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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. 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.

  3. 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.

  4. 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

  5. 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.

  6. 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.

  7. 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

  8. 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

  9. 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.].

  10. 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

  11. 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

  12. 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

  13. 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

  14. 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

  15. 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

  16. 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.

  17. 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

  18. 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

  19. 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

  20. 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

  1. 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.

  2. 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

  3. 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

  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. 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

  7. 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

  8. 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.

  9. 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

  10. 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.

  11. 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

  12. 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

  13. 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

  14. 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

  15. 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

  16. 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.

  17. 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

  18. 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

  19. 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.

  20. 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.

  1. 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.

  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. 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

  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. 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

  7. 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

  8. 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

  9. 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.

  10. 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

  11. 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

  12. 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

  13. 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

  14. 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 ...

  15. 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.

  16. Nail abnormalities

    MedlinePlus

    Beau's lines; Fingernail abnormalities; Spoon nails; Onycholysis; Leukonychia; Koilonychia; Brittle nails ... 2012:chap 71. Zaiac MN, Walker A. Nail abnormalities associated with systemic pathologies. Clin Dermatol . 2013;31: ...

  17. Nail Fungus

    MedlinePlus

    ... nail polish daily for a year. Medicated nail cream. Your doctor may prescribe an antifungal cream, which you rub into your infected nails after soaking. These creams may work better if you first thin the ...

  18. 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.

  19. 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.

  20. [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.

  1. Your Nails

    MedlinePlus

    ... luh) — which comes from the Latin word for "moon" — is that pale half circle just above the ... Problems Most of the time, your nails are pink and healthy, but sometimes nails have problems. Some ...

  2. 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 ...

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. [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.

  8. 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.”

  9. 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.

  10. 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

  11. 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.

  12. Fungal nail infection

    MedlinePlus

    ... Common fungal infections include: Athlete's foot Jock itch Ringworm on the skin of the body or head ... fungal infection. Alternative Names Nails - fungal infection; Onychomycosis; Tinea unguium Images Nail infection, candidal Yeast and mold ...

  13. Nail Problems (Toenails)

    MedlinePlus

    ... perform a procedure to permanently excessive perspiration. prevent ingrown nails. The corner of the nail that ingrows, along with the matrix or root of Prevention that piece of nail, are removed by use of a ◆ Proper hygiene and regular inspec- chemical, a laser, or by other methods. tion of the feet ...

  14. 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

  15. 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.

  16. [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.

  17. Nail Fungal Infections

    MedlinePlus

    ... Are treatments usually effective?Are there any side effects of the treatment?If my treatment works, will my nail grow back normally?If I've had one fungal nail infection, am I likely to get another?What kinds of shoes should I wear?Should I wear gloves when ...

  18. 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

  19. 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.

  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. 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.

  2. 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/ ...

  3. 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, ...

  4. Nail Care Products

    MedlinePlus

    ... Acrylics") Artificial nails are composed primarily of acrylic polymers and are made by reacting together acrylic monomers, such as ethyl methacrylate monomer, with acrylic polymers, such as polymethylmethacrylate. When the reaction is completed, ...

  5. 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.

  6. 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.

  7. 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.

  8. 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."

  9. 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.

  10. 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.

  11. 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.

  12. 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.

  13. 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/ ...

  14. 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.

  15. 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

  16. 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.

  17. 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

  18. 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

  19. [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.

  20. Teaching Your Child Healthy Nail Care

    MedlinePlus

    ... aad", "size=300x250", "vpos=t", "hpos=r", "zone=public", "mcat1=de12", ]; for (var c = 0; c Teaching your child healthy nail care Nails take a ... by wearing flip-flops or shower sandals in public places, such as beaches, ... nails are usually healthy, but teaching them to check their nails at a young ...

  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. 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

  6. 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.

  7. 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 ...

  8. 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.

  9. 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

  10. 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.

  11. 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.

  12. 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

  13. 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

  14. 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.

  15. 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.

  16. 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.

  17. 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.

  18. 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

  19. 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

  20. 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

  1. 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

  2. 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.

  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. [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.

  5. 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.

  6. 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.

  7. 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

  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. 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.

  10. 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.

  11. 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.

  12. [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.

  13. 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 ...

  14. 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

  15. 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.

  16. 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.

  17. 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.

  18. 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.

  19. 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

  20. 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.

  1. 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

  2. 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.

  3. 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

  4. 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…

  5. 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.

  6. 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

  7. 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.

  8. 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.

  9. 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

  10. 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.

  11. 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.

  12. 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.

  13. [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.

  14. 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.

  15. Nails

    MedlinePlus

    ... 2017 American Academy of Dermatology. All rights reserved. Reproduction or republication strictly prohibited without prior written permission. ... 2017 American Academy of Dermatology. All rights reserved. Reproduction or republication strictly prohibited without prior written permission.

  16. 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.

  17. 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.

  18. 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

  19. 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.

  20. 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.

  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. [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.

  8. 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.

  9. 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

  10. 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.

  11. 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.

  12. 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

  13. 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.

  14. 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

  15. 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.

  16. 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.

  17. 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....

  18. 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

  19. 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.

  20. 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.

  1. 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

  2. [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.

  3. Femoral neck fracture fