were within the 46-66 range, whereas the functional scores were within 40-68. The coronal deformity varied between 30° varus and 5° valgus. The final femoral mechanical axis was between 2° valgus and 3° varus; the axis of the limb was between 4° valgus and 3° varus. Knee scores improved in all cases, with scores between 75 and 90 points (p = 0.028); functional scores were between 64 and 90 points (p = 0.043).The final range of mobility was within the 70°-110° range, with a slight improvement over the preoperative status (p = 0.042). No complications have arisen throughout the follow-up (mean 16 months). The use of navigation constitutes a good option in the treatment with total arthroplasties for patients with femoral hardware retained.

  11. Biomechanical rationale for implant choices in femoral neck fracture fixation in the non-elderly.

    PubMed

    Panteli, Michalis; Rodham, Paul; Giannoudis, Peter V

    2015-03-01

    Femoral neck fractures represent a relatively uncommon injury in the non-elderly population often resulting from high-energy trauma. The cornerstone of their management is anatomic reduction and stable internal fixation of the femoral neck in an attempt to salvage the femoral head. Complications including avascular necrosis of the femoral head, non-union and post-traumatic osteoarthritis are not uncommon. The clinical outcomes of these patients can be improved with good pre-operative planning, optimization of surgical procedures and introduction of new improved implants and techniques. In the herein study, we attempt to describe the biomechanical properties of the hip and compare the performance of the most commonly used devices. Experimental evidence suggests that in Pauwels type III fracture patterns a cephalomedullary nail was significantly stronger in axial loading. Moreover, in unstable basicervical patterns cannulated screws (triangular configuration) demonstrated a lower ultimate load to failure, whereas in subcapital or transervical patterns both the cannulated screws (triangular configuration) and the sliding hip screw demonstrated no compromise in fixation strength. The fracture pattern appears to be the major determinant of the ideal type of implant to be selected. For a successful outcome each patient needs to be considered on an individual basis taking into account all patient and implant related factors.

  12. Ingrown nails: a comparison of the nail matrix phenolization method with the elevation of the nail bed-periosteal flap procedure.

    PubMed

    Mori, H; Umeda, T; Nishioka, K; Iida, H; Aoki, K; Yokoyama, A

    1998-01-01

    Seventy-five procedures were performed on 62 patients with ingrown nails from 1992 to 1996. Those consisted of 51 nail matrix phenolization methods (NMP) and 24 elevation of the nail bed-periosteal flap procedures (ENF). Ingrown nails were classified into type A (normal nail plate) and type B (incurved nail plate). The duration and intensity of postoperative pain were assessed, and the recurrence rate was monitered. The recurrence rate was 3.9% in the NMP group and 4.1% in the ENF group. Concerning the recurrence rate, there was no statistical significance between ENF and NMP in both types. Postoperative pain intensity was less in the NMP group than in the ENF group in both types (P < 0.01). The same tendency was seen in postoperative pain duration. However, the NMP group had longer duration of wound healing compared with the ENF group in type A (P < 0.01). We conclude that NMP is a recommendable treatment for most ingrown nails.

  13. Did You Know Biting Your Nails Can Make You Sick?

    MedlinePlus

    ... symptoms of an infection called paronychia include a red, swollen area around the nail. If the infection is bacterial, you may develop pus-filled blisters. Nail biting is bad for your smile. The habit can cause your teeth to shift out of place or cause them to chip ...

  14. Evaluating a county-based Healthy nail Salon Recognition Program

    EPA Science Inventory

    To determine whether nail solons that participate in the SF recognition program have reduced measured levels of toluene, methyl methacrylate (MMA), and total volatile organic compounds (TVOC)as compared to nail salons that do not participate. We also evaluated changes in worker ...

  15. An unusual foreign body in urethra: nail clippers.

    PubMed

    Hatipoglu, Namik; Yucel, Mehmet; Hatipoglu, Nebahat; Yentur, Serhat; Semercioz, Attila

    2011-01-01

    A 37-year-old mentally retarded male patient complained of voiding difficulties. Physical examination revealed a foreign body in the urethra. The foreign body was found to be nail clippers and was removed with open surgery. This case of self-inserted nail clippers in the urethra by the patient is the first published report to our knowledge.

  16. Recovery of nail dystrophy potential new therapeutic indication of tofacitinib.

    PubMed

    Jaller, Jose A; Jaller, Juan J; Jaller, Antonio M; Jaller-Char, Juan J; Ferreira, Sineida Berbert; Ferreira, Rachel; Scheinberg, Morton

    2017-04-01

    Nail dystrophy is a heterogeneous skin condition and in some subtypes, is associated with autoimmune diseases in particular psoriasis and psoriatic arthritis. In this report, we show that tofacitinib, a novel therapy for rheumatoid arthritis, appears to be beneficial in patients with nail disease refractory to other conventional modes of therapy.

  17. Do fungi play a role in psoriatic nails?

    PubMed

    Szepietowski, Jacek C; Salomon, Joanna

    2007-11-01

    Onychomycosis is the most common disease of the nails and constitutes about a half of all nail abnormalities. Some factors like increasing age, male sex, repeated nail damage, genetic predispositions and underlying conditions, such as diabetes, immunodeficiency or peripheral arterial disease may predispose to develop onychomycosis. It is also suggested that abnormalities in nail morphology are the predisposing factors to onychomycosis. Psoriasis is one of the most common reasons of disturbed nail morphology and the spectrum of nail changes in psoriasis is very wide. Thus, there were suggestions that dystrophic nails in psoriatic patients lose their natural preventing barrier and therefore are more predisposed to fungal infection. This paper summarizes the knowledge about prevalence of onychomycosis among psoriatic patients and contains a literature review concerning this problem. Most authors report that the prevalence of onychomycosis in psoriatic patients is not higher than that in control population. However, especially yeasts and maybe moulds, probably as concomitant pathogens, are more often isolated from psoriatic patients than from non-psoriatic population. In reasonable cases, the mycological examination is required, especially when the clinical picture of the nails suggests the presence of fungal infection. In these cases, antifungal treatment may be beneficial for psoriatic patients.

  18. Evaluating a county-based Healthy nail Salon Recognition Program

    EPA Science Inventory

    To determine whether nail solons that participate in the SF recognition program have reduced measured levels of toluene, methyl methacrylate (MMA), and total volatile organic compounds (TVOC)as compared to nail salons that do not participate. We also evaluated changes in worker ...

  19. Various simultaneous nail changes due to valproic acid use.

    PubMed

    Solak, Berna; Oztas Kara, Rabia; Erdem, T

    2017-03-01

    There are only a few case reports about nail changes due to valproic acid in the literature despite its widespread use. We present a 50-year-old man who had onycholysis, roughness of the nail surface and brownish-yellow discoloration of both fingernails and toenails, which remarkably ameliorated upon cessation of valproic acid.

  20. Iontophoretically Enhanced Ciclopirox Delivery into and Across Human Nail Plate

    PubMed Central

    HAO, JINSONG; SMITH, KELLY A.; LI, S. KEVIN

    2009-01-01

    Transungual delivery of antifungal drugs is hindered by the low permeability of human nail plates, and as such, repeated dosing over a long period of time is necessary for effective treatment. The objectives of this study were to explore the possibilities of (a) enhancing the delivery of ciclopirox (CIC) across human nail plates and (b) sustaining CIC delivery from the larger resultant drug depot in the nail plates with constant voltage iontophoresis. In vitro passive and 9 V cathodal iontophoretic transport experiments of CIC across human nails were performed. Transungual CIC delivery with Penlac® was the control. The amounts of CIC released from and deposited in the nails were determined in drug release and extraction experiments, respectively. Iontophoresis increased the flux of CIC permeated across the nail approximately 10 times compared to passive delivery from the same formulation or from Penlac®. A significant amount of CIC was loaded into and released from the nails; the CIC concentrations were estimated to be above the minimum inhibitory concentrations of CIC for dermatophytic molds. The apparent transport lag time decreased in iontophoretic transport. The results demonstrate that iontophoresis was able to deliver an effective amount of CIC into and across the nails, and this suggests the feasibility of a constant voltage battery-powered transungual iontophoretic device. PMID:19117048

  1. Development of ciclopirox nail lacquer with enhanced permeation and retention.

    PubMed

    Thapa, Raj Kumar; Choi, Ju Yeon; Go, Toe Gyung; Kang, Min Hyung; Han, Sang Duk; Jun, Joon-Ho; Son, Mi Won; Yong, Chul Soon; Kim, Jong Oh

    2016-07-01

    Onychomycosis is a prevailing disease caused by fungal infection of nails that mostly affects athletes and the elderly. Ciclopirox is approved by the US Food and Drug Administration for the topical treatment of onychomycosis. However, the desired penetration of ciclopirox into the nail bed has not been achieved via topical application for efficient treatment. Therefore, the main aim of this study was to enhance ciclopirox permeation and retention in nail by the development of a new nail lacquer formulation. We screened the effects of different solvents, alkalizing agents, and permeation enhancers on the permeation of bovine hooves by ciclopirox and its retention in human nail clippings. The results suggest that isopropyl alcohol, potassium hydroxide, and urea as the solvent, alkalizing agent, and permeation enhancer, respectively, improved the permeation of the ciclopirox nail lacquer formulation the most with high flux rates. Comparison of the final formulation and marketed product revealed enhanced retention of ciclopirox from our developed formulation in human nail clippings. Therefore, our newly developed nail lacquer may be a potentially effective formulation for the treatment of onychomycosis in humans.

  2. Iontophoretically enhanced ciclopirox delivery into and across human nail plate.

    PubMed

    Hao, Jinsong; Smith, Kelly A; Li, S Kevin

    2009-10-01

    Transungual delivery of antifungal drugs is hindered by the low permeability of human nail plates, and as such, repeated dosing over a long period of time is necessary for effective treatment. The objectives of this study were to explore the possibilities of (a) enhancing the delivery of ciclopirox (CIC) across human nail plates and (b) sustaining CIC delivery from the larger resultant drug depot in the nail plates with constant voltage iontophoresis. In vitro passive and 9 V cathodal iontophoretic transport experiments of CIC across human nails were performed. Transungual CIC delivery with Penlac was the control. The amounts of CIC released from and deposited in the nails were determined in drug release and extraction experiments, respectively. Iontophoresis increased the flux of CIC permeated across the nail approximately 10 times compared to passive delivery from the same formulation or from Penlac. A significant amount of CIC was loaded into and released from the nails; the CIC concentrations were estimated to be above the minimum inhibitory concentrations of CIC for dermatophytic molds. The apparent transport lag time decreased in iontophoretic transport. The results demonstrate that iontophoresis was able to deliver an effective amount of CIC into and across the nails, and this suggests the feasibility of a constant voltage battery-powered transungual iontophoretic device.

  3. Biomechanical effect of different femoral neck blade position on the fixation of intertrochanteric fracture: a finite element analysis.

    PubMed

    Lee, Pei-Yuan; Lin, Kun-Jhih; Wei, Hung-Wen; Hu, Jin-Jia; Chen, Wen-Chuan; Tsai, Cheng-Lun; Lin, Kang-Ping

    2016-06-01

    Medial migration or cutout of the neck helical blade has commonly occurred in the treatment of trochanteric fracture of the femur. The position of the helical blade within the femoral head is one of the influencing factors that cause the blade to perforate the intact joint surface; however, the ideal placement of the helical blade is not currently known. A finite element model of a femur/nail construct was utilized to analyze five possible blade positions in the femoral head. Normal strain at the fracture surface, the minimum principal strain in the cancellous bone, and the von Mises stress in the implant itself were calculated and compared between different blade positions. The results showed that a large area of normal compressive strain at the fracture surface was observed in the inferior and posterior blade positions. The volume of cancellous bone strained to yielding in the femoral head and neck was lower for the inferior and posterior positions, whereas it was the highest for the superior position. The inferior and posterior positions had lower von Mises stress in the implant itself. The inferior and posterior positions may be the ideal position for the intramedullary nail with a helical neck blade.

  4. Magnetic resonance imaging of nail unit in psoriatic arthritis.

    PubMed

    Soscia, Ernesto; Scarpa, Raffaele; Cimmino, Marco Amedeo; Atteno, Mariangela; Peluso, Rosario; Sirignano, Cesare; Costa, Luisa; Iervolino, Salvatore; Caso, Francesco; Del Puente, Antonio; Salvatore, Marco; Soricelli, Andrea

    2009-08-01

    The use of magnetic resonance imaging (MRI) has modified the imaging strategies of inflammatory arthritides. In psoriatic arthritis (PsA), MRI study of the nail unit identifies nail involvement that appears as the initial lesion for induction of distal phalanx damage and consequently of distal interphalangeal joint arthritis. All psoriatic patients, also in the absence of a clinically evident onychopathy, show characteristic MRI changes of the nail. This evidence could have practical diagnostic value because MRI study of the nail could document diagnosis in patients with undifferentiated spondyloarthropathies who have barely evident psoriasis. We discuss the advantages and problems related to the use of low- and high-field MRI in the study of the nail unit of patients with PsA.

  5. Drug delivery into microneedle-porated nails from nanoparticle reservoirs.

    PubMed

    Chiu, Wing Sin; Belsey, Natalie A; Garrett, Natalie L; Moger, Julian; Price, Gareth J; Delgado-Charro, M Begoña; Guy, Richard H

    2015-12-28

    This study demonstrates the potential of polymeric nanoparticles as drug reservoirs for sustained topical drug delivery into microneedle-treated human nail. Laser scanning confocal microscopy was used to image the delivery of a fluorescent model compound from nanoparticles into the nail. A label-free imaging technique, stimulated Raman scattering microscopy, was applied, in conjunction with two-photon fluorescence imaging, to probe the disposition of nanoparticles and an associated lipophilic 'active' in a microneedle-porated nail. The results provide clear evidence that the nanoparticles function as immobile reservoirs, sequestered on the nail surface and in the microneedle-generated pores, from which the active payload can be released and diffuse laterally into the nail over an extended period of time.

  6. Safe surgical technique: intramedullary nail fixation of tibial shaft fractures.

    PubMed

    Zelle, Boris A; Boni, Guilherme

    2015-01-01

    Statically locked, reamed intramedullary nailing remains the standard treatment for displaced tibial shaft fractures. Establishing an appropriate starting point is a crucial part of the surgical procedure. Recently, suprapatellar nailing in the semi-extended position has been suggested as a safe and effective surgical technique. Numerous reduction techiques are available to achieve an anatomic fracture alignment and the treating surgeon should be familiar with these maneuvers. Open reduction techniques should be considered if anatomic fracture alignment cannot be achieved by closed means. Favorable union rates above 90 % can be achieved by both reamed and unreamed intramedullary nailing. Despite favorable union rates, patients continue to have functional long-term impairments. In particular, anterior knee pain remains a common complaint following intramedullary tibial nailing. Malrotation remains a commonly reported complication after tibial nailing. The effect of postoperative tibial malalignment on the clinical and radiographic outcome requires further investigation.

  7. Nail injury and diquat exposure: forgotten but not gone.

    PubMed

    Kibby, Thomas; Ring, Daniel S

    2012-01-01

    Primary fingernail changes that result from chemical exposures are seldom encountered in clinical practice. A cluster investigation was conducted on employees at a pesticide packaging company. Six employees reported simultaneous onset of defects occurring in their fingernails, including nail discoloration, nail dimpling, and nail shedding. Multiple pesticides and herbicides including diquat were used in the facility at the time of the cluster onset. A literature review noted 6 articles published before 1975 documenting similar nail changes associated with paraquat, diquat, or other herbicide use. Only one such case report published after 1985 could be located. Diquat was the only material that was previously reported in the medical literature as causing nail defects and also in use at this facility. Diquat exposure is the most plausible explanation for the observed changes in these workers' fingernails.

  8. Preliminary clinical experience with a new fluted humeral nail.

    PubMed

    Garnavos, C; Lunn, P G

    1994-05-01

    The early clinical results of humeral nailing using a fluted intramedullary nail with a locking screw are reported. The True-Flex nail has been designed with a proximal cancellous screw to prevent 'back-tracking' and with flutes to give rotational control. The design features have proved to be successful in the authors' brief clinical experience in 12 patients with complicated fractures, non-unions or pathological lesions. Eight of the 10 fractures healed uneventfully, one by delayed union; one had to be revised because of loosening due to use of a nail which was too narrow. There were no serious complications. Return of function in the arm was good. This humeral nail may be suitable for fixation of some complicated and difficult fractures and lesions of the humeral shaft.

  9. Expandable intramedullary nails for fixation of tibial shaft fractures.

    PubMed

    Ghafil, Dior; Ackerman, Pieter; Baillon, Renaud; Verdonk, Rene; Delince, Philippe

    2012-12-01

    Interlocking intramedullary nailing is currently the preferred treatment for most tibial fractures requiring operative treatment, with good results and a relatively low complication rate as reported in large clinical series. However, vascular and neurological complications caused by interlocking screws have been reported. In addition, insertion of distal interlocking screws can be technically demanding and may entail substantial exposure. We present the results with an expandable self-locking nail in the management of 52 AO type A and B tibial shaft fractures. The mean time to union was 15.8 weeks and the rate of union was 98%. The average surgical time was 60 minutes. Complications were those usually seen in diaphysis nailing and no complication was noted during nail expansion. Interlocking screws are not necessary, which reduces the risk of iatrogenic lesions. The expandable nail allows effective management of AO type A and B diaphyseal fractures of the tibia, a lower radiation exposure and shorter operative time.

  10. [Distribution of Luliconazole in Nail Plate by In Vitro Permeation and Efficacy by Zone of Inhibition Test after Treatment of Luliconazole Nail Solution].

    PubMed

    Shimamura, Tsuyoshi; Miyamae, Akiko; Arai, Masakazu; Minemura, Aya; Nozawa, Akira; Kubota, Nobuo

    2016-01-01

    To clarify the character of luliconazole nail solution we have developed, we investigated luliconazole distribution and antifungal activity in nail plate. An in vitro permeation study which measured luliconazole concentration of sliced nail in the transverse direction after treatment of luliconazole nail solution was conducted to investigate for concentration dependency and the influences of nail thickness and treatment duration. When 0.2, 1, 3, 5, and 7.5% luliconazole nail solutions were used, luliconazole was detected in the all the layers of nail and there was a concentration gradient from the dorsal side to deep nail layers. The luliconazole concentration was almost same after 14-day treatment with 5% luliconazole nail solution when using nails of different thicknesses. And we confirmed that concentration of luliconazole into the nail was increased depending on the treatment duration. In zone of inhibition test after 14-day treatment, 5% luliconazole nail solution showed statistically high formation rate of zones of inhibition compared to 8% ciclopirox nail lacquer. Above all, these data suggested that 5% luliconazole nail solution has the potential to show high therapeutic effect for onychomycosis.

  11. Treatment of the femoral shaft nonunion with double plate fixation and bone grafting: A case series of 14 patients.

    PubMed

    Maimaitiyiming, Asihaerjiang; Amat, Abdusami; Rehei, Aili; Tusongjiang, Mamatkeremula; Li, Cao

    2015-01-01

    The management of femoral shaft nonunion still remains a challenge in orthopaedic surgery. It represents a serious postoperative problem for the patient, associated with plate breakage and loosening, bone defect, shortening deformity and infection. A double plate fixation combined with bone grafting may become a promising therapeutic strategy for the treatment of patients with femoral shaft nonunion. In this study, our goal was to evaluate the clinical outcome of a novel approach for 14 consecutive patients with femoral shaft nonunion using double plate fixation with bone grafting. Retrospective data from June 2010 to August 2012 were obtained from records for 14 consecutive femoral shaft aseptic nonunion patients treated with double plate fixation combined with bone grafting. Nine patients were men and five patients were woman and average age of the patients was 26 years (range from 22 to 32 years). The mean time since injury was 26.2 months. The nonunion had resulted from repeated internal fixation failure (including plate or intramedullary nail fixation) in nine cases and primary internal fixation in five cases. All the 14 patients were followed up for an average of 14.8 (10-25) months. All cases achieved bony union without wound infection or fixation failure and the mean time to union was 5.2 months (range 4-7 months). Double plate fixation and bone grafting are a promising method for femoral shaft nonunion. In addition, this strategy is useful for such a nonunion caused by a repeated plate or intramedullary nail fixation failure with bone defect due to its strong stability with three-dimensional fixation and fully bone graft availability. Copyright © 2015 Elsevier Ltd. All rights reserved.

  12. Onychophagia (Nail biting), anxiety, and malocclusion.

    PubMed

    Sachan, Avesh; Chaturvedi, T P

    2012-01-01

    Nail biting is a stress removing habit adopted by many children and adults. People usually do it when they are nervous, stressed, hungry, or bored. All of these situations are having a common phenomenon between them is anxiety. Onychophagia is also a sign of other emotional or mental disorders. It is a habit that is not easy to quit and reflection of extreme nervousness or inability to handle stressful conditions. This abnormal habit may cause various malocclusions associated with dentoalveolar segment of the oral cavity. Crowding and rotations of incisors are common with this habit.

  13. Nail DNA and Possible Biomarkers: A Pilot Study

    PubMed Central

    Park, Joshua; Liang, Debbie; Kim, Jung Woo; Luo, Yongjun; Huang, Taesheng; Kim, Soo-Young

    2012-01-01

    Objectives Nail has been a substitute DNA source for genotyping. To investigate the integrity and consistency of nail DNA amplification for biomarker study, nail clippings from 12 subjects were collected at monthly intervals. The possibility of longer amplification and existence of GAPDH RNA/protein, were also investigated with three nail samples. Methods Three primer sets were designed for quantitative amplification of nuclear and mitochondrial genes and analysis of their consistency. The mean threshold cycles in amplification of the target genes were compared to test the consistency of polymerase chain reaction (PCR) performance among individual factors including age groups, sex, family, the nail source, and by the size of the amplification segments. Results The amplification of the target genes from nail DNA showed similar integrity and consistency between the nail sources, and among the serial collections. However, nail DNA from those in their forties showed earlier threshold cycles in amplification than those in their teens or seventies. Mitochondrial DNA (mtDNA) showed better DNA integrity and consistency in amplification of all three targets than did nuclear DNA (nucDNA). Over 9 kb of mtDNA was successfully amplified, and nested quantitative PCR showed reliable copy numbers (%) between the two loci. Reverse transcription PCR for mRNA and immunoblotting for GAPDH protein successfully reflected their corresponding amounts. Regarding the existence of RNA and protein in nails, more effective extraction and detection methods need to be set up to validate the feasibility in biomarker study. Conclusions Nail DNA might be a feasible intra-individual monitoring biomarker. Considering integrity and consistency in target amplification, mtDNA would be a better target for biomarker research than nucDNA. PMID:22880155

  14. Is there a bone-nail specific entry point? Automated fit quantification of tibial nail designs during the insertion for six different nail entry points.

    PubMed

    Amarathunga, J P; Schuetz, M A; Yarlagadda, K V D; Schmutz, B

    2015-04-01

    Intramedullary nailing is the standard fixation method for displaced diaphyseal fractures of tibia. Selection of the correct nail insertion point is important for axial alignment of bone fragments and to avoid iatrogenic fractures. However, the standard entry point (SEP) may not always optimise the bone-nail fit due to geometric variations of bones. This study aimed to investigate the optimal entry for a given bone-nail pair using the fit quantification software tool previously developed by the authors. The misfit was quantified for 20 bones with two nail designs (ETN and ETN-Proximal Bend) related to the SEP and 5 entry points which were 5 mm and 10 mm away from the SEP. The SEP was the optimal entry point for 50% of the bones used. For the remaining bones, the optimal entry point was located 5 mm away from the SEP, which improved the overall fit by 40% on average. However, entry points 10 mm away from the SEP doubled the misfit. The optimised bone-nail fit can be achieved through the SEP and within the range of a 5 mm radius, except posteriorly. The study results suggest that the optimal entry point should be selected by considering the fit during insertion and not only at the final position.

  15. Finite Element Analysis of Absorbable Sheath to Prevent Stress Shielding of Tibial Interlocking Intramedullary Nail

    NASA Astrophysics Data System (ADS)

    Dong, Yansheng; Wang, Yongqing; Dong, Limin; Jia, Peng; Lu, Fengcheng

    2017-07-01

    The nail with absorbable sheath (AS nail) is designed to reduce the stress shielding effect of internal fixation with interlocking intramedullary nail. In order to verify its feasibility, two types of the finite element models of internal fixation of tibia with the AS nail and the common metal nail (CM nail) are established using the Softwares of Mimics, Geomagic, SolidWorks and ANSYS according to the CT scanning data of tibia. The result of the finite element analysis shows that the AS nail has great advantages compared with the CM nail in reducing the stress shielding effect in different periods of fracture healing. The conclusion is that the AS nail can realize the static fixation to the dynamic fixation from the early to the later automatically to shorten the time of fracture healing, which also provides a new technique to the interlocking intramedullary nail.

  16. Intramedullary nailing of humeral shaft fractures.

    PubMed

    Sims, S H; Smith, S E

    1995-01-01

    Twenty-one patients with 22 acute traumatic fractures of the humeral diaphysis were treated either with the True/Flex intramedullary rod or the Russell-Taylor rod. Follow-up is provided on 20 fractures. Indications for fixation on all but 3 patients was either multiple fractures, associated chest or abdominal trauma, vascular interruption, or open fracture. The series included 4 open fractures. Time to union averaged 7.6 weeks, with two nonunions, both in open fractures. Two isolated preoperative radial nerve palsies resolved fully; four brachial plexus injuries had a more complex recovery. No iatrogenic nerve damage was encountered. Excluding those patients with brachial plexus deficits, shoulder range of motion returned reliably. Impingement with a rod prominence was noted in 1 fracture. Functionally, all of the fractures, aside from those associated with a brachial plexus injury, had a normal or only mildly limiting result as reported by the patient. Additionally, eight humeral nonunions were treated with a reamed Russell-Taylor humeral nail with supplemental iliac crest bone graft at the time of nailing in 3 patients. Five of these 8 patients went on to union.

  17. Nail Biting; Etiology, Consequences and Management

    PubMed Central

    Ghanizadeh, Ahmad

    2011-01-01

    Nail biting (NB) is a common, but unresolved, problem in psychiatry, psychology, medicine and dentistry. While it seems that NB is a simple behavior that can be stopped easily, many of the children with NB have already tried to stop it, but they have not been successful. The frustrations due to failed attempt involve others such as parents and siblings. The present review aims at providing an overview of prevalence, co-morbidities, education and counseling, and management for NB. Overall, the reviewed literatures suggest that co-morbidities of psychiatric disorders and other stereotypic behaviors in clinical sample of children with NB is more than 80%, and more than half of the parents suffer from psychiatric disorders mainly depression. Treatment of NB, however, is not as easy as it seems. The management of NB is much more complicated than just focusing on stopping it. Nail biting cannot be managed without considering its co-morbidities, antecedents and consequences. It might be concluded form the reviewed literature that children with NB, parents, siblings, and teachers should be educated about what to do and what not to do about NB. Punishment is not effective. Moreover, clinical randomized controlled trials are required to make available evidence-based behavioral and pharmacologic treatment protocols. PMID:23358880

  18. Femoral Head and Neck Excision.

    PubMed

    Harper, Tisha A M

    2017-07-01

    Femoral head and neck excision is a surgical procedure that is commonly performed in small animal patients. It is a salvage procedure that is done to relieve pain in the coxofemoral joint and restore acceptable function of the limb. Femoral head and neck excision is most commonly used to treat severe osteoarthritis in the coxofemoral joint and can be done in dogs and cats of any size or age. The procedure should not be overused and ideally should not be done when the integrity of the coxofemoral joint can be restored. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. An Initial lexicon of sensory properties for nail polish.

    PubMed

    Sun, C; Koppel, K; Chambers, E

    2014-06-01

    The objective of this study was to develop an initial lexicon for sensory properties of nail polish and to validate this lexicon using a descriptive analysis study of selected samples. Seventeen commercial products from four categories (regular, flake-containing, water-based and gel) were used in this study. Descriptive sensory analysis was conducted in this study to characterize and evaluate application and removal properties of these nail polishes. Data was then processed by ANOVA, Principal Component Analysis (PCA) and Pearson's Correlation Coefficient analysis to explore the differences among samples and attributes. A lexicon of 21 sensory attributes was developed to describe the application of nail polish. It included three initial texture attributes, thirteen initial appearance attributes and five aroma attributes. A lexicon of five attributes in five stages was developed to describe the removal of nail polish. The results from ANOVA and PCA showed that attributes in the lexicon separated the different product categories. The results of this study indicated that descriptive sensory analysis can be used to evaluate nail polish. The results of this study present scientists who are working on nail polish an additional tool to describe application and removal properties of nail polish. © 2014 Society of Cosmetic Scientists and the Société Française de Cosmétologie.

  20. A nail drilling method suitable for the diagnosis of onychomycosis.

    PubMed

    Mochizuki, Takashi; Kawasaki, Masako; Tanabe, Hiroshi; Ishizaki, Hiroshi

    2005-02-01

    We describe a nail drilling method suitable for the diagnosis of onychomycosis. Thirty-three patients with onychomycosis in which the big toenail had a white band or spike were enrolled in this study. We drilled a hole about 3-mm-wide in the most proximal part of the white band or spike using a ball-shaped metal file and then, through the hole, sampled the underlying nail material softened by fungi after removing the superficial hard nail plate. Fungi in 32 (97.0%) of the nail samples were detected by direct KOH examination. When incubated on Sabouraud's dextrose agar slant with chloramphenicol and cycloheximide, fungal cultures were obtained from 27 (81.8%) of the 33 nail samples. Fourteen of the fungal isolates were identified as T. rubrum, 11 as T. mentagrophytes, and 2 as Acremonium sp. The nail drilling method is suitable for diagnosing onychomycosis with a white band or spike, because it gives a high isolation rate and leaves the patients' nail relatively more intact compared with other methods.

  1. Enhancing the nail permeability of topically applied drugs.

    PubMed

    Murdan, Sudaxshina

    2008-11-01

    The topical therapy of nail diseases, especially of onychomycosis, and to a smaller extent, of nail psoriasis, is desirable to avoid the side effects associated with their systemic therapy, to increase patient compliance and reduce the cost of treatment. Systemic therapy is however the mainstay of treatment due to the poor permeability of the nail plate to topically applied drugs. For effective topical therapy, ungual drug permeation must be enhanced. This can be achieved by disrupting the nail plate using physical techniques or chemical agents. Alternatively, drug permeation into the intact nail plate may be encouraged, for example, by iontophoresis or by formulating the drug within a vehicle which enables high drug partition out of the vehicle and into the nail plate. The physical techniques (manual and electrical nail abrasion, acid etching, ablation by lasers, microporation, application of low-frequency ultrasound and electric currents) and chemicals (thiols, sulphites, hydrogen peroxide, urea, water, enzymes) that have shown ungual enhancer activity are discussed in this review. Optimal drug formulation, while crucial to ungual drug delivery, is only briefly reviewed due to the limited literature.

  2. How low should you go: novel device for nail trephination.

    PubMed

    Ciocon, David; Gowrishankar, T R; Herndon, Terry; Kimball, Alexa B

    2006-06-01

    The most commonly used treatment for subungual hematomas is nail trephination, a technique that is not standardized and that poorly controls for trephination depth. The objective was to test the safety and tolerance of a new device for nail trephination that uses innovative "mesoscission" or microcutting technology to create holes of specific depths in the nail plate without penetrating the nail bed. Fourteen adult subjects with healthy toenails had five holes drilled in a random single-blind fashion at different test settings into their right great toenail with this device and were assessed for pain and pressure tolerance as well as perioperative and postoperative complications. Nail trephination with this device in this small pilot study was controlled and well tolerated. The study population was small (n = 14) and the follow-up evaluation relied on patient self-report, which is not always reliable. The follow-up period was only 1 week and did not allow for evaluation of permanent nail plate deformity. Mesoscission may be a controlled and practical alternative to traditional nail trephining methods.

  3. Finger Tendon Travel Associated with Sequential Trigger Nail Gun Use.

    PubMed

    Lowe, Brian; Albers, James; Hudock, Stephen; Krieg, Edward

    2013-04-01

    Pneumatic nail guns used in wood framing are equipped with one of two triggering mechanisms. Sequential actuation triggers have been shown to be a safer alternative to contact actuation triggers because they reduce traumatic injury risk. However, the sequential actuation trigger must be depressed for each individual nail fired as opposed to the contact actuation trigger, which allows the trigger to be held depressed as nails are fired repeatedly by bumping the safety tip against the workpiece. As such, concerns have been raised about risks for cumulative trauma injury, and reduced productivity, due to repetitive finger motion with the sequential actuation trigger. This study developed a method to predict cumulative finger flexor tendon travel associated with the sequential actuation trigger nail gun from finger joint kinematics measured in the trigger actuation and productivity standards for wood-frame construction tasks. Finger motions were measured from six users wearing an instrumented electrogoniometer glove in a simulation of two common framing tasks-wall building and flat nailing of material. Flexor tendon travel was calculated from the ensemble average kinematics for an individual nail fired. Finger flexor tendon travel was attributable mostly to proximal interphalangeal and distal interphalangeal joint motion. Tendon travel per nail fired appeared to be slightly greater for a wall-building task than a flat nailing task. The present study data, in combination with construction industry productivity standards, suggest that a high-production workday would be associated with less than 60 m/day cumulative tendon travel per worker (based on 1700 trigger presses/day). These results suggest that exposure to finger tendon travel from sequential actuation trigger nail gun use may be below levels that have been previously associated with high musculoskeletal disorder risk.

  4. Finger Tendon Travel Associated with Sequential Trigger Nail Gun Use

    PubMed Central

    Lowe, Brian; Albers, James; Hudock, Stephen; Krieg, Edward

    2015-01-01

    TECHNICAL ABSTRACT Background Pneumatic nail guns used in wood framing are equipped with one of two triggering mechanisms. Sequential actuation triggers have been shown to be a safer alternative to contact actuation triggers because they reduce traumatic injury risk. However, the sequential actuation trigger must be depressed for each individual nail fired as opposed to the contact actuation trigger, which allows the trigger to be held depressed as nails are fired repeatedly by bumping the safety tip against the workpiece. As such, concerns have been raised about risks for cumulative trauma injury, and reduced productivity, due to repetitive finger motion with the sequential actuation trigger. Purpose This study developed a method to predict cumulative finger flexor tendon travel associated with the sequential actuation trigger nail gun from finger joint kinematics measured in the trigger actuation and productivity standards for wood-frame construction tasks. Methods Finger motions were measured from six users wearing an instrumented electrogoniometer glove in a simulation of two common framing tasks–wall building and flat nailing of material. Flexor tendon travel was calculated from the ensemble average kinematics for an individual nail fired. Results Finger flexor tendon travel was attributable mostly to proximal interphalangeal and distal interphalangeal joint motion. Tendon travel per nail fired appeared to be slightly greater for a wall-building task than a flat nailing task. The present study data, in combination with construction industry productivity standards, suggest that a high-production workday would be associated with less than 60 m/day cumulative tendon travel per worker (based on 1700 trigger presses/day). Conclusion and Applications These results suggest that exposure to finger tendon travel from sequential actuation trigger nail gun use may be below levels that have been previously associated with high musculoskeletal disorder risk. PMID

  5. Allergic contact dermatitis from acrylic nails in a flamenco guitarist.

    PubMed

    Alcántara-Nicolás, F A; Pastor-Nieto, M A; Sánchez-Herreros, C; Pérez-Mesonero, R; Melgar-Molero, V; Ballano, A; De-Eusebio, E

    2016-12-01

    Acrylates are molecules that are well known for their strong sensitizing properties. Historically, many beauticians and individuals using store-bought artificial nail products have developed allergic contact dermatitis from acrylates. More recently, the use of acrylic nails among flamenco guitarists to strengthen their nails has become very popular. A 40-year-old non-atopic male patient working as a flamenco guitarist developed dystrophy, onycholysis and paronychia involving the first four nails of his right hand. The lesions were confined to the fingers where acrylic materials were used in order to strengthen his nails to play the guitar. He noticed improvement whenever he stopped using these materials and intense itching and worsening when he began reusing them. Patch tests were performed and positive results obtained with 2-hydroxyethyl methacrylate (2-HEMA), 2-hydroxyethyl acrylate (2-HEA), ethyleneglycol-dimethacrylate (EGDMA) and 2-hydroxypropyl methacrylate (2-HPMA). The patient was diagnosed with occupational allergic contact dermatitis likely caused by acrylic nails. Artificial nails can contain many kinds of acrylic monomers but most cases of contact dermatitis are induced by 2-HEMA, 2-HPMA and EGDMA. This is the first reported case of occupational allergic contact dermatitis from acrylates in artificial nails in a professional flamenco guitar player. Since the practice of self-applying acrylic nail products is becoming very popular within flamenco musicians, we believe that dermatology and occupational medicine specialists should be made aware of the potentially increasing risk of sensitization from acrylates in this setting. © The Author 2016. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  6. Partial-limb salvage after persistent infection in the distal femoral prosthesis: straight-plasty--a novel technique.

    PubMed

    Kundu, Zile Singh; Gupta, Vinay; Gogna, Paritosh; Sangwan, Sukhbir Singh

    2014-03-01

    A 35 years old female had giant cell tumour (GCT) of the distal femur for which wide resection and distal femoral endoprosthetic replacement was performed. Massive infection of prosthesis required removal and replacement of the prosthesis with nail antibiotic cement spacer, which also proved to be futile. Ultimately the whole of the infected thigh had to be excised. The limb could be preserved partially using straight-plasty instead of amputation. Patient is well rehabilitated and doing well at a follow-up of 3 years.

  7. [Coombs-negative autoimmune hemolytic anemia developed after formation of post-operative pseudoaneurysm for femoral neck fracture].

    PubMed

    Hagihara, Masao; Hua, Jian; Inoue, Morihiro; Michikawa, Naohiko

    2011-03-01

    An 85-year-old woman was admitted to our hospital with severe anemia after nail-plate fixation of the left femoral neck fracture. The patient was diagnosed with Coombs-negative autoimmune hemolytic anemia based on the measurement of red blood cell (RBC)-bound IgG molecules per cell. Pseudoaneurysm of the left profunda femoris artery was detected on magnetic resonance imaging and successfully removed by surgical repair of the artery. Anemia promptly improved, and the number of RBC-bound IgG normalized after the surgery. The destruction of RBCs was thought to have been responsible for temporary induction of anti-RBC autoimmune antibodies.

  8. Ultrasound anatomy of normal nails unit with 18 mhz linear transducer.

    PubMed

    Cecchini, Andrea; Montella, Andrea; Ena, Pasquale; Meloni, Giovanni Battista; Mazzarello, Vittorio

    2009-01-01

    Interest is growing in non-invasive diagnostic methods for nails in dermatological pathology. Currently, nail disease diagnosis is based mostly on clinical evaluation; instrumental examination, traditionally, has been performed by magnetic resonance. Ultrasound (US) can be proposed as an easier and more available method for the study of the nail apparatus. In this study, the nail unit normal ultrasound anatomy was investigated to obtain data on adult normal parameters. On 35 healthy volunteers (20 women and 15 men--average age of 27 years) we performed an ultrasonographic study on the nail plate (dorsal and ventral), nail matrix and nail bed of all fingers of the hands using a 18 MHz linear transducer with Esaote Mylab 50. A thick gel layer allowed for appropriate transmission of ultrasound without any additional device. Macroscopic nail features were studied by clinical examination and photographic analysis. The following ultrasound parameters were investigated: nail thickness; nail bed thickness; matrix lenght; matrix-bone distance. Blood flow was studied with the use of colour and power colour Doppler. The nail apparatus echographic anatomy consists in: (a) nail plate, represented by two hyperechoic bands (dorsal and ventral) with an hypoechoic or anechoic space between them; (b) nail bed, represented by an area of dys-homogeneous hypo-echogeneity; (c) nail matrix, represented by a markedly hypoechoic area corresponding to the region under the nail sulcus; (d) ligaments, sometimes well detectable and formed by a specialized connective tissue; and (e) vessels, well evaluable through doppler examination.

  9. Ultrastructural and trace metal studies on radiographers' hair and nails.

    PubMed

    Majumdar, S; Chatterjee, J; Chaudhuri, K

    1999-02-01

    Scalp hair and fingernail samples of 42 medical radiographers and 42 nonradiographers (control) with matching age groups and food habits were collected for this study. Trace metal estimation by atomic absorption spectrometry (AAS) has indicated a significant increase (P < 0.001) in Zn, Cu, and Cd contents in the radiographers' hair and nails. Scanning electron microscopy (SEM) revealed structural changes in the hair and nails of radiographers. Significant alterations in the Zn and Cd contents along with extensive structural damage in the hair and nails probably indicate that low-dose X-radiation imposes stress on these radiation workers.

  10. A comparison of locked versus nonlocked Enders rods for length unstable pediatric femoral shaft fractures.

    PubMed

    Ellis, Henry Bone; Ho, Christine A; Podeszwa, David A; Wilson, Philip L

    2011-12-01

    Stainless steel flexible Enders rods have been used for intramedullary fixation of pediatric femur fractures with good success. Despite intraoperative anatomic alignment, length unstable femur fractures can present postoperatively with fracture shortening. The purpose of this study was to review all length unstable pediatric femoral shaft fractures in which Enders rods were used and compare those that were locked to those that were not locked. A retrospective clinical and radiographic review of all patients at a single institution undergoing flexible intramedullary fixation for length unstable femoral shaft fractures from 2001 to 2008. A length unstable fracture was defined as either a comminuted fracture or a spiral fracture longer than twice the diameter of the femoral shaft. A total of 107 length unstable femoral shaft fractures fixed with Enders rods were identified, of which 37 cases (35%) had both Enders rods "locked" through the eyelet in the distal femur with a 2.7 mm fully threaded cortical screw. Patient demographics, clinical course, complications, fracture characteristics, and radiographic outcomes were compared for the locked and nonlocked groups. There were no statistical differences between the groups in demographic data, operative variables, fracture pattern, fracture location, time to union, femoral alignment, or major complications. Shortening of the femur and nail migration measured at 1 to 6 weeks postoperatively was significantly greater for the nonlocked cases. The medial and lateral locked Enders rods moved 1.3 and 1.9 mm, respectively, and the unlocked Enders each moved 12.1 mm (P < 0.05). At final follow-up there were significantly more (P < 0.05) clinical complaints in nonlocked group, including limp, clinical shortening, and painful palpable rods. Locking Enders rods for length unstable pediatric fractures is an excellent option to prevent shortening and resulted in no additional complications, added surgical time, or increased blood loss

  11. Locking plate fixation of distal femoral fractures is a challenging technique: a retrospective review

    PubMed Central

    Toro, Giuseppe; Calabrò, Giampiero; Toro, Antonio; de Sire, Alessandro; Iolascon, Giovanni

    2015-01-01

    Summary Distal femoral fractures have typically a bimodal occurrence: in young people due to a high-energy trauma and in older people related to a low-energy trauma. These fractures are associated to a very high morbidity and mortality in elderly. Distal femoral fractures might be treated with plates, intramedullary nails, external fixations, and prosthesis. However, difficulties in fracture healing and the rate of complications are important clinical issues. The purpose of this retrospective review was to present our experience in treatment of distal femoral fracture in a sample of older people in order to evaluate the technical pitfalls and strategies used to face up the fractures unsuccessfully treated with locking plates. We included people aged more than 65 years, with a diagnosis of distal femoral fracture, treated with locking plates. We considered ‘unsuccessfully treated’ the cases with healing problems or hardware failures. Of the 12 patients (9 females and 3 males; mean aged 68.75 ± 3.31 years) included, we observed 3 ‘unsuccessfully cases’, 2 due to nonunions and 1 due to an early hardware failure, all treated using a condylar blade plate with a bone graft. One patient obtained a complete fracture healing after 1 year and in the other cases there was a nonunion. We observed as most common technical pitfalls: inadequate plate lengthening, fracture bridging, and number of locking screws. The use of locking plates is an emerging technique to treat these fractures but it seems more challenging than expected. In literature there is a lack of evidences about the surgical management of distal femoral fractures that is still an important challenge for the orthopaedic surgeon that has to be able to use all the fixation devices available. PMID:27134634

  12. Ciclopirox vs amorolfine: in vitro penetration into and permeation through human healthy nails of commercial nail lacquers.

    PubMed

    Monti, Daniela; Tampucci, Silvia; Chetoni, Patrizia; Burgalassi, Susi; Mailland, Federico

    2014-02-01

    One of the pre-requisite for a successful topical antifungal drug indicated for onychomycosis is its bioavailability into the nail unit for achieving fungal eradication and clinical benefit. The aim of this study was to compare in vitro permeation/penetration through and into human nails of amorolfine (MRF) from a 5% anhydrous commercial formulation (Loceryl®) and ciclopirox (CPX) from the 8% aqueous formulation in hydroxypropyl chitosan (HPCH) technology (Onytec®). The ability of the active ingredient to reach efficacious concentrations to inhibit nail pathogens was also evaluated. The amounts of drug permeated and retained in human healthy nails were determined using a suitably modified diffusion apparatus. HPLC analysis of the samples was performed. The HPCH-based CPX formulation demonstrated an efficient penetration into and permeation through the nail plates. Conversely, Loceryl® produced an amount of MRF permeated through and penetrated into the human toenails significantly lower than CPX. The evaluation of the efficacy index showed a higher potential efficacy of Onytec® with respect to Loceryl® on nail pathogens. The present work not only reinforced the previous results on different experimental substrates, but pointed out the superiority of HPCH-based Onytec® formulation containing CPX with respect to Loceryl® commercial product with MRF, both in terms of higher permeation through and penetration into the human nail, and for the efficacy towards the most common ungual pathogens.

  13. Antifungal activity, experimental infections and nail permeation of an innovative ciclopirox nail lacquer based on a water-soluble biopolymer.

    PubMed

    Togni, Giuseppe; Mailland, Federico

    2010-05-01

    P-3051 is an innovative 8% ciclopirox nail lacquer, based on hydroxypropyl chitosan (HPCH) as a film-forming agent. The authors' aim was to investigate P-3051's in vitro antifungal activity, as well as its in vitro and in vivo nail permeation. The dilution susceptibility tests performed for Trichophyton rubrum (T. rubrum) and Candida parapsilosis (C. parapsilosis) showed that the minimum inhibitory concentrations (MICs) of P-3051, as percent of ciclopirox, was for both fungi < or = 0.0015% (equivalent to a concentration of 15.6 mg/ ml). In the biological assay of in vitro nail permeation and fungal inhibition, the authors observed that P-3051 permeated well through bovine hoof membranes and produced dose-dependent inhibitory effects on dermatophyte, yeast and mold strains. Moreover, the inhibition effects were higher than those obtained by equal amounts of the ciclopirox reference nail lacquer. P-3051 and the reference showed the same protective activity in experimental infections with strains of dermatophytes isolated from clinical samples. The amount of ciclopirox remained in cut fingernails washed six hours after in vivo application of P-3051 ranged between 18 and 35% of the applied dose. After in vitro application to cut human nails, 40-50% of the applied ciclopirox penetrated during the first six hours, independent of nails being infected or uninfected, intact or filed. In both experiments, the concentration of ciclopirox is largely higher (three to four orders of magnitude) than the MICs for nail pathogens.

  14. Femoral head cartilage disarticulation disorder

    USDA-ARS?s Scientific Manuscript database

    Femoral head cartilage disarticulation disorder and necrosis is a major skeletal problem in broiler breeders since they are maintained for a long time in the farm. The etiology of this disease is not well understood. A field study was conducted to understand the basis of this metabolic disease. Six ...

  15. Cardiac resynchronization therapy: Femoral approach.

    PubMed

    Brandão, Luís; Miranda, Rita; Almeida, Sofia; Ribeiro, Luciano; Alvarenga, Carlos; João, Isabel; Pereira, Hélder

    2017-04-01

    We describe the case of a 62-year-old female patient with bilateral subclavian vein occlusion, in whom a cardiac resynchronization system was implanted via a femoral vein. Copyright © 2017 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  16. The best location for proximal locking screw for femur interlocking nailing: A biomechanical study

    PubMed Central

    Karaarslan, Ahmet A; Karakaşli, Ahmet; Aycan, Hakan; Çeçen, Berivan; Yildiz, Didem Venüs; Sesli, Erhan

    2016-01-01

    Background: Proximal locking screw deformation and screw fracture is a frequently seen problem for femur interlocking nailing that affects fracture healing. We realized that there is lack of literature for the right level for the proximal locking screw. We investigated the difference of locking screw bending resistance between the application of screws on different proximal femoral levels. Materials and Methods: We used a total of 80 proximal locking screws for eight groups, 10 screws for each group. Three-point bending tests were performed on four types of screws in two different trochanteric levels (the lesser trochanter and 20 mm proximal). We determined the yield points at three-point bending tests that a permanent deformation started in the locking screws using an axial compression testing machine. Results: The mean yield point value of 5 mm threaded locking screws applied 20 mm proximal of lesser trochanter was 1022 ± 49 (range 986–1057) (mean ± standard deviation, 95% confidence interval). On the other hand, the mean yield point value of the same type of locking screws applied on the lesser trochanteric level was 2089 ± 249 (range 1911–2268). Which means 103% increase of screw resistance between two levels (P = 0.000). In all screw groups, on the lesser trochanter line we determined 98–174% higher than the yield point values of the same type of locking screws in comparison with 20 mm proximal to the lesser trochanter (P = 0.000). Conclusion: According to our findings, there is twice as much difference in locking screw bending resistance between these two application levels. To avoid proximal locking screw deformation, locking screws should be placed in the level of the lesser trochanter in nailing of 1/3 middle and distal femur fractures. PMID:26955183

  17. Development of a fixation device for robot assisted fracture reduction of femoral shaft fractures: a biomechanical study.

    PubMed

    Weber-Spickschen, T S; Oszwald, M; Westphal, R; Krettek, C; Wahl, F; Gosling, T

    2010-01-01

    Robot assisted fracture reduction of femoral shaft fractures provides precise alignment while reducing the amount of intraoperative imaging. The connection between the robot and the fracture fragment should allow conventional intramedullary nailing, be minimally invasive and provide interim fracture stability. In our study we tested three different reduction tools: a conventional External Fixator, a Reposition-Plate and a Three-Point-Device with two variations (a 40 degrees and a 90 degrees version). We measured relative movements between the tools and the bone fragments in all translation and rotation planes. The Three-Point-Device 90 degrees showed the smallest average relative displacement and was the only device able to withstand the maximum applied load of 70 Nm without failure of any bone fragment. The Three-Point-Device 90 degrees complies with all the stipulated requirements and is a suitable interface for robot assisted fracture reduction of femoral shaft fractures.

  18. Witkop tooth and nail syndrome and orthodontics.

    PubMed

    Altug-Atac, Ayse T; Iseri, Haluk

    2008-03-01

    This case report presents the orthodontic treatment of a patient with Witkop syndrome, an autosomal dominant genetic disorder characterized by the absence of several teeth and abnormalities of the nails. The patient, a 6-year 4-month-old boy, was referred to our clinic for treatment of severe overjet and openbite. Radiographic and clinical evaluations showed peg-shaped maxillary lateral incisors and the congenital absence of three mandibular incisors as well as spoon-shaped fingernails. Treatment of openbite and overjet was initiated with functional appliances, and fixed orthodontic appliances were inserted at age 10 years 3 months. The edentulous spaces are being maintained for implants that will be provided once the patient's growth is complete. Evaluations of long-term treatment results to date have indicated improvements in both facial and dental esthetics.

  19. Fingernails: Do's and Don'ts for Healthy Nails

    MedlinePlus

    ... under your fingernails. Repeated or prolonged contact with water can contribute to split fingernails. Wear cotton-lined rubber gloves when washing dishes, cleaning or using harsh chemicals. Practice good nail hygiene. ...

  20. 14. Detail view of the old rotating nail case and ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    14. Detail view of the old rotating nail case and glass display cases now located in the second floor meeting room; looking southeast. - Horsepasture Store, U.S. Route 58 & State Route 687, Horse Pasture, Henry County, VA

  1. Hypotrichosis and nail dysplasia: a novel hidrotic ectodermal dysplasia.

    PubMed

    Harrison, Shannon; Sinclair, Rodney

    2004-05-01

    We report a unique isolated hair and nail ectodermal dysplasia in a 3-year-old girl. Clinical examination revealed short, sparse scalp hair, absent eyebrows, short eyelashes and nail dystrophy in all digits. Nail changes included shortened nail plate with distal onycholysis and loss of the cuticle. Sweating and teeth were normal. Development was normal. Scanning electron microscopy of the hair only demonstrated trichorrhexis nodosa. There was no pili torti. Vertically sectioned scalp biopsy revealed hypoplastic hair follicles and a horizontally sectioned biopsy showed a decrease in the overall number of hair follicles present. Treatment with topical minoxidil 5% 1 mL twice each day massaged into the scalp led to only minimal improvement and was discontinued after 12 months.

  2. Nail Biting: Does It Cause Long-Term Damage?

    MedlinePlus

    ... healthy ways, such as physical activity, to manage stress and anxiety Keeping your nails neatly trimmed or manicured Occupying your hands or mouth with alternate activities, such as playing a musical ...

  3. Coexistence of nail lichen planus and lichen planus pigmentosus*

    PubMed Central

    Lemes, Luciana Rodino; Verde, Renata Brandão Villa; Durães, Sandra Maria Barbosa; Araripe Junior, Adolpho de Alencar; Pantaleão, Luciana

    2016-01-01

    We describe a fifty-six-year old, Afro-descendent female patient showing dystrophy of her twenty nails and hyperchromic, asymptomatic macule on her face. Histopathological examination of the macule showed vacuolization of the basal layer, melanophages in the superficial dermis and lymphoplasmocytic inflammatory infiltrate. Nail biopsy revealed orthokeratotic hyperkeratosis and lichenoid inflammatory infiltrate. Lichen planus pigmentosus is an uncommon variety of lichen planus. It is characterized by typical hyperpigmented macules on the face and neck. Nail changes might be present in 10% of lichen planus cases, but no associations with lichen planus pigmentosus have been described. We report a case of lichen planus in twenty nails associated with lichen planus pigmentosus on the patient's face. PMID:28300883

  4. Coexistence of nail lichen planus and lichen planus pigmentosus.

    PubMed

    Lemes, Luciana Rodino; Verde, Renata Brandão Villa; Durães, Sandra Maria Barbosa; Araripe, Adolpho de Alencar; Pantaleão, Luciana

    2016-01-01

    We describe a fifty-six-year old, Afro-descendent female patient showing dystrophy of her twenty nails and hyperchromic, asymptomatic macule on her face. Histopathological examination of the macule showed vacuolization of the basal layer, melanophages in the superficial dermis and lymphoplasmocytic inflammatory infiltrate. Nail biopsy revealed orthokeratotic hyperkeratosis and lichenoid inflammatory infiltrate. Lichen planus pigmentosus is an uncommon variety of lichen planus. It is characterized by typical hyperpigmented macules on the face and neck. Nail changes might be present in 10% of lichen planus cases, but no associations with lichen planus pigmentosus have been described. We report a case of lichen planus in twenty nails associated with lichen planus pigmentosus on the patient's face.

  5. Penetrating Cardiac Nail Gun Injury in a Child.

    PubMed

    Kulaylat, Afif N; Chesnut, Charles H; Patel, Sunil; Rocourt, Dorothy V; Clark, Joseph B

    2016-08-01

    Nail gun injuries primarily occur in the extremities of adult males as a consequence of accidental occupational trauma. Such injury involving the thorax is much less common, and penetrating cardiac injury secondary to pneumatic nail gun discharge is rare. Although potentially lethal, most cases with cardiac trauma are survivable with expedient surgical intervention. Despite improvements in engineered safety mechanisms, the incidence of nail gun injuries has risen as use of the devices has increased. The widespread availability of these tools to nonprofessional consumers exposes a broader population to the potential hazards associated with these devices. We describe the presentation and successful management of the first reported case of penetrating cardiac nail gun injury in a young child.

  6. 6. REMAINS OF PLANK WALL NAILED TO POSTS WITHIN CANAL ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    6. REMAINS OF PLANK WALL NAILED TO POSTS WITHIN CANAL CONSTRUCTED TO PROTECT OUTSIDE CANAL BANK. VIEW IS TO THE WEST. - Snake River Ditch, Headgate on north bank of Snake River, Dillon, Summit County, CO

  7. Tibiotalocalcaneal Arthrodesis Using a Nitinol Intramedullary Hindfoot Nail.

    PubMed

    Hsu, Andrew R; Ellington, J Kent; Adams, Samuel B

    2015-10-01

    Tibiotalocalcaneal (TTC) arthrodesis using an intramedullary hindfoot nail is a common procedure for deformity correction and the treatment of combined tibiotalar and subtalar end-stage arthritis. Nonunion at one or both fusion sites is a difficult complication that can result in reoperation, significant morbidity, and below-knee amputation. There is currently a need for sustained compression across fusion sites using a TTC hindfoot nail with good mechanical stability. The DynaNail TTC Fusion System (MedShape, Inc, Atlanta, GA) uses an internal nitinol compression element to apply sustained compression across the tibiotalar and subtalar joints after surgery. In preliminary clinical cases, we have found that the nail is safe, reliable, and has promising clinical and radiographic results in settings of hindfoot arthritis, complex deformity, Charcot arthropathy, and talar avascular necrosis. Expert opinion, Level V. © 2015 The Author(s).

  8. The pattern of femoral diaphyseal fractures in children admitted in Sarawak General Hospital.

    PubMed

    Rasit, A H; Mohammad, A W; Pan, K L

    2006-02-01

    Trend towards changing the face of management for pediatric femoral fractures tends to advocate operative treatment. This study was undertaken to review our current practice in the wake of recent progress in the management of pediatric femoral fractures. Fifty patients with femoral diaphyseal fracture treated in Sarawak General Hospital were reviewed retrospectively after an average follow-up of 2.6 years. There were 36 boys and 14 girls, with a mean age of 6.2 years (range five months to 14 years). Children under six years of age constituted the majority of the patients. Half of the fractures were caused by road traffic accident. Nine patients had associated injuries. The most common site of fracture was at the middle third (N=31). The treatment regimens were delayed hip spica (DHS) in 16, immediate hip spica (IHS) in 24, plate osteosynthesis (PO) in five, titanium elastic nailing (TEN) in five, and external fixation (EF) in one. The minimum hospital stay was two days, and the maximum 33 days (mean, 9.7 days). Malunion was the commonest complication. Conservative treatment is the preferred option for children under six years of age. It is cost-effective with minimal complication. The other treatment options are reserved for specific indication in older children. Diaphyseal fractures of the femur in children can be adequately managed non-operatively.

  9. Confocal Raman spectrocopy for the analysis of nail polish evidence.

    PubMed

    López-López, Maria; Vaz, Joana; García-Ruiz, Carmen

    2015-06-01

    Nail polishes are cosmetic paints that may be susceptible of forensic analysis offering useful information to assist in a crime reconstruction. Although the nail polish appearance could allow a quick visual identification of the sample, this analysis is subjected to the perception and subjective interpretation of the forensic examiner. The chemical analysis of the nail polishes offers great deal of information not subjected to analyst interpretation. Confocal Raman spectroscopy is a well-suited technique for the analysis of paints due to its non-invasive and non-destructive nature and its ability to supply information about the organic and inorganic components of the sample. In this work, 77 regular and gel nail polishes were analyzed with confocal Raman spectroscopy using two laser wavelengths (532 and 780 nm). The sample behavior under the two laser wavelengths and the differences in the spectra taken at different points of the sample were studied for each nail polish. Additionally, the spectra obtained for all the nail polishes were visually compared. The results concluded that the longer laser wavelength prevents sample burning and fluorescence effects; the similarity among the spectra collected within the sample is not directly related with the presence of glitter particles; and 64% of the samples analyzed showed a characteristic spectrum. Additionally, the use of confocal Raman spectroscopy for the forensic analysis of nail polishes evidence in the form of flakes or smudges on different surfaces were studied. The results showed that both types of evidence can be analyzed by the technique. Also, two non-invasive sampling methods for the collection of the evidence from the nails of the suspect or the victim were proposed: (i) to use acetone-soaked cotton swabs to remove the nail varnishes and (ii) to scrape the nail polish from the nail with a blade. Both approaches, each exhibiting advantages and drawbacks in terms of transport and handling were appropriate

  10. Nail surgery: best way to obtain effective anesthesia.

    PubMed

    Jellinek, Nathaniel J; Vélez, Nicole F

    2015-04-01

    Nail procedures require an effective and reliable approach to anesthesia of the distal digit. Several techniques have been described in the literature. Herein, the relevant anatomy of the nail unit, pain pathways, anesthetic options, and several injection approaches to achieve complete anesthesia are reviewed. Also considered are the potential pitfalls and complications and their management. Ultimately, the physician's approach must be individualized to the patient, procedure, and setting.

  11. Practical Aspects of Posttrauma Reconstruction With an Intramedullary Lengthening Nail.

    PubMed

    Bernstein, Mitchell

    2017-06-01

    Limb equalization using the Ilizarov method has evolved and adapted the use of internal lengthening devices. One of the newest devices, termed "PRECICE," is a magnetically controlled telescoping nail. Complications such as pin site infection and skin irritation are eliminated. Despite trauma surgeons' familiarity with intramedullary nailing, the Ilizarov method requires sound knowledge of deformity analysis and awareness of specific complications associated with distraction osteogenesis. This manuscript discusses some of the practical preoperative and intraoperative components of limb lengthening.

  12. Dermoscopy and Onychomycosis: guided nail abrasion for mycological samples*

    PubMed Central

    Bet, Diego Leonardo; dos Reis, Ana Lucia; Chiacchio, Nilton Di; Belda Junior, Walter

    2015-01-01

    Mycological examination is still the cornerstone for the diagnosis of onychomycosis for many dermatologists, but sampling technique interferes on its sensitivity and specificity. Nail abrasion may be used to reach the most proximal part of the lesion and can be easily accomplished with an electric abrasor. We suggest nail plate dermoscopy to identify the best location for localized abrasion to obtain adequate samples for mycological examination. PMID:26734877

  13. Optical properties of human nails in THz frequency range

    NASA Astrophysics Data System (ADS)

    Guseva, Victoria A.; Gusev, Sviatoslav I.; Demchenko, Petr S.; Sedykh, Egor A.; Khodzitsky, Mikhail K.

    2017-03-01

    This work is devoted to investigation of optical properties (dispersion of refractive index, permittivity and absorption coefficient) of human nails in THz frequency range. These data were obtained by THz time-domain spectroscopy (TDS) technique in transmission mode. These results may be used to develop non-invasive technique of human pathologies control using nail as reference sample in reflection mode of THz TDS.

  14. White Nail Radio Transmitter: Billion Dollar Savings through Energy Efficiency

    DTIC Science & Technology

    2011-05-10

    energy consumption ashore by 50 percent CNO, Navy Energy Vision, P 10 White Nail Vision Your Cell Phone Cell ...Greenhouse Gas Power 4 1 Energy Navy Use 7.3 Billion kWh White Nail Cell Phone Savings 11 Billion kWh One and a half times!!! Saves the output of four of...Estimated Total Number of transmitters 3,000,000 Estimated total power saved Watt 1,250,000,000 Cell Phone Transmitter Efficiency 1.25 Gigawatts

  15. The functional results of tibial shaft fractures treated with intramedullary nail compressed by proximal tube.

    PubMed

    Karaarslan, Ahmet Adnan; Acar, Nihat; Aycan, Hakan; Sesli, Erhan

    2016-04-01

    Nailing of tibial shaft fractures is considered the gold standard surgical method by many surgeons. The aim of this retrospective study was to investigate and compare the clinical outcome of tibial shaft fractures treated with intramedullary nails compressed by proximal tube and conventional intramedullary interlocking nails. Fifty-seven patients with tibial shaft fractures, treated with intramedullary nails compressed by proximal tube (n = 32) and the conventional interlocking nails (n = 25), were reviewed. All fractures except for one were united without any additional surgical intervention in the proximal compression tube nail group, whereas in the conventional interlocking nail group, six patients needed dynamization surgery (p = 0.005) and three cases of nonunion were recorded. In the proximal compression tube nail group, faster union occurred in 20 ± 2 (16-24) weeks (mean ± SD; range) without failure of locking screws and proximal nail migration, whereas in the conventional interlocking nail group, union occurred in 22 ± 2.5 (17-27) weeks (p = 0.001) with two failures of locking screws and two proximal nail migration. The proximal compression tube nail system is safer than the conventional nailing methods for the treatment for transverse and oblique tibial shaft fractures with a less rate of nonunion, proximal locking screw failure and proximal nail migration.

  16. Nail polish as a source of exposure to triphenyl phosphate.

    PubMed

    Mendelsohn, Emma; Hagopian, Audrey; Hoffman, Kate; Butt, Craig M; Lorenzo, Amelia; Congleton, Johanna; Webster, Thomas F; Stapleton, Heather M

    2016-01-01

    Triphenyl phosphate (TPHP) is primarily used as either a flame retardant or plasticizer, and is listed as an ingredient in nail polishes. However, the concentration of TPHP in nail polish and the extent of human exposure following applications have not been previously studied. We measured TPHP in ten different nail polish samples purchased from department stores and pharmacies in 2013-2014. Concentrations up to 1.68% TPHP by weight were detected in eight samples, including two that did not list TPHP as an ingredient. Two cohorts (n=26 participants) were recruited to assess fingernail painting as a pathway of TPHP exposure. Participants provided urine samples before and after applying one brand of polish containing 0.97% TPHP by weight. Diphenyl phosphate (DPHP), a TPHP metabolite, was then measured in urine samples (n=411) and found to increase nearly seven-fold 10-14h after fingernail painting (p<0.001). To determine relative contributions of inhalation and dermal exposure, ten participants also painted their nails and painted synthetic nails adhered to gloves on two separate occasions, and collected urine for 24h following applications. Urinary DPHP was significantly diminished when wearing gloves, suggesting that the primary exposure route is dermal. Our results indicate that nail polish may be a significant source of short-term TPHP exposure and a source of chronic exposure for frequent users or those occupationally exposed. Copyright © 2015 Elsevier Ltd. All rights reserved.

  17. Nail psoriasis: clinical presentation and best practice recommendations.

    PubMed

    Edwards, Felicity; de Berker, David

    2009-01-01

    Nail involvement in psoriasis is common and can have a significant impact on quality of life. Manifestations of nail dystrophy in psoriasis include pitting, onycholysis, subungual hyperkeratosis and splinter haemorrhages. Clear evidence regarding the range of treatment options for nail psoriasis is lacking. Topical therapies, including corticosteroids and vitamin D(3) analogues, are simple to administer and readily available, but are not effective in treating all types of psoriatic nail dystrophy. Other topical agents have been tried, but may be less readily available. Intralesional corticosteroid injections can be helpful, but may be painful and time consuming. Psoralen plus ultraviolet A treatment has been shown to improve subungual hyperkeratosis, onycholysis, discolouration and nail crumbling, but not pitting. The possibility of future harm with other types of radiation treatment, including superficial radiotherapy and Grenz rays, limits their use. The use of systemic therapies, including the recent introduction of biological agents, is largely restricted to those with concomitant widespread cutaneous or joint involvement because of cost implications and potential toxicity. Further studies regarding the treatment of nail psoriasis are required in order to ascertain the best regimen of therapy for each patient.

  18. Prevalence and nature of nail alterations in pediatric patients.

    PubMed

    Iglesias, A; Tamayo, L; Sosa-de-Martínez, C; Durán-McKinster, C; Orozco-Covarrubias, L; Ruiz-Maldonado, R

    2001-01-01

    The purpose of this investigation was to explore the frequency and nature of ungual alterations in patients of a pediatric dermatology department at a third-level pediatric hospital. The first 20 patients with nail alterations seen each year during a 5-year period from 1992 through 1996 were included, totaling 100 patients. The rate of nail alterations was 11% (1/9) in pediatric dermatology patients. There were 5 infants, 19 preschoolers (2- to 5-year-olds), 38 school children (6- to 11-year-olds), and 38 adolescents (12- to 17-year-olds). The most frequent diagnoses were onychomycosis (23), nail alterations in a genodermatosis (23), nail alterations associated with dermatoses (16), onychocryptosis (11), and paronychia (10). Toenails were involved in 54 patients, fingernails in 25, and both in 21 patients. Twenty nails were involved in 21 patients. A high prevalence of nail alterations was found in pediatric dermatology patients, some of which were nonspecific, while others provided important diagnostic clues.

  19. An international survey about nail histology processing techniques.

    PubMed

    Wlodek, Christina; Lecerf, Pauline; Andre, Josette; Ruben, Beth S; de Berker, David

    2017-09-01

    There are limited data on nail histopathology techniques. The objective of this study was to examine nail histopathology techniques currently in use internationally. An online survey was sent to the European Nail Society and Council for Nail Disorders during 2015-2016. There were 57 respondents, from twenty countries comprising dermatologists, podiatrists and pathologists. Specimens were unmarked or marked using ink or a suture and fixed in 10% formalin, from 6 to 48 hours before embedding in paraffin wax (90% [17/19]), liquid nitrogen (frozen section, 1/19) and 2-hydroxyethylmethacrylate (plastic, 1/19). Nail softening was undertaken by 71% (17/24) of respondents for 6 to 48 hours using Mollifex Gurr (12.5%, 3/24), 10% potassium hydroxide solution (12.5%, 3/24) or 10% potassium thioglycolate cream (12.5%, 3/24). Section thickness was 4 to 9 µm (62.5%), using a steel microtome (92%,12/13) on glass slides (91.6%, 11/12). Hematoxylin and eosin (H&E) was routine for all biopsies and Periodic acid Schiff (PAS) for fungus. The favored stain for differentiating melanin and hemoglobin was Fontana-Masson (60%, 6/10). For pigmented lesions, Melan-A was always employed by all respondents (9/9). Nail histopathology processing has some small variations from normal skin processing. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  20. Nail Polish as a Source of Exposure to Triphenyl Phosphate

    PubMed Central

    Mendelsohn, Emma; Hagopian, Audrey; Hoffman, Kate; Butt, Craig M.; Lorenzo, Amelia; Congleton, Johanna; Webster, Thomas F.; Stapleton, Heather M.

    2015-01-01

    Triphenyl phosphate (TPHP) is primarily used as either a flame retardant or plasticizer, and is listed as an ingredient in nail polishes. However, the concentration of TPHP in nail polish and the extent of human exposure following applications have not been previously studied. We measured TPHP in ten different nail polish samples purchased from department stores and pharmacies in 2013–2014. Concentrations up to 1.68% TPHP by weight were detected in eight samples, including two that did not list TPHP as an ingredient. Two cohorts (n=26 participants) were recruited to assess fingernail painting as a pathway of TPHP exposure. Participants provided urine samples before and after applying one brand of polish containing 0.97% TPHP by weight. Diphenyl phosphate (DPHP), a TPHP metabolite, was then measured in urine samples (n=411) and found to increase nearly seven-fold 10–14 hours after fingernail painting (p<0.001). To determine relative contributions of inhalation and dermal exposure, ten participants also painted their nails and painted synthetic nails adhered to gloves on two separate occasions, and collected urine for 24 hours following applications. Urinary DPHP was significantly diminished when wearing gloves, suggesting that the primary exposure route is dermal. Our results indicate that nail polish may be a significant source of short-term TPHP exposure and a source of chronic exposure for frequent users or those occupationally exposed. PMID:26485058

  1. A study of dermoscopic features of nail psoriasis

    PubMed Central

    Artuz, Ferda

    2017-01-01

    Introduction Dermoscopy is a non-invasive imaging method that enables the evaluation of pigmented and non-pigmented skin lesions. More recently, dermoscopy has been recognized as an effective tool in the diagnosis of nail diseases. Aim To evaluate the dermoscopic features of nail psoriasis and to assess the relationship between these features and disease severity. Material and methods A total of 67 patients with clinically evident nail psoriasis (14 women, 53 men) were prospectively enrolled. Following a thorough clinical examination, patients were graded according to the Nail Psoriasis Severity Index and physician’s global assessment score. A dermoscopic examination of all fingernails and toenails was performed using a videodermatoscope. Mann-Whitney U and χ2 tests were used for statistical analysis, with a significance threshold of p < 0.05. Results The most frequently observed dermoscopic features were splinter haemorrhage (73.1%), pitting (58.2%), distal onycholysis (55.2%), dilated hyponychial capillaries (35.8%) and the pseudo-fiber sign (34.3%). The pseudo-fiber sign, dilated hyponychial capillaries, nail plate thickening and crumbling, subungual hyperkeratosis, transverse grooves, trachyonychia, pitting and salmon patches were positively associated with disease severity. Conclusions The pseudo-fiber sign described in this study appears to be a novel dermoscopic feature of nail psoriasis. We have demonstrated positive associations between a number of dermoscopic manifestations and disease severity. Further studies are required to support the present findings. PMID:28286468

  2. Tumors of the nail unit. A review. Part I: acquired localized longitudinal melanonychia and erythronychia.

    PubMed

    Perrin, Christophe

    2013-08-01

    The article aims to be a guide to the interpretation of tumors specific to the nail, that is, tumors presenting peculiar histological features linked specifically to the nail unit. Therefore, the classical epithelial, fibroepithelial, and fibrous skin tumors occurring in the nail region are not analyzed. The interpretation of nail biopsies requires the identification and integration of the 2 main clinical modes of presentation of nail tumors, the acquired localized (monodactylous) longitudinal (ALL) band pattern, and the "masked" nail tumor. The ALL band pattern often allows the recognition of a nail tumor in its early phase of progression, with a limited differential diagnosis. The masked nail tumor mimics an inflammatory nail process, as a clinically misleading reactive benign lesion, which delays diagnosis with the subsequent development of partial nail loss and a locally destructive evolution. ALL band pattern appears as a longitudinal band starting at the matrix and extending to the tip of the nail plate. The band is usually single, rarely bifid. This clinical pattern can divided into 2 presentations. The generic term of ALL maculonychia could be proposed to define the macular aspect of the colored band of the nail plate. It encompasses 3 syndromes: longitudinal melanonychia, longitudinal erythronychia, and longitudinal leukonychia. ALL pachyonychia is a rare presentation. Pachyonychia indicates a localized thickening of the nail plate specific to the matrical nail tumor. In this group, there is differentiation toward cells of the nail matrix. The prototype tumor is the onychomatricoma, which present classically with a yellow (xantholeukonychia) band pattern. Recently, a new clinical band pattern has been described as longitudinal pachymelanonychia with 2 etiologies: pigmented onychomatricoma and onychocytic matricoma. The first part of this review delineate, in the first section, the distinctive microanatomical features of the nail unit and the second is

  3. Histopathological examination of bone debris from reaming of interlocking intra-medullary nail fixation of long bone fractures with concomitant head injury.

    PubMed

    Khallaf, Fathy G; Kehinde, Elijah O

    2015-12-01

    The aim of study was to test, for the presence of osteoblasts in the reaming debris of intramedullary nailing of femoral and tibial fracture in patients with and without severe head injury. Two groups of patients were studied. Group A (n = 32) had long bone fractures in addition to having head injuries. Group B (n = 35) had only long bone fractures. The fractures in the 2 groups of patients was treated by inter medullary nailing. Osteoblasts in the debris of the inter medullary nailing was compared between the 2 groups of patients. The results demonstrated that histopathological specimens from reaming debris of fractured femur and tibia in patients with head injury showed osteoblasts in (82.9%) and in (27.5%) of patients with isolated long bone fractures (p < 0.001). Healing indicators in diaphyseal fractures and concomitant head injury confirm fast and adequate healing in these patients and the presence of plenty of osteoblasts in their reaming debris may reflect a proof of accelerated fracture healing environment.

  4. Radiation-free distal locking of intramedullary nails: evaluation of a new electromagnetic computer-assisted guidance system.

    PubMed

    Stathopoulos, Ioannis; Karampinas, Panagiotis; Evangelopoulos, Dimitrios-Stergios; Lampropoulou-Adamidou, Kalliopi; Vlamis, John

    2013-06-01

    Distal locking of intramedullary nails (IMNs) is a difficult part of intramedullary nailing (IMN) that could be time-consuming and expose the surgeon, the surgery personnel and the patient to a considerable amount of radiation as fluoroscopy is usually guiding the procedure. Utilization of electromagnetic fields for that purpose offers an attractive alternative. The SURESHOT™ Distal Targeting System (Smith & Nephew, Inc., Memphis, TN, USA) is a novel commercially available radiation-free aiming system that utilizes computerized electromagnetic field tracking technology for the distal locking of IMNs. In order to evaluate the efficacy of the system we conducted the present study. Nineteen patients (six females-thirteen males, mean age 39.5 years, range 17-85 years) with closed diaphyseal fracture of the femur (eight patients) or the tibia (eleven patients) were treated with IMN using the SURESHOT™ Distal Targeting System for the distal interlocking. All targeting attempts were successful at first try and followed by correct positioning of the screws. Mean time for distal locking of tibial IMNs (two screws) was 219sec (range 200-250sec). Mean time for distal locking of femoral IMNs (two screws) was 249 (range 220-330sec). In the current study the SURESHOT™ Distal Targeting System proved to be accurate, fast and easy to learn. Copyright © 2012 Elsevier Ltd. All rights reserved.

  5. Treatment of patellar instability in a case of hereditary onycho-osteodysplasia (nail-patella syndrome) with medial patellofemoral ligament reconstruction: A case report.

    PubMed

    Gong, Yubao; Yang, Chen; Liu, Yang; Liu, Jianguo; Qi, Xin

    2016-06-01

    Hereditary onycho-osteodysplasia, also known as nail-patella syndrome (NPS), is a rare genetic disorder that is primarily characterized by poorly developed nails and patella. Patients with NPS frequently suffer from patellar instability that requires surgical management. The present case report describes a 25-year-old man with NPS. The patient presented with left knee pain and was found to have recurrent left patellar dislocation. The knee pain was first reported 1-year after a minor knee trauma incident. Following complete evaluation, a diagnosis of NPS was reached. The patient underwent surgical intervention using medial patellofemoral ligament (MPFL) reconstruction with a gracilis tendon autograft looped through two transverse 3.2-mm drill holes in the patella and fixed at the natural MPFL insertion site on the medial femoral condyle with an interference screw. The surgery resulted in stabilization of the patella in the femoral trochlea and the patient did not have any subsequent dislocations or subluxations. The patient had an excellent range of knee movement in the follow-up period. This case indicates that MPFL reconstruction in patients with patellar dislocation secondary to NPS can successfully restore normal patellar tracking and result in good range of movement and functional activity.

  6. Treatment of patellar instability in a case of hereditary onycho-osteodysplasia (nail-patella syndrome) with medial patellofemoral ligament reconstruction: A case report

    PubMed Central

    GONG, YUBAO; YANG, CHEN; LIU, YANG; LIU, JIANGUO; QI, XIN

    2016-01-01

    Hereditary onycho-osteodysplasia, also known as nail-patella syndrome (NPS), is a rare genetic disorder that is primarily characterized by poorly developed nails and patella. Patients with NPS frequently suffer from patellar instability that requires surgical management. The present case report describes a 25-year-old man with NPS. The patient presented with left knee pain and was found to have recurrent left patellar dislocation. The knee pain was first reported 1-year after a minor knee trauma incident. Following complete evaluation, a diagnosis of NPS was reached. The patient underwent surgical intervention using medial patellofemoral ligament (MPFL) reconstruction with a gracilis tendon autograft looped through two transverse 3.2-mm drill holes in the patella and fixed at the natural MPFL insertion site on the medial femoral condyle with an interference screw. The surgery resulted in stabilization of the patella in the femoral trochlea and the patient did not have any subsequent dislocations or subluxations. The patient had an excellent range of knee movement in the follow-up period. This case indicates that MPFL reconstruction in patients with patellar dislocation secondary to NPS can successfully restore normal patellar tracking and result in good range of movement and functional activity. PMID:27284321

  7. Nail apparatus melanoma initially diagnosed as nail matrix blue nevus: a case report with dermatoscopy and dermatopathology

    PubMed Central

    Akay, Bengu Nisa; Heper, Aylin Okcu; Thomas, Luc; Balme, Brigitte; Clark, Simon; Rosendahl, Cliff

    2017-01-01

    We present a case of nail apparatus melanoma in a 50-year-old woman presenting as new and changing longitudinal melanonychia of the right thumb. Very heavy melanin pigmentation involving both the epidermis and dermis interfered with dermatopathological assessment, which initially leads to a diagnosis of nail matrix blue nevus. After consultation with a specialist multidisciplinary clinic the diagnosis was revised to invasive melanoma, a diagnosis consistent with the clinical and dermatoscopic assessment. PMID:28243499

  8. Chloronychia: green nail syndrome caused by Pseudomonas aeruginosa in elderly persons.

    PubMed

    Chiriac, Anca; Brzezinski, Piotr; Foia, Liliana; Marincu, Iosif

    2015-01-01

    Green nails, also known as chloronychia or green nail syndrome, are characterized by green discoloration of the nail plate (greenish-yellow, greenish-brown, greenish-black), proximal chronic non-tender paronychia, and distolateral onycholysis. The cause is Pseudomonas aeruginosa infection of the nail plate in persons whose hands are constantly exposed to water, soaps, and detergents or are subject to mechanical trauma, especially in the elderly. Green or black coloration of the nails should raise suspicion for Pseudomonas infection and be treated with an oral quinolone (ciprofloxacin), particularly in aged patients. We present three cases of green nails in elderly persons.

  9. Chloronychia: green nail syndrome caused by Pseudomonas aeruginosa in elderly persons

    PubMed Central

    Chiriac, Anca; Brzezinski, Piotr; Foia, Liliana; Marincu, Iosif

    2015-01-01

    Green nails, also known as chloronychia or green nail syndrome, are characterized by green discoloration of the nail plate (greenish-yellow, greenish-brown, greenish-black), proximal chronic non-tender paronychia, and distolateral onycholysis. The cause is Pseudomonas aeruginosa infection of the nail plate in persons whose hands are constantly exposed to water, soaps, and detergents or are subject to mechanical trauma, especially in the elderly. Green or black coloration of the nails should raise suspicion for Pseudomonas infection and be treated with an oral quinolone (ciprofloxacin), particularly in aged patients. We present three cases of green nails in elderly persons. PMID:25609938

  10. Fixator-assisted nailing and consecutive lengthening over an intramedullary nail for the correction of tibial deformity.

    PubMed

    Bilen, F E; Kocaoglu, M; Eralp, L; Balci, H I

    2010-01-01

    We report the results of using a combination of fixator-assisted nailing with lengthening over an intramedullary nail in patients with tibial deformity and shortening. Between 1997 and 2007, 13 tibiae in nine patients with a mean age of 25.4 years (17 to 34) were treated with a unilateral external fixator for acute correction of deformity, followed by lengthening over an intramedullary nail with a circular external fixator applied at the same operating session. At the end of the distraction period locking screws were inserted through the intramedullary nail and the external fixator was removed. The mean amount of lengthening was 5.9 cm (2 to 8). The mean time of external fixation was 90 days (38 to 265). The mean external fixation index was 15.8 days/cm (8.9 to 33.1) and the mean bone healing index was 38 days/cm (30 to 60). One patient developed an equinus deformity which responded to stretching and bracing. Another developed a drop foot due to a compartment syndrome, which was treated by fasciotomy. It recovered in three months. Two patients required bone grafting for poor callus formation. We conclude that the combination of fixator-assisted nailing with lengthening over an intramedullary nail can reduce the overall external fixation time and prevent fractures and deformity of the regenerated bone.

  11. [Osteonecrosis of the femoral head].

    PubMed

    Lafforgue, Pierre

    2002-03-15

    The femoral head is the main location of avascular osteonecrosis. The lesion remains asymptomatic for several months or years before causing non specific hip pain. Risk factors have been identified, mainly femoral neck fractures, corticosteroid therapy and related conditions (lupus erythematosus, organ transplantations), alcohol abuse, dyslipidemia, sickle cell disease, HIV infection, caisson workers, Gaucher's disease, male sex. When typical radiological signs are lacking, MRI is the best investigation. Progression toward hip joint damage highly depends on the necrotic volume assessed at MRI. The combination of plain radiographs which help staging the severity of osteonecrosis, and MRI which indicates the prognosis of the lesion, determines the therapeutic options: symptomatic pain relief therapies or surgical treatment (core decompression, osteotomy or total hip replacement).

  12. Arthroplasty in Femoral Head Osteonecrosis

    PubMed Central

    Nam, Dong Cheol; Jung, Kwangyoung

    2014-01-01

    Osteonecrosis of the femoral head is a destructive joint disease requiring early hip arthroplasty. The polyethylene-metal design using a 22-mm femoral head component, introduced by Charnley in 1950, has been widely used for over half a century. Since then, different materials with the capacity to minimize friction between bearing surfaces and various cement or cementless insert fixations have been developed. Although the outcome of second and third generation designs using better bearing materials and technologies has been favorable, less favorable results are seen with total hip arthroplasty in young patients with osteonecrosis. Selection of appropriate materials for hip arthroplasty is important for any potential revisions that might become inevitable due to the limited durability of a prosthetic hip joint. Alternative hip arthroplasties, which include hemiresurfacing arthroplasty and bipolar hemiarthroplasty, have not been found to have acceptable outcomes. Metal-on-metal resurfacing has recently been suggested as a feasible option for young patients with extra physical demands; however, concerns about complications such as hypersensitivity reaction or pseudotumor formation on metal bearings have emerged. To ensure successful long-term outcomes in hip arthroplasty, factors such as insert stabilization and surfaces with less friction are essential. Understanding these aspects in arthroplasty is important to selection of proper materials and to making appropriate decisions for patients with osteonecrosis of the femoral head. PMID:27536561

  13. [Slipped upper femoral epiphysis (SUFE)].

    PubMed

    Wirth, T

    2011-08-01

    A slipped upper femoral epiphysis (SUFE) is the most common disease of the hip among adolescents. In the light of our current knowledge on the development of coxarthrosis, it represents a first line model case that has led to a series of novel ideas in the therapy for SUFE. The development of coxarthrosis from a cam impingement, i.e., the loss of offset of the neck of the femur and degenerative damage to the acetabular lip as its early form, is seen again in the clinical picture of slipped upper femoral epiphysis. Depending on the degree of slippage, we see a varying severity of the loss of offset and thus also different extents of the potential damage to the hip joint. This knowledge is by no means new. The questions of reorientation of the epiphysis of the humeral head and thus restoration of the anatomy of the coxal end of the femur have been addressed by renowned surgeons and answered with the development of widely varying procedures for surgical correction. However, within the framework of the surgical techniques introduced for treatment of impingement syndromes of the hip, these therapeutic options have been supplemented and broadened. The current discussion about the best therapeutic strategies emphasizes the fascination of the clinical entity of upper femoral epiphysis and constitutes a central component of this article. © Georg Thieme Verlag KG Stuttgart · New York.

  14. Reconstruction of large area defect of the nail bed by cross finger fascial flap combined with split-thickness toe nail bed graft: A new surgical method.

    PubMed

    Yang, Jianyun; Wang, Tao; Yu, Cong; Gu, Yudong; Jia, Xiaotian

    2017-02-01

    Fingertip injury commonly results in avulsion of the nail bed. For large area defects of the nail bed with distal phalanx exposure, methods for reconstruction of soft tissue defects are scarcely mentioned in the literature.From May 2014 to January 2016, 6 patients with large area defects of the nail bed with distal phalanx exposure were enrolled. A new surgical method, cross finger fascial flap combined with thin split-thickness toe nail bed graft, was applied in all patients.All the 6 patients were followed-up at least 3 months. Good blood supply and no infections were observed. The lengths of the thumb or fingers were preserved. Acceptable appearance and nail bed growth were noted. The donor sites showed no dysfunction or deformity.Cross finger fascial flap combined with thin split-thickness toe nail bed graft is a new and rewarding surgical method to reconstruct large area defect of the nail bed with distal phalanx exposure.

  15. Reconstruction of large area defect of the nail bed by cross finger fascial flap combined with split-thickness toe nail bed graft

    PubMed Central

    Yang, Jianyun; Wang, Tao; Yu, Cong; Gu, Yudong; Jia, Xiaotian

    2017-01-01

    Abstract Fingertip injury commonly results in avulsion of the nail bed. For large area defects of the nail bed with distal phalanx exposure, methods for reconstruction of soft tissue defects are scarcely mentioned in the literature. From May 2014 to January 2016, 6 patients with large area defects of the nail bed with distal phalanx exposure were enrolled. A new surgical method, cross finger fascial flap combined with thin split-thickness toe nail bed graft, was applied in all patients. All the 6 patients were followed-up at least 3 months. Good blood supply and no infections were observed. The lengths of the thumb or fingers were preserved. Acceptable appearance and nail bed growth were noted. The donor sites showed no dysfunction or deformity. Cross finger fascial flap combined with thin split-thickness toe nail bed graft is a new and rewarding surgical method to reconstruct large area defect of the nail bed with distal phalanx exposure. PMID:28178151

  16. Dose-Effect Relationships for Femoral Fractures After Multimodality Limb-Sparing Therapy of Soft-Tissue Sarcomas of the Proximal Lower Extremity

    SciTech Connect

    Pak, Daniel; Vineberg, Karen A.; Griffith, Kent A.; Sabolch, Aaron; Chugh, Rashmi; Biermann, Janet Sybil; Feng, Mary

    2012-07-15

    Purpose: We investigated the clinical and dosimetric predictors for radiation-associated femoral fractures in patients with proximal lower extremity soft tissue sarcomas (STS). Methods and Materials: We examined 131 patients with proximal lower extremity STS who received limb-sparing surgery and external-beam radiation therapy between 1985 and 2006. Five (4%) patients sustained pathologic femoral fractures. Dosimetric analysis was limited to 4 fracture patients with full three-dimensional dose information, who were compared with 59 nonfracture patients. The mean doses and volumes of bone (V{sub d}) receiving specified doses ({>=}30 Gy, 45 Gy, 60 Gy) at the femoral body, femoral neck, intertrochanteric region, and subtrochanteric region were compared. Clinical predictive factors were also evaluated. Results: Of 4 fracture patients in our dosimetric series, there were three femoral neck fractures with a mean dose of 57.6 {+-} 8.9 Gy, V30 of 14.5 {+-} 2.3 cc, V45 of 11.8 {+-} 1.1 cc, and V60 of 7.2 {+-} 2.2 cc at the femoral neck compared with 22.9 {+-} 20.8 Gy, 4.8 {+-} 5.6 cc, 2.5 {+-} 3.9 cc, and 0.8 {+-} 2.7 cc, respectively, for nonfracture patients (p < 0.03 for all). The femoral neck fracture rate was higher than at the subtrochanteric region despite lower mean doses at these subregions. All fracture sites received mean doses greater than 40 Gy. Also, with our policy of prophylactic femoral intramedullary nailing for high-risk patients, there was no significant difference in fracture rates between patients with and without periosteal excision. There were no significant differences in age, sex, tumor size, timing of radiation therapy, and use of chemotherapy between fracture and nonfracture patients. Conclusions: These dose-volume toxicity relationships provide RT optimization goals to guide future efforts for reducing pathologic fracture rates. Prophylactic femoral intramedullary nailing may also reduce fracture risk for susceptible patients.

  17. Exploring the biology of the nail: An intriguing but less-investigated skin appendage.

    PubMed

    Saito, Masataka; Ohyama, Manabu; Amagai, Masayuki

    2015-09-01

    The nail is a highly keratinized structure covering the tip of the digit, and considered to have several important functions in our daily life. In recent years, as biological aspects of the nail organ have been characterized, we realize that the nail unit and the hair follicle share various biological and immunological features. In particular, development and homeostasis of the nail unit also requires intimate epithelial-mesenchymal interactions that involve signaling pathways such as Wnt. There is also a striking immunological resemblance between both appendages, since the nail matrix, like the anagen hair bulb and the bulge, was shown to present unique characteristics of an immune privileged site. On the other hand, considerable progress in identifying nail stem cells has succeeded in locating putative stem cell niches in the nail unit. In this context, it is intriguing that nail stem cells residing in the nail matrix were recently shown to possess the ability to organize the process leading to digit regeneration. Further elucidation of signaling pathways governing epithelial-mesenchymal interactions in the nail unit seems to be a key to develop a novel therapeutic tool to treat amputees using nail epithelium. However, it is at least certain that the nail unit has a promising potential for the future of regenerative medicine. This review explores the biology of the nail organ by focusing on intriguing knowledge gained from recent studies.

  18. Investigation of the content and of the distribution of chemical elements in human nails by SRXRF.

    PubMed

    Trunova, V A; Brenner, N V; Zvereva, V V

    2009-01-01

    The purpose of this investigation is to analyze 20 nails in individuals (and several persons) for the definition of how chemical elements distribute from nail to nail. The aim was to determine whether it will be rightful to take only one nail for the elemental analysis for the diagnostic of human state in future or not? Another purpose of the research is to analyze the elemental content of nails in temporal dynamic (in several persons). Analytical determinations of 20 nails of nine donors (healthy persons), nails of both hands and both feet were carried out. The analysis was performed by SRXRF. Symmetry of the elemental distribution in nails of right and left hands and right and left feet was found. The analysis of the distribution of chemical elements on the total area of a nail (55 points) was performed. The nail cutaway reflects adequately the distribution of several chemical elements over the nail plate area. In this study the elemental concentrations in nails of three donors in a 6-month period was determined. This study found the content of the chemical elements in donors' nails changes with time, individually.

  19. Nail bed INJury Assessment Pilot (NINJA-P) study: should the nail plate be replaced or discarded after nail bed repair in children? Study protocol for a pilot randomised controlled trial.

    PubMed

    Jain, Abhilash; Sierakowski, Adam; Gardiner, Matthew D; Beard, David; Cook, Jonathan; Cooper, Cushla; Greig, Aina

    2015-01-01

    Nail bed injuries account for the majority of paediatric hand trauma cases. Despite their frequency, controversy remains regarding their treatment. The accepted teaching is to remove the fingernail, repair the underlying nail bed with fine sutures and replace the nail under the nail fold. A recent study by Miranda et al. (Plast Reconst Surg. 129(2):394e-396e, 2012) suggests that replacing the nail is associated with increased complications, in particular post-operative infection. Nail bed INJury Assessment Pilot (NINJA-P) is an external pilot study for a large pragmatic, multicentre, randomised, controlled study (NINJA) to assess whether the nail should be replaced or discarded after nail bed repair in children under the age of 16. NINJA-P is a randomised pilot study. The participants are patients below 16 years of age who require surgical repair of the nail bed. Eligible patients will be randomised to receive one of two possible interventions. Group 1 will have the nail replaced after nail bed repair, and group 2 will have the nail discarded. The clinical outcome measures include the presence of post-operative complications at 2 weeks and 30 days, the cosmetic appearance of the nail at 4 months and the level of pain experienced by the child at their first dressings change at 2 weeks. In order to inform the design of the main NINJA trial, the following feasibility data will also be recorded: the number of potentially eligible children and the proportion which agree to take part in the study, the proportion of children who received the allocated treatment and reasons for any non-compliance and the proportion of participants with a valid response at each follow-up point. Neither the patient, family members nor treating physicians will be blinded. A replaced nail can take several weeks to fall off once a new nail has grown out. The cosmetic appearance of the nail at 4 months will be assessed by a blinded assessor. The NINJA-P pilot study will inform the design

  20. Femoral Nerve Palsy with Patella Fracture

    PubMed Central

    Lee, Sang Hyoung; Lee, Tong Joo; Woo, Min Su

    2013-01-01

    Femoral neuropathy may be associated with various etiologies and can cause severe walking disability. We present the case of a 25-year-old woman who underwent surgical repair for a patella fracture and complained of lower extremity pain, paresthesia, and weakness postoperatively. Electromyography and magnetic resonance imaging (MRI) revealed partial peripheral neuropathy of the left femoral nerve associated with the patella fracture. To our knowledge, this is the first reported case of femoral neuropathy associated with a patella fracture. PMID:24369003

  1. Tissue sparing total femoral arthroplasty: technical note.

    PubMed

    Willimon, Samuel Clifton; Bolognesi, Michael P; Attarian, David E

    2011-01-01

    It is predicted that the number of revision hip and knee arthroplasties will double by the years 2026 and 2015, respectively. As the burden of end-stage prosthetic disease increases, there will be a greater potential need for total femoral arthroplasty. This report describes a patient with a femoral neck fracture nonunion with an ipsilateral multiply revised failed total knee arthroplasty treated by a tissue sparing total femoral arthroplasty. The technique is described, and potential benefits are reviewed.

  2. Pre-operative Decision-Making in the Treatment of High-Angle "Vertical" Femoral Neck Fractures in Young Adult Patients.

    PubMed

    Luttrell, Kevin; Beltran, Michael; Collinge, Cory

    2014-04-01

    To identify the current implant and diagnostic imaging preferences among orthopedic trauma experts for the treatment of high-energy vertical femoral neck fractures in young adult patients. Web-based survey SETTING:: N/A PARTICIPANTS:: Active members of the Orthopaedic Trauma Association (OTA) METHODS:: A cross sectional expert opinion survey was administered to active members of the OTA to determine their preferences for implant use and imaging in the surgical treatment of a vertical femoral neck fracture in a young adult patient (e.g. 60° Pauwels' angle fracture in a healthy 30 year old patient). Questions were also asked regarding the reason this implant was selected, whether the surgeon felt their choice was supported by the literature, and what imaging studies are routinely obtained to guide decision-making. Data was collected using simple multiple-choice questions and/or a 5-point Likert item. Two-hundred and seventy-two surgeons (47%) responded to the survey. The preferred constructs for a vertical femoral neck fracture in a healthy young patient were a sliding hip screw with or without an anti-rotation screw (47%), parallel cannulated screws with an off-axis screw (28%), and parallel cannulated screw constructs (15%). When asked if their designated construct "was clearly supported by the literature," 46% were either unsure or disagreed. Seventy percent of surgeons chose their preferred implant because it was "biomechanically most stable." The majority of surgeons required AP pelvis (70%) and standard hip (88%) radiographs, however only 29% of surgeons required a CT scan (59% found CT helpful but not required). Twenty seven percent of surgeons have changed their implant choice intraoperatively. Femoral neck fractures in young adult patients are a challenging problem with high rates of failed treatment. Many options for treatment exist and a consensus on the best method remains elusive. Our survey demonstrates the diversity and disagreement among OTA member

  3. Treatment of subtrochanteric fractures. A comparison of the Gamma nail and the dynamic hip screw: short-term outcome in 58 patients

    PubMed Central

    Saarenpää, I.; Heikkinen, T.

    2006-01-01

    The aim of this non-randomised prospective study was to evaluate the short-term outcome of Gamma nail and dynamic hip screw (DHS) fixation in the treatment of subtrochanteric hip fractures due to low-energy trauma in the elderly. All of the 1,624 femoral hip fractures in 1,511 patients of the Oulu Hospital, aged over 49 years, were prospectively registered from 1991−1999 using special forms. Seventy-three (4.5%) of the fractures were subtrochanteric. After exclusions, 58 patients constituted the final study group. Of these, 43 were treated with Gamma nails and 15 with DHS. Background factors before the fracture, complications, reoperations and functional parameters at 4 months were recorded using standardised forms. Intraoperative and hospital data were collected from patient records. The Seinsheimer fracture types IIIA, IIC and V were the most common fracture patterns when the Seinsheimer classification system was used, and Fielding II and AO 31A3.3, respectively, were the most common types in the Fielding and AO classification system. There were four (9%) intraoperative complications in the Gamma nail group as compared to none in the DHS group. On the other hand, postoperative complications were more common in the DHS group (27%) than in the Gamma nail group (7%). We recognised a correlation between certain fracture types and the likelihood of typical intra- or postoperative complications or difficulties with both devices: In Gamma nailing, difficulty in closed reduction as well as the rate of open reduction and the use of supplementary fixation were most frequent in the Seinsheimer IIC fractures. It is also noticeable that all of the postoperative device failures and fracture displacements of the DHS group occurred in the Seinsheimer type IIIA category. Detailed fracture classification is essential for the choice of the fixation device, and the present study confirms the presumption that, despite the perioperative problems associated with Gamma nailing, this

  4. Green nail syndrome treated with the application of tobramycin eye drop.

    PubMed

    Bae, Youin; Lee, Gang Mo; Sim, Ji Hoon; Lee, Sanghoon; Lee, Sung Yul; Park, Young Lip

    2014-08-01

    Green nail syndrome (chromonychia) is a nail disorder characterized by onycholysis and green-black discoloration of the nail bed. This condition is often associated with chronic paronychia. Pseudomonas aeruginosa is the most commonly identified organism in cultures from the affected area. Despite the various treatment options available, removal of the nail is still necessary in many cases. A 35-year-old man presented with dark-greenish discoloration of the nail plate and onycholysis on the left thumbnail. He had been treated with oral antifungal and antibiotic agents for several months; however, the lesion showed no improvement. The diagnosis of green nail syndrome was established after a positive bacterial culture, and on the basis of the antibiotic sensitivity test result, tobramycin eye drop (Tobrex®) was then prescribed. Three weeks later, the nail discoloration almost vanished but the onycholysis remained. Herein, we recommend the application of tobramycin eye drop as an easy and safe treatment option for green nail syndrome.

  5. Computed modeling of humeral mid-shaft fracture treated by bundle nailing.

    PubMed

    Obruba, Petr; Capek, Lukas; Henys, Petr; Kopp, Lubomir

    2016-10-01

    Elastic bundle nailing is a method for simple humeral mid-shaft fracture osteosynthesis. The aim of our subsequent numerical simulations was to find out torsional and bending stiffness of an elastic bundle nailed humerus. Parametrical 3D numerical model was developed. The diameter of nails was the varying parameter of 1.8, 2.5, 3 and 4 mm. From our results can be seen that the bending stiffness in bundle nailing technique does not depend on nail diameter. On the contrary the torsional stiffness does highly depend on nail diameter. The dependency of the maximal stress on a nail diameter during bending and torsion of the humerus is non-linear. It can be seen that the higher diameter is used the higher stress occurs. Achieved results allow us for the recommendation of optimal nail diameter for this method, which lies between 2 and 3 mm.

  6. 76 FR 23559 - Certain Steel Nails From the United Arab Emirates: Initiation of Antidumping Duty Investigation

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-27

    ... steel nails from the United Arab Emirates (UAE) filed in proper form by Mid Continent Nail Corporation... petitioner made adjustments for foreign inland freight, foreign port expenses, ocean freight, U.S....

  7. Enhancing transungual delivery and spreading of efinaconazole under the nail plate through a unique formulation approach.

    PubMed

    Kircik, Leon H

    2014-12-01

    Onychomycosis is a very common nail disorder seen in dermatological practice. It is difficult to treat successfully for a multitude of reasons, and although topical antifungal therapy might be considered ideal for mild to moderate onychomycosis, efficacy has been limited by poor nail penetration of active ingredient through the nail plate into the nail bed and nail matrix to the site of infection. The intrinsic properties of an antifungal and its vehicle formulation are both considered important contributors to effective treatment. Here we review the formulation approach to efinaconazole topical solution, 10% an effective and well-tolerated treatment for onychomycosis. We demonstrate that the low surface tension formulation affords better penetration of efinaconazole through the nail plate, and also to the site of infection by spreading into the space between the nail and nail bed.

  8. Primary versus secondary distal femoral arthroplasty for treatment of total knee arthroplasty periprosthetic femur fractures.

    PubMed

    Chen, Antonia F; Choi, Lisa E; Colman, Matthew W; Goodman, Mark A; Crossett, Lawrence S; Tarkin, Ivan S; McGough, Richard L

    2013-10-01

    Current methods of fixing periprosthetic fractures after total knee arthroplasty (TKA) are variable, and include open reduction and internal fixation (ORIF) via plating, retrograde nailing, or revision using standard revision TKA components or a distal femoral arthroplasty (DFA). The purpose of this study is to compare patients who failed plating techniques requiring subsequent revision to DFA to patients who underwent primary DFA. Of the 13 patients (9.2%) who failed primary ORIF, causes included nonunion (53.8%), infection (30.8%), loosening (7.7%), and refracture (7.7%). There were significantly more surgical procedures for ORIF revision to DFA compared to primary DFA. Complications for patients who underwent primary reconstruction with DFAs included extensor mechanism disruption (8.3%), infection (5.6%), and dislocation (2.8%). Primary reconstruction via ORIF is beneficial for preserving bone stock, but primary DFA may be preferred in osteopenic patients, or those at high risk for nonunion.

  9. Osteoinductive composite coatings for flexible intramedullary nails.

    PubMed

    Bolbasov, E N; Popkov, A V; Popkov, D A; Gorbach, E N; Khlusov, I A; Golovkin, A S; Sinev, A; Bouznik, V M; Tverdokhlebov, S I; Anissimov, Y G

    2017-06-01

    This work presents composite coatings based on a copolymer of vinylidene fluoride with tetrafluoroethylene (VDF-TeFE) and hydroxyapatite (HA) for flexible intramedullary nails (FIN). The effect of the proportion of VDF-TeFE (100-25% wt.) on physicochemical and biological properties of the composite coatings was investigated. It was shown that a decrease of VDF-TeFE in the coating hinders its crystallization in β and γ forms which have piezoelectric properties. The decrease also reduces an adhesive strength to 9.9±2.4MPa and a relative elongation to 5.9±1.2%, but results in increased osteogenesis. It was demonstrated that the composite coatings with 35% VDF-TeFE has the required combination of physicochemical properties and osteogenic activity. Comparative studies of composite coatings (35% VDF-TeFE) and calcium phosphate coatings produced using micro-arc oxidation, demonstrated comparable results for strength of bonding of these FINs with trabecular bones (~530MPa). It was hypothesized that the high osteoinductive properties of the composite coatings are due to their piezoelectric properties. Copyright © 2017 Elsevier B.V. All rights reserved.

  10. Sensory factors affecting female consumers' acceptability of nail polish.

    PubMed

    Sun, C; Koppel, K; Adhikari, K

    2015-12-01

    The objectives of this study were to determine what sensory factors impact consumers' acceptability of nail polishes, to explore how these sensory factors impact consumers' acceptability of nail polishes, to investigate whether there are any consumer segments according to their overall acceptability on different nail polishes and to scrutinize how the consumer segments are related to the sensory factors. Ninety-eight females participated in a nail polish consumer study at Kansas State University. Eight commercial products belonging to four categories - regular (REG), gel (GEL), flake (FLK) and water-based (WAT) - were evaluated. Each nail polish sample was evaluated twice by each participant in two different tasks - a task devoted to applying and evaluating the product and a task devoted to observing the appearance and evaluating the product. Pearson's correlation analysis, analysis of variance (ANOVA), external preference mapping, cluster analysis and internal preference mapping were applied for data analysis. Participants' scores of overall liking of the nail polishes were similar in the application task and in the observation task. In general, participants liked the REG and GEL product samples more than the FLK and WAT samples. Among all the sensory attributes, appearance attributes were the major factors that affected participants' overall liking. Aroma seemed to be a minor factor to participants' overall liking. Some sensory attributes, such as runny, shininess, opacity, spreadability, smoothness, coverage and wet appearance, were found to drive participants' overall acceptability positively, whereas others such as pinhole, fatty-edges, blister, brushlines, pearl-like, flake-protrusion, glittery and initial-drag impacted participants' overall acceptability negatively. Four clusters of participants were identified according to their overall liking scores from both the application task and the observation task. Participants' acceptability, based on different

  11. Pigmented lesions of the nail unit: clinical and histopathologic features.

    PubMed

    Ruben, Beth S

    2010-09-01

    Probably the most common reason to perform biopsy of the nail unit is for the evaluation of irregular pigmentation, especially longitudinal melanonychia or pigmented bands. When narrow and solitary, these are usually the product of melanocytic activation/hypermelanosis, lentigines, or melanocytic nevi. Multiple pigmented bands are generally a benign finding, the result of melanocytic activation, as seen in racial pigmentation in darker-skinned patients, for example. In the context of an irregular, broad, heterogeneous or "streaky" band, the chief concern is the exclusion of subungual melanoma. Before assessing the histologic features of any such entities, it is important to understand the normal nail anatomy and melanocytic density of nail unit epithelium, as well as the type of specimen submitted, and whether it is adequate to undertake a proper histologic evaluation. The criteria for diagnosis and prognosis of melanoma of the nail unit are still evolving, and a variety of factors must be weighed in the balance to make a correct diagnosis. The importance of the clinical context cannot be overemphasized. There are also nonmelanocytic conditions to be considered that may produce worrisome nail discoloration, such as subungual hemorrhage, squamous cell carcinoma, and pigmented onychomycosis.

  12. The effect of nail polish on pulse oximetry readings.

    PubMed

    Hakverdioğlu Yönt, Gülendam; Akin Korhan, Esra; Dizer, Berna

    2014-04-01

    Pulse oximeters utilise the pulsatile nature of arterial blood flow to distinguish it from venous flow and estimate oxygen saturation in arterial blood. Pulse oximetry is primarily used in hospital wards, emergency rooms, intensive care units, operating rooms and home care. The objective of this study is to determine whether the use of nail polish of various colours have an effect on oximeter readings of oxygen saturation value. The sample group of this study is comprised of 40 healthy women. In the first phase of the study, readings were taken on left and right hand fingers, with no nail polish, to determine any differences in oxygen saturation value. In the second phase of the study, 10 different colours of nail polish, namely dark red, yellow, dark blue, green, purple, brown, white, metallic, black and pink, of the same brand were applied. Readings were recorded once oxygen saturation values on the screen became stable. Number and percentage distributions along with Wilcoxon signed ranks and Friedman test were used in the analysis of data. Only red nail polish did not yield statistically significant reading results. We conclude that different nail polish colours cause a clinically significant change in pulse oximeter readings in healthy volunteers. Copyright © 2013 Elsevier Ltd. All rights reserved.

  13. Frizzled6 deficiency disrupts the differentiation process of nail development

    PubMed Central

    Cui, Chang-Yi; Klar, Joakim; Georgii-Heming, Patrik; Fröjmark, Anne-Sophie; Baig, Shahid M.; Schlessinger, David; Dahl’, Niklas

    2013-01-01

    Nails protect the soft tissue of the tips of digits. The molecular mechanism of nail (and claw) development is largely unknown, but we have recently identified a Wnt receptor gene, Frizzled6 (Fzd6) that is mutated in a human autosomal-recessive nail dysplasia. To investigate the action of Fzd6 in claw development at the molecular level, we compared gene expression profiles of digit tips of wild-type and Fzd6−/− mice, and show that Fzd6 regulates the transcription of a striking number of epidermal differentiation-related genes. Sixty-three genes encoding keratins, keratin associated proteins, and transglutaminases and their substrates were significantly down-regulated in the knockout mice. Among them, four hard keratins, Krt86, Krt81, Krt34 and Krt31; two epithelial keratins, Krt6a and Krt6b; and transglutaminase1 were already known to be involved in nail abnormalities when dysregulated. Immunohistochemical studies revealed decreased expression of Krt86, Krt6b and involucrin in the epidermal portion of the claw field in the knockout embryos. We further showed that Dkk4, a Wnt antagonist, was significantly down-regulated in Fzd6−/− mice along with Wnt, Bmp and Hh family genes; and Dkk4 transgenic mice showed a subtly but appreciably modified claw phenotype. Thus, Fzd6-mediated Wnt signaling likely regulates the overall differentiation process of nail/claw formation. PMID:23439395

  14. Nail psoriasis successfully treated with intralesional methotrexate: case report.

    PubMed

    Sarıcaoglu, Hayriye; Oz, Arife; Turan, Hakan

    2011-02-01

    Psoriasis is a common, chronic disease which affects nearly 3% of the population. The lifetime incidence of nail involvement increases up to 80-90% for psoriatic patients. Nail psoriasis is considered a significant social problem. Many topical agents have been used for psoriatic nails with various side effects and some benefits; management is currently inconclusive. Methotrexate (MTX) is a folic acid analog, which irreversibly binds to dehydrofolate reductase and blocks deoxyribonucleic acid synthesis. It is considered a potential treatment option for rapidly growing cells and has an anti-inflammatory effect through inhibition of the polyamine pathway in autoimmune diseases. Intralesional MTX has been used successfully for various indications. We present a case successfully treated with low-dose intralesional MTX with no observed side effects in a 26-year-old female psoriatic patient suffering from nail dystrophy. In contrast, conventional topical and systemic therapies have various side effects, which limit their use. We conclude that intralesional MTX injection seems to be a safe and effective treatment option for nail psoriasis; however, large controlled studies are needed.

  15. A practical method to detect mycoses of the nails.

    PubMed

    Goihman-Yahr, Mauricio; Franco-Arcia, Francisco; Maldonado, Carlota

    2015-01-01

    The authors present a method that allows for reliable identification of fungal structures in nails with suspected colonization by fungi. The method is based on the well-known technique of heating nail fragments in 20% potassium hydroxide, but its details allow for reliable and quick processing of samples, when convenient. The method requires simple equipment and is designed for individual practices but might be employed as is or with minor technical improvements by a dermatology department. Minor changes will make it feasible to simultaneously process several samples. The results that were obtained show that while experienced clinicians achieve positive clinical diagnoses in the majority of instances, inaccuracies occur in a sizable proportion of cases. In addition, the varied combination of yeasts and hyphae that were found, bolster the view that microscopic examination is necessary to justify and optimize systemic treatment of mycoses of the nails. Our technique permits the processing and observation of the totality of samples obtained from a single nail or several nails.

  16. Patterns of clinical nail appearances in patients with cutaneous psoriasis

    PubMed Central

    MARINA, ELENA MIHAELA; BOTAR-JID, CAROLINA; BOLBOACA, SORANA DANIELA; ROMAN, IULIA IOANA; SENILA, CORINA SIMONA; MIHU, CARMEN MIHAELA; TATARU, DUMITRU ALEXANDRU

    2017-01-01

    Background and aim Nail manifestations are often an overlooked aspect in psoriatic disease, cutaneous and joint involvement being far more often reported and investigated. The reported prevalence of nail changes varies in literature, specific fingernail clinical features having different degrees of occurrence. The aim of this study was to describe specific clinical patterns of fingernail alterations in adult patients with plaque-type psoriasis in a university hospital in the North-West of Romania. Methods Clinical data of 35 patients with fingernail psoriasis were collected and analyzed. Psoriasis Area and Severity Index (PASI) and Nail Psoriasis Severity Index (NAPSI) scores were used to quantify disease extension in each patient. Results PASI score proved linearly correlated with NAPSI score (p<0.05). The age of onset of fingernail psoriasis was positively correlated with age of onset cutaneous psoriasis (p<0.0001). Furthermore, the duration of cutaneous involvement and NAPSI proved significantly related (p<0.05). The third fingernail in the right hand and first fingernail in the left hand were in most of the cases severely affected. The most common observed nail pattern was pitting, followed by salmon patches and subungual hyperkeratosis. Conclusion Important nail changes appear even in moderate forms of cutaneous psoriasis. Particular localization of specific fingernail psoriasis pattern enables the possibility of detecting early stage disease. PMID:28246493

  17. Nail haemorrhages in native highlanders of the Peruvian Andes

    PubMed Central

    Heath, Donald; Harris, Peter; Williams, David; Krüger, Hever

    1981-01-01

    Nail haemorrhages are of interest to the chest physician and cardiologist. While the common type in the distal part of the nail is produced by the minor trauma of daily life, the rarer form—scattered through the nail substance—appears to be related to hypoxaemia brought about by heart and lung disease. We thought it would be of interest to study a population which was naturally hypoxaemic because of living at high altitude. Accordingly we have studied the frequency and types of nail haemorrhage in Quechua Indians who are permanently exposed to the hypobaric hypoxia of the Andes. We found the haemorrhages to be common both in mestizos living on the coastal plain and in the native highlanders. They appeared to increase in frequency with altitude but were of the distal type and would thus seem to be the result of minor trauma as at sea level. However, just as in cases of cyanotic congenital heart disease at low altitude, those with exaggerated hypoxaemia and pronounced elevation of haematocrit—namely, subjects with Monge's disease (chronic mountain sickness)—had scattered haemorrhages in the nail substance. Images

  18. Use of internal lengthening nails in post-traumatic sequelae.

    PubMed

    Alrabai, Hamza M; Gesheff, Martin G; Conway, Janet D

    2017-04-07

    External fixators are a well-established modality for treating fractures with bone defects, leg-length discrepancy, malunion, nonunion and other post-traumatic consequences. However, use of internal lengthening rods has remarkably increased recently for post-traumatic conditions. The main advantage of internal lengthening rods is eliminating pin-site complications. Internal lengthening rods are also associated with less pain. Motorised internal lengthening rods show promising performance in post-traumatic cases. Rigorous pre-operative planning is paramount to reducing lengthening-related complications. Certain types of internal lengthening rods offer bidirectional movement capability. Nail mechanism malfunction is a possibility with all kinds of nails. Direct doctor supervision is required, especially in the initial stages while the nail is lengthening. Internal lengthening nails are not as stiff as regular nails, with intricate internal mechanisms that can be broken under inattentive weightbearing activities. Preliminary positive outcomes indicate the role of internal lengthening rods in treating post-traumatic problems of leg-length discrepancy, malunion and nonunion.

  19. Deep intramedullary infection in tibial lengthening over an intramedullary nail.

    PubMed

    Kim, Seung-Ju; Cielo Balce, Gracia; Huh, Young-Jae; Song, Sang-Yoon; Song, Hae-Ryong; Kim, Seung-Ju

    2011-08-01

    Tibial lengthening over an intramedullary (IM) device is associated with a risk of deep intramedullary infection; there is so far no guideline for decision making between early removal and delayed removal of the nail. Tibial lengthening over an intramedullary nail/Rush pin was performed in 118 limb segments (63 patients) from 2004 to 2008 in our institution. Fifty five patients had bilateral tibial lengthening. Ninety nine of the 118 segments went on to healing without infection, while 13 segments developed superficial infection and 6 segments developed deep infection. Among 6 patients with deep infection, 4 patients underwent early removal of the nail when deep infection signs and symptoms occurred and 2 patients underwent delayed removal of the nail at 11 months. The 6 segments with deep infection differed significantly with respect t to the callus pattern (p < 0.05) and density (p = 0.0001) from those without infection and with superficial infection. In this small sugroup, removal of the nail was delayed in two patients as there was visible callus bridging at more than one cortex, and deep infection subsided after local drainage.

  20. Diffusion of uncharged solutes through human nail plate.

    PubMed

    Baswan, Sudhir M; Li, S Kevin; Kasting, Gerald B

    2016-01-01

    Passive diffusion data for uncharged solutes in hydrated human nail plate are collected and compared to the predictions of two theories for diffusion of uncharged solutes in dense keratin matrices. Quantitative agreement between the experimental data and the theories examined is poor. Concerns with both the experiments and the theories are identified and discussed. It is evident from the analysis that magnitude of the experimental nail permeability data may be questioned, as may the extrapolation procedures used to estimate the properties of dense fiber arrays from more dilute systems. Despite these caveats, it can be inferred that the microstructure of the nail plate is more complex than that assumed in the described models. The influence of residual lipids is implicated. More rigorous experiments and theoretical analysis of mass transport in the nail plate system are warranted. Successful completion of these tasks could lead not only to better predictions of transungual drug delivery, but also to better models of skin permeability, if hydrated nail plate can indeed serve as a model for the corneocyte phase of (partially hydrated) stratum corneum.

  1. Comparative study of nail sampling techniques in onychomycosis.

    PubMed

    Shemer, Avner; Davidovici, Batya; Grunwald, Marcelo H; Trau, Henri; Amichai, Boaz

    2009-07-01

    Onychomycosis is a common problem. Obtaining accurate laboratory test results before treatment is important in clinical practice. The purpose of this study was to compare results of curettage and drilling techniques of nail sampling in the diagnosis of onychomycosis, and to establish the best technique and location of sampling. We evaluated 60 patients suffering from distal and lateral subungual onychomycosis and lateral subungual onychomycosis using curettage and vertical and horizontal drilling sampling techniques from three different sites of the infected nail. KOH examination and fungal culture were used for detection and identification of fungal infection. At each sample site, the horizontal drilling technique has a better culture sensitivity than curettage. Trichophyton rubrum was by far the most common pathogen detected by both techniques from all sampling sites. The drilling technique was found to be statistically better than curettage at each site of sampling, furthermore vertical drilling from the proximal part of the affected nail was found to be the best procedure for nail sampling. With each technique we found that the culture sensitivity improved as the location of the sample was more proximal. More types of pathogens were detected in samples taken by both methods from proximal parts of the affected nails.

  2. 77 FR 27080 - Certain Steel Nails From the United Arab Emirates

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-08

    ... COMMISSION Certain Steel Nails From the United Arab Emirates Determination On the basis of the record \\1... certain steel nails, provided for in subheadings 7317.00.55, 7317.00.65, and 7317.00.75 of the Harmonized... that imports of certain steel nails from the United Arab Emirates were being sold at LTFV within...

  3. 76 FR 29266 - Certain Steel Nails From the United Arab Emirates

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-20

    ... COMMISSION Certain Steel Nails From the United Arab Emirates Determination On the basis of the record \\1... imports from the United Arab Emirates of certain steel nails, provided for in subheadings 7317.00.55, 7317... steel nails from the United Arab Emirates. Accordingly, effective March 31, 2011, the...

  4. Withdrawal strength of ring-shank nails embedded in southern pine lumber

    Treesearch

    M. J. Skulteti; D. A. Bender; S. G. Winistorfer; D. G. Pollock

    1997-01-01

    Ring-shank nails are used extensively in post-frame construction due to their superior performance, yet surprisingly little testing has been done on nail sizes above 12d Experience in the post-frame industry suggests that published allowable design values for ring-shank nails may be overly conservative and need revision. The goal of the research reported herein was to...

  5. [Effect of continuous femoral nerve catheter length on blockade of femoral nerve, lateral femoral cutaneous nerve and obturator nerve].

    PubMed

    Zhu, Feng; Hu, Yan; Zhang, Wei

    2013-02-18

    To assess the effects of length of continuous femoral catheter on blockade of femoral nerve, lateral femoral cutaneous nerve and obturator nerve. In the study, 70 patients with American Association of Anesthesiologist grades I-II undergoing total knee arthroplasty were randomly divided into three groups, femoral nerve catheters were inserted 5 cm, 10 cm or 20 cm with assistance of a nerve stimulator, patient-controlled analgesia pumps were connected after load of 30 mL 0.3% ropivacaine via the catheters. Sensory blockade of the femoral nerve, lateral femoral cutaneous nerve and obturator nerve were recorded at 24 h postoperatively. Visual analog scale (VAS) pain scores during rest and motion were recorded at 24 h and 48 h postoperatively. The blockade effect of lateral femoral nerve in the 20 cm group was the best. There was no significant difference in sensory blockade between the 5 cm group and the 10 cm group. There was no significant difference in VAS score among the three groups. When continuous femoral nerve block is used for postoperative analgesia after total knee arthroplasty surgery, the catheters that are inserted 5 cm, 10 cm or 20 cm could provide similar and satisfying analgesia effect.

  6. Outcomes after trifocal femoral fractures.

    PubMed

    Griffin, Michelle; Dick, Alastair G; Umarji, Shamim

    2014-01-01

    Trifocal femur fractures are those of the femoral neck, diaphysis, and distal femur. These high-energy injuries predominantly occur in young people with the potential for long-term complications and disability. We present the cases of two men who were treated with proximal dynamic hip screws and distal periarticular locking plates to effectively manage trifocal femur fractures. Our cases have shown union at 2 years with good functional outcomes without the need for reintervention. We provide evidence for a successful surgical treatment option for these rare and complex injuries.

  7. Outcomes after Trifocal Femoral Fractures

    PubMed Central

    Griffin, Michelle; Dick, Alastair G.; Umarji, Shamim

    2014-01-01

    Trifocal femur fractures are those of the femoral neck, diaphysis, and distal femur. These high-energy injuries predominantly occur in young people with the potential for long-term complications and disability. We present the cases of two men who were treated with proximal dynamic hip screws and distal periarticular locking plates to effectively manage trifocal femur fractures. Our cases have shown union at 2 years with good functional outcomes without the need for reintervention. We provide evidence for a successful surgical treatment option for these rare and complex injuries. PMID:24800097

  8. Application of Nail Polish During Topical Management of Onychomycosis

    PubMed Central

    Del Rosso, James Q.

    2016-01-01

    Topical antifungal management of toenail onychomycosis has been fraught with several therapeutic challenges including difficulty gaining access to the site of infection and the need for prolonged durations of therapy. In addition, there has been a marked lack of information on the impact of toenail polish application on drug penetration after application. This article reviews available data from studies evaluating the effect of nail polish on antifungal drag penetration using ex vivo laboratory models with cadaver fingernail plates with both tavaborole 5% solution and efinaconazole 10% solution. In addition, changes in nail polish appearance and color transfer to applicators are also discussed, with changes noted with topical efinaconazole. Importantly, there are no data on whether or not nail polish application alters the efficacy of these topical agents. PMID:27672416

  9. Road Nail: Experimental Solar Powered Intelligent Road Marking System

    NASA Astrophysics Data System (ADS)

    Samardžija, Dragan; Teslić, Nikola; Todorović, Branislav M.; Kovač, Erne; Isailović, Đorđe; Miladinović, Bojan

    2012-03-01

    Driving in low visibility conditions (night time, fog or heavy precipitation) is particularly challenging task with an increased probability of traffic accidents and possible injuries. Road Nail is a solar powered intelligent road marking system of wirelessly networked signaling devices that improve driver safety in low visibility conditions along hazardous roadways. Nails or signaling devices are autonomous nodes with capability to accumulate energy, exchange wireless messages, detect approaching vehicles and emit signalization light. We have built an experimental test-bed that consists of 20 nodes and a cellular gateway. Implementation details of the above system, including extensive measurements and performance evaluations in realistic field deployments are presented. A novel distributed network topology discovery scheme is proposed which integrates both sensor and wireless communication aspects, where nodes act autonomously. Finally, integration of the Road Nail system with the cellular network and the Internet is described.

  10. The Chinese Nail Murders: forensic medicine in Imperial China.

    PubMed

    Summers, W C

    1999-01-01

    Robert van Gulik was a respected Dutch sinologist and author who first translated a collection of traditional Chinese detective stories into English and then created additional fictional stories based on the same characters and setting in the Tang dynasty. One of these stories, The Chinese Nail Murders, draws on van Gulik's professional interest in law and his knowledge of early Chinese works on forensic medicine. This novel develops a common theme in Chinese detective fiction, murder by a nail wound to the head. The difficulty in detection of this mode of violence posed a particular problem for the examining magistrate because postmortem examination was mostly limited to external observations. This essay compares the development of Chinese and Western forensic medicine in the context of the nail murder motif.

  11. The Chinese Nail Murders: forensic medicine in Imperial China.

    PubMed Central

    Summers, W. C.

    1999-01-01

    Robert van Gulik was a respected Dutch sinologist and author who first translated a collection of traditional Chinese detective stories into English and then created additional fictional stories based on the same characters and setting in the Tang dynasty. One of these stories, The Chinese Nail Murders, draws on van Gulik's professional interest in law and his knowledge of early Chinese works on forensic medicine. This novel develops a common theme in Chinese detective fiction, murder by a nail wound to the head. The difficulty in detection of this mode of violence posed a particular problem for the examining magistrate because postmortem examination was mostly limited to external observations. This essay compares the development of Chinese and Western forensic medicine in the context of the nail murder motif. PMID:11138936

  12. Surgical treatment of nail bed subungual exostosis

    PubMed Central

    Malkoc, Melih; Korkmaz, Ozgur; Keskinbora, Mert; Seker, Ali; Oltulu, Ismail; Bulbul, Ahmet Murat; Say, Ferhat; Cakir, Aslı

    2016-01-01

    INTRODUCTION A subungual exostosis (SE) is a bony overgrowth that is permanently attached to the tip of the distal phalanx. Its pathology differs from osteocartilaginous exostoses in that it mainly involves the overgrowth of normal bone, which may present beneath the toenail or on the sides of the toe. This retrospective study aimed to report the results of surgical treatment when the diagnosis of SE was delayed; the condition was initially considered to be another pathology affecting a different nail or the terminal toe. METHODS A total of 17 patients (12 female, five male) were included in the study. All surgical resections were performed by the same surgeon using the same surgical technique, with the patient under digital anaesthesia. The patients were evaluated pre- and postoperatively (on Weeks 1 and 6, the first year, and the last follow-up visit) using the American Orthopaedic Foot and Ankle Society questionnaire and the Visual Analogue Scale score. RESULTS The patients underwent surgery for SE removal between December 2009 and October 2012. Their mean age was 21.3 ± 4.4 (range 14–29) years and the mean follow-up period was 27.1 ± 7.8 (range 18–45) months. Clinical or radiological recurrence was not observed in any of the patients during the follow-up period. Four patients had superficial infections, which were treated using appropriate antibiotic therapies. CONCLUSION As SE is an uncommon benign lesion, its diagnosis may be delayed. Radiography may be useful in obtaining a differential diagnosis. PMID:26778465

  13. [Intramedullary locked fixation and compression nail (IP-XS-Nail): treatment of ankle joint fractures].

    PubMed

    Gehr, Jonas; Friedl, Wilhelm

    2006-06-01

    Reconstruction of the anatomy of the ankle joint while protecting the soft tissue, and osteosynthesis to maintain stability for function and weight bearing. Distal fractures of the fibula, bimalleolar fractures, and isolated fractures of the medial malleolus. Very small (< 5 mm) distal fragments (if fixation of the fragments is not possible using a small XXS nail) and very narrow (< 2.5 mm) medullary cavity (conversion to plate fixation). With displaced fibula fractures, open reduction should be performed with fracture retention using wide-armed reduction forceps, insertion of a central guide wire into the medullary cavity, use of a cannulated drill bit, introduction of the nail using an aiming arm and locked fixation with threaded wire. After checking the position using X-ray, the wire should be shortened using the bolt cutters. POSTOPERATIVE MANAGEMENT (Depending on the Weber classification): Full weight bearing for all isolated distal fractures of the fibula (Weber types A and B) and isolated fractures of the medial malleolus. For distal fractures of the fibula (Weber types A and B) with additional fracture of the medial malleolus or involvement of the medial ligament partial weight bearing of 20 kp for 4 weeks, followed by full weight bearing. For all Weber C fractures and/or additional Volkmann fracture only 10 kp of partial weight bearing with a rocker-sole orthosis should be allowed for 6 weeks followed by full weight bearing. No weight bearing for 6 weeks until the screws are removed is only recommended, if positioning screws have been used for Weber C fractures. In the period from 05/2000 to 01/2002, 194 ankle fractures were treated with the IP-XS-Nail((R)). Follow-up examinations were conducted on 162 patients with an average age of 51.2 years after an average of 15 months. 62 Weber B fractures (38.3%) and 45 Weber C fractures (27.7%) were evaluated. There were bimalleolar fractures in 55 cases (34.0%). According to the Olerud Score (clinical and

  14. Unusual presentation of a femoral stress fracture

    PubMed Central

    Ejnisman, Leandro; Wajnsztejn, Andre; Queiroz, Roberto Dantas; Ejnisman, Benno

    2013-01-01

    Stress fractures are common injuries in sports medicine. Among these fractures, femoral neck stress fractures frequently have a benign course, especially when it happens in the medial aspect of the neck. This case report describes a stress fracture of the medial aspect of the femoral neck that developed a complete fracture and underwent surgical fixation. PMID:23283621

  15. Management of gamma nail breakage with bipolar hemi-arthroplasty.

    PubMed

    Wee, J L H; Sathappan, S S; Yeo, M S W; Low, Y P

    2009-01-01

    Gamma nail breakage is an uncommon occurrence that often arises from fatigue failure of the implant, with a reported incidence ranging from 0.2 to 5.7 percent. We report a 73-year-old woman with a three-part intertrochanteric fracture and who presented two years postoperatively with gamma nail failure secondary to fracture non-union. This patient underwent a revision long-stem bipolar hemi-arthroplasty and has been followed-up for 24 months, with good functional and radiological results.

  16. Intramedullary Nail Fixation of Distal Tibia Fractures: Tips and Tricks.

    PubMed

    Talerico, Michael; Ahn, Jaimo

    2016-11-01

    The objective of this article is to highlight the salient points of preoperative planning, intraoperative considerations for fracture reduction methods, and implant fixation when treating distal diaphyseal or diametaphyseal tibia fractures with an intramedullary nail. Through review of the necessary preoperative considerations, techniques available to hold and maintain a reduction, and lastly how to maximize the selected implant of intramedullary nail, we hope to assist the treating surgeon in simplifying these sometimes complex fractures into manageable injuries that can be treated successfully with an intramedullary implant.

  17. Suprapatellar Nailing of Tibial Shaft Fractures in Total Knee Arthroplasty.

    PubMed

    Woyski, Dustin; Emerson, Jason

    2016-12-01

    Fractures of the tibial shaft in patients with ipsilateral total knee arthroplasty are rare but difficult to treat. Nonoperative treatment of these fractures with casting or bracing limits weight bearing for an extended period and can result in unacceptable malalignment. Operative fixation with plate and screws also limits early weight bearing and requires healing of soft tissue that is of poor quality. The authors present a method of internal fixation that uses a standard intramedullary tibial nail and suprapatellar instrumentation. This method can easily be performed, avoids the tibial baseplate, and does not require alteration of the instrumentation or intramedullary nail.

  18. Relaxation response in femoral angiography.

    PubMed

    Mandle, C L; Domar, A D; Harrington, D P; Leserman, J; Bozadjian, E M; Friedman, R; Benson, H

    1990-03-01

    Immediately before they underwent femoral angiography, 45 patients were given one of three types of audiotapes: a relaxation response tape recorded for this study, a tape of contemporary instrumental music, or a blank tape. All patients were instructed to listen to their audiotape during the entire angiographic procedure. Each audiotape was played through earphones. Radiologists were not told the group assignment or tape contents. The patients given the audiotape with instructions to elicit the relaxation response (n = 15) experienced significantly less anxiety (P less than .05) and pain (P less than .001) during the procedure, were observed by radiology nurses to exhibit significantly less pain (P less than .001) and anxiety (P less than .001), and requested significantly less fentanyl citrate (P less than .01) and diazepam (P less than .01) than patients given either the music (n = 14) or the blank (n = 16) control audiotapes. Elicitation of the relaxation response is a simple, inexpensive, efficacious, and practical method to reduce pain, anxiety, and medication during femoral angiography and may be useful in other invasive procedures.

  19. 77 FR 24462 - Certain Steel Nails From the People's Republic of China: Amended Final Results of the Second...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-24

    ... International Trade Administration Certain Steel Nails From the People's Republic of China: Amended Final... the antidumping duty order on certain steel nails (``steel nails'') from the People's Republic of... Department's final margin calculations. \\1\\ See Certain Steel Nails from the People's Republic of...

  20. 76 FR 23279 - Certain Steel Nails From the People's Republic of China: Amended Final Results of the First...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-26

    ... Works/Stanley Fastening Systems LP, and an unaffiliated wire drawing subcontractor are collectively..., nails made of round wire and nails that are cut. Certain steel nails may be of one piece construction or... such as plastic, paper, or wire. Certain steel nails subject to this proceeding are...

  1. Vascularized nail transfer from non-replantable digit: a case report.

    PubMed

    Zemirline, Ahmed; Taleb, Chihab; Goukodadja, Oswald; Liverneaux, Philippe

    2014-01-01

    We report the case of a traumatic amputation by circular saw of the ring and small fingers, associated with middle finger nail matrix loss and tendon, bone and joint exposure. The replantation was not attempted with patient's consent. Since the nail unit from the ring finger was intact, we decided to harvest the ring finger nail unit for major finger reconstruction. Although the principle of vascularized transfer from a severely damaged finger is widely recognized and the vascularized nail transfer from toe is a relatively common procedure, there is no description of a vascularized nail transfer from a non-replantable digit in the literature.

  2. Fluoride in the urine, hair, and nails of phosphate fertiliser workers.

    PubMed Central

    Czarnowski, W; Krechniak, J

    1990-01-01

    The fluoride content in the urine, hair, and nails of 106 workers employed in a phosphate fertiliser plant was significantly raised above the control level. Positive correlations were found between the group means for concentrations of fluorides in urine and hair (r = 0.77), urine and nails (r = 0.99), and hair and nails (r = 0.70). Individual values in the whole population gave significant correlations between concentrations in urine and nails (r = 0.73). The obtained results indicate that the fluoride content in hair and nails may be used as an indicator of occupational exposure to fluorides. PMID:2162698

  3. Treatment of ingrown nail with a special device composed of shape-memory alloy.

    PubMed

    Park, Se-Won; Park, Ji-Ho; Lee, Jong-Hee; Lee, Dong-Youn; Lee, Joo-Heung; Yang, Jun-Mo

    2014-04-01

    Ingrown nail is a common nail problem resulting in pain and disability in daily life. Recently, a new treatment modality for an ingrown nail was reported that used a device composed of shape-memory alloy, K-D. The aim of the present study was to determine the efficacy, recurrence rate and complications of K-D. Between June 2010 and September 2012, 24 patients (31 nails) underwent treatment of symptomatic incurved nails with a K-D. Patients were evaluated at pretreatment and during every visit. The mean age of the patients involved was 43.4 years. The mean period of follow up was 161 days. The mean maintenance period was 41 days. The right first toenail was the most common site. Almost ingrown nails healed and the nail deformity was corrected after the procedure. Among the 31 nails, seven of the ingrown nails recurred during follow up (22.6% recurrence rate). The recurrence rate of the patients with stage 1, 2 and 3 ingrown nails was 22.2%, 33.3% and 14.2%, respectively. The majority of patients were very satisfied. There were no side-effects in most patients except loss of nail in one patient. K-D has some advantages such as simple application steps, no deformity after the procedure, high patient satisfaction and obvious effect compared to other non-invasive and invasive methods. © 2014 Japanese Dermatological Association.

  4. Ciclopirox delivery into the human nail plate using novel lipid diffusion enhancers.

    PubMed

    Hafeez, Farhaan; Hui, Xiaoying; Selner, Marc; Rosenthal, Bert; Maibach, Howard

    2014-06-01

    Onychomycosis is a common fungal infection of the nail plate and bed that affects up to 14% of the population and can have a substantial impact on the quality of life of those affected. This study compared the onychopharmacokinetics, nail absorption, nail distribution, and nail penetration of [(14)C]-ciclopirox dissolved in novel lipid diffusion enhancers with that of a commercial ciclopirox nail lacquer using the in vitro finite dose model. The penetration rate of ciclopirox was determined by applying doses of topical formulation twice daily to human nail plates for 11 d. Drug absorption was then measured by monitoring its rate of appearance in each nail layer and in the cotton pad/nail supporting bed. After a multiple day treatment, cumulative concentrations of ciclopirox formulated with lipid enhancers in the deep nail layer and the nail bed were significantly greater than cumulative concentrations of the commercial ciclopirox lacquer (p < 0.001) as well as several orders of magnitude greater than the minimal inhibitory concentration (MIC) deemed necessary to inhibit the growth of the causative dermatophyte species. When formulated with lipid enhancers, the amount of ciclopirox in the ventral/intermediate layer and supporting bed dramatically exceed the inhibitory concentration of ciclopirox for the most common onychomycosis organisms. These results suggest that topical ciclopirox with lipid enhancers has the potential to be an effective topical treatment for onychomycosis, and the lipidic pathway of the nail can be utilized as a means of effective transungual delivery.

  5. Expression of follicular sheath keratins in the normal nail with special reference to the morphological analysis of the distal nail unit.

    PubMed

    Perrin, Christophe

    2007-12-01

    The origin and the histology of the distal nail unit remain controversial. For some authors the nail bed is completely derived from the matrix epithelium and is not a self-regenerating, independent structure. The term onycholemmal keratinization has been used variably to describe both the so-called superficial horny layer without the granular layer of the nail bed, and the epidermal keratin of the hyponychium (HYN) and the eponychium. On the other hand, several contradictory systems of comparisons and homologies between components of the nail unit and those of the follicular sheaths have been proposed. Recently, the expression profiles of the epithelial keratins of the follicular sheaths have been determined in the human anagen hair follicle, but they have been only partially analyzed in the nail unit. This study was conducted to elucidate the morphology of the distal nail unit. To clarify the degree of homology between the nail unit and follicular sheaths, a selected set of keratins (K) was used. Formalin-fixed paraffin sections of adult nails were examined using mono- and polyclonal keratin antibodies, which are characteristic, respectively, for the inner root sheath, the companion layer, and the outer root sheath, as well as K10 and the antibody Ki-67 (antigen expressed in cycling cells). Longitudinal as well as transverse sections were investigated. The pattern of the keratins in the nail unit differs from that of the follicle in two points: the lack of an IRS-like compartment and of the companion layer. The expression of K6hf was observed almost exclusively in the nail bed. K6 and K16 were expressed in the eponychium, the apical matrix, and the nail bed, but not in the ventral matrix. Distribution of K6 and K16 was essentially suprabasal. On the basis of morphologic and biochemical considerations, the distal nail unit can be divided into three segments. The nail bed, which represents the main segment of distal nail unit, does not differentiate into a thin

  6. Influence of type of medullary nail on the development of local infection. An experimental study of solid and slotted nails in rabbits.

    PubMed

    Melcher, G A; Claudi, B; Schlegel, U; Perren, S M; Printzen, G; Munzinger, J

    1994-11-01

    Any operation involving the implantation of a foreign body increases the risk of infection. The implant material and its surface, the dead space, and any necrosis or vascular changes play a significant role in susceptibility to infection. We investigated the effect of the dead space in an intramedullary nail on the rate of local infection. We inoculated the intramedullary cavities of rabbit tibiae with various concentrations of a human pathogen, of Staphylococcus aureus strain, and then inserted either a solid or a hollow slotted stainless-steel nail. We found a significantly higher rate of infection after use of the slotted nail (59%) than after the solid nail (27%) (p < 0.05).

  7. Brushes and picks used on nails during the surgical scrub to reduce bacteria: a randomised trial.

    PubMed

    Tanner, J; Khan, D; Walsh, S; Chernova, J; Lamont, S; Laurent, T

    2009-03-01

    Though brushes are no longer used on the hands and forearms during the surgical scrub, they are still widely used on the nails. The aim of this study was to determine whether nail picks and nail brushes are effective in providing additional decontamination during a surgical hand scrub. A total of 164 operating department staff were randomised to undertake one of the following three surgical hand-scrub protocols: chlorhexidine only; chlorhexidine and a nail pick; or chlorhexidine and a nail brush. Bacterial hand sampling was conducted before and 1h after scrubbing using a modified version of the glove juice method. No statistically significant differences in bacterial numbers were found between any two of the three intervention groups. Nail brushes and nail picks used during surgical hand scrubs do not decrease bacterial numbers and are unnecessary.

  8. Lichen nitidus presenting with nail changes--case report and review of the literature.

    PubMed

    Tay, Evelyn Yuxin; Ho, Madeline Sheun Ling; Chandran, Nisha Suyien; Lee, Joyce Siong-See; Heng, Yee Kiat

    2015-01-01

    Lichen nitidus of the nail is rare and can precede the onset of skin lesions. Delayed diagnosis is common. We present an unusual case of lichen nitidus-associated nail changes that preceded the onset of skin lesions in a 4-year-old Indian girl. We also conduct a review of six other cases of lichen nitidus with nail involvement from the English-language literature. Clues to the diagnosis of lichen nitidus include violaceous or pigmentary changes of the nail fold and subtle lichenoid papules on the affected digits. Lichen nitidus of the nails appears to be less severe than nail changes of lichen planus and is generally self-limiting. Understanding the natural history of lichen nitidus of the nails will help physicians better counsel patients and their families.

  9. Removal of a bent tibial intramedullary nail: a rare case report and review of the literature.

    PubMed

    Aggerwal, Sameer; Soni, Ashwani; Saini, Uttam-C; Gahlot, Nitesh

    2011-04-01

    Intramedullary interlocking nailing is a gold standard for treatment of tibial shaft fractures. Bending of a nail secondary to trauma is a rare complication, which may be encountered in healed or unhealed tibial shaft fractures. Removal of such bent nail is always a challenge. We reported this case to discuss various techniques for removal of bent nails and to share our experience in removing a bent tibial intramedullary nail in a 30-year-old man, who was admitted in our department with re-fracture of the right tibial shaft due to a roadside accident two years after the initial surgical treatment. The intramedullary nail, bent by 30 degrees and visible on anterioposterior as well as on lateral radiographs, was firstly weakened by partially cutting the convex wall, then straightened by applying external force, and finally removed by using the standard nail removal method.

  10. Treatment of neglected femoral neck fracture

    PubMed Central

    Jain, Anil K; Mukunth, R; Srivastava, Amit

    2015-01-01

    Intra-capsular femoral neck fractures are seen commonly in elderly people following a low energy trauma. Femoral neck fracture has a devastating effect on the blood supply of the femoral head, which is directly proportional to the severity of trauma and displacement of the fracture. Various authors have described a wide array of options for treatment of neglected/nonunion (NU) femoral neck fracture. There is lack of consensus in general, regarding the best option. This Instructional course article is an analysis of available treatment options used for neglected femoral neck fracture in the literature and attempt to suggest treatment guides for neglected femoral neck fracture. We conducted the “Pubmed” search with the keywords “NU femoral neck fracture and/or neglected femoral neck fracture, muscle-pedicle bone graft in femoral neck fracture, fibular graft in femoral neck fracture and valgus osteotomy in femoral neck fracture.” A total of 203 print articles were obtained as the search result. Thirty three articles were included in the analysis and were categorized into four subgroups based on treatment options. (a) treated by muscle-pedicle bone grafting (MPBG), (b) closed/open reduction internal fixation and fibular grafting (c) open reduction and internal fixation with valgus osteotomy, (d) miscellaneous procedures. The data was pooled from all groups for mean neglect, the type of study (prospective or retrospective), classification used, procedure performed, mean followup available, outcome, complications, and reoperation if any. The outcome of neglected femoral neck fracture depends on the duration of neglect, as the changes occurring in the fracture area and fracture fragments decides the need and type of biological stimulus required for fracture union. In stage I and stage II (Sandhu's staging) neglected femoral neck fracture osteosynthesis with open reduction and bone grafting with MPBG or Valgus Osteotomy achieves fracture union in almost 90% cases

  11. Poor relation between biomechanical and clinical studies for the proximal femoral locking compression plate.

    PubMed

    Viberg, Bjarke; Rasmussen, Katrine M V; Overgaard, Søren; Rogmark, Cecilia

    2017-08-01

    Background and purpose - The proximal femur locking compression plate (PF-LCP) is a new concept in the treatment of hip fractures. When releasing new implants onto the market, biomechanical studies are conducted to evaluate performance of the implant. We investigated the relation between biomechanical and clinical studies on PF-LCP. Methods - A systematic literature search of relevant biomechanical and clinical studies was conducted in PubMed on December 1, 2015. 7 biomechanical studies and 15 clinical studies were included. Results - Even though the biomechanical studies showed equivalent or higher failure loads for femoral neck fracture, the clinical results were far worse, with a 37% complication rate. There were no biomechanical studies on pertrochanteric fractures. Biomechanical studies on subtrochanteric fractures showed that PF-LCP had a lower failure load than with proximal femoral nail, but higher than with angled blade plate. 4 clinical studies had complication rates less than 8% and 9 studies had complication rates between 15% and 53%. Interpretation - There was no clear relation between biomechanical and clinical studies. Biomechanical studies are generally inherently different from clinical studies, as they examine the best possible theoretical use of the implant without considering the long-term outcome in a clinical setting. Properly designed clinical studies are mandatory when introducing new implants, and they cannot be replaced by biomechanical studies.

  12. Treatment of a Femur Nonunion with Microsurgical Corticoperiosteal Pedicled Flap from the Medial Femoral Condyle

    PubMed Central

    Guzzini, Matteo; Guidi, Marco; Civitenga, Carolina; Ferri, Germano; Ferretti, Andrea

    2016-01-01

    Introduction. The vascularized corticoperiosteal flap is harvested from the medial femoral condyle and it is nourished by the articular branch of the descending genicular artery and the superomedial genicular artery. This flap is usually harvested as a free flap for the reconstruction of bone defects at forearm, distal radius, carpus, hand, and recently at lower limb too. Case Report. A 50-year-old Caucasian man referred to our department for hypertrophic nonunion of the distal femur, refractory to the conservative treatments. The first surgical choice was the revision of the nail and the bone reconstruction with a corticoperiosteal pedicled flap from the medial femoral condyle. We considered union to have occurred 3.5 months after surgery when radiographs showed bridging of at least three of the four bony cortices and clinically the patient was able to walk with full weight bearing without any pain. At the last follow-up (25 months), the patient was completely satisfied with the procedure. Discussion. The corticoperiosteal flap allows a faster healing of fractures with a minimal morbidity at the donor site. We suggest that the corticoperiosteal pedicled flap graft is a reliable and effective treatment for distal femur nonunion. PMID:27064589

  13. Treatment of femoral shaft fractures in children using the "Tobruk" method.

    PubMed

    O'Donnell, Turlough M P; Murphy, Diarmuid P; Mullett, Hannan; Moore, David P; Fogarty, Esmond E; Dowling, Frank E

    2006-08-01

    The "Tobruk" technique of plaster augmentation of a Thomas' splint can be used for the treatment of femoral shaft fractures in children. The radiological and clinical data of 118 patients treated using this method were reviewed over a consecutive 3-year period. The mean age of the patients was 4.25 years. Mean hospital stay was 14.11 days. Mean time spent in the "Tobruk" splint was 44.77 days. Loss of reduction during splintage occurred in 9.32% of patients. Skin complications occurred in 5 patients (4.2%), and cast repairs were necessary in 3 patients. "Tobruk" splinting is a relatively safe and effective way of treating femoral shaft fractures in children. Although its use is not widespread, especially in the United States, until better results are achieved with spica casting and elastic stable intramedullary nails, it does provide a valid option in the treatment of these fractures. A controlled randomized prospective trial with long-term follow-up is needed to fully elucidate its value.

  14. Comparative microscopic analysis of nail clippings from patients with cutaneous psoriasis and psoriatic arthritis*

    PubMed Central

    Fonseca, Gabriela Poglia; Werner, Betina; Seidel, Gabriela; Staub, Henrique Luiz

    2017-01-01

    BACKGROUND The nail involvement in psoriasis is related to psoriatic arthritis and may represent a predictor of the disease. OBJECTIVES To analyze, through nail clipping, clinically normal and dystrophic nails of patients with cutaneous psoriasis and psoriatic arthritis. METHODS This is a cross-sectional multicenter study, conducted between August 2011 and March 2012. Patients were divided into four groups: patients with cutaneous psoriasis and onychodystrophy, patients with cutaneous psoriasis and clinically normal nails, patients with psoriatic arthritis and onychodystrophy and patients with psoriatic arthritis and clinically normal nails. We calculated NAPSI (Nail Psoriasis Severity Index) of the nail with more clinically noticeable change. After collection and preparation of the nail clipping, the following microscopic parameters were evaluated: thickness of the nail plate and subungual region, presence or absence of parakeratosis, serous lakes, blood, and fungi. RESULTS There were more layers of parakeratosis (p=0.001) and a greater thickness of the subungual region in patients with cutaneous psoriasis and onychodystrophy (p=0.002). Serous lakes were also more present in the same group (p=0.008) and in patients with psoriatic arthritis and normal nails (p=0.047). The other microscopic parameters showed no significant difference between normal and dystrophic nails or between patients with psoriatic arthritis or cutaneous psoriasis. STUDY LIMITATIONS Small sample size and use of medications. CONCLUSIONS Nail clipping is a simple and quick method to assess the nails of patients with nail psoriasis although does not demonstrate difference between those with joint changes or exclusively cutaneous psoriasis. PMID:28225951

  15. Drug permeation through the three layers of the human nail plate.

    PubMed

    Kobayashi, Y; Miyamoto, M; Sugibayashi, K; Morimoto, Y

    1999-03-01

    The in-vitro permeation characteristics of a water soluble model drug, 5-fluorouracil, and a poorly water soluble model drug, flurbiprofen, were investigated through three layers of the human nail plate (namely, the dorsal, intermediate and ventral nail plates), using a modified side-by-side diffusion cell. The dorsal-filed nail plate, the ventral-filed nail plate and the dorsal-and-ventral-filed nail plate were prepared to known thicknesses and then used with the full-thickness nail plate to investigate the permeation characteristics of each single layer. Most of the lipids in the human nail plate were found in the dorsal and ventral layers. The rank orders of the permeation fluxes for 5-fluorouracil and flurbiprofen were both: dorsal-and-ventral-filed nail plate > dorsal-filed nail plate > ventral-filed nail plate > full-thickness nail plate. With respect to 5-fluorouracil permeation through each single layer, the permeability coefficient of the intermediate layer was higher than those of other single layers. However in the case of flurbiprofen, the permeability coefficient of the ventral layer was higher than other single layers. The diffusion coef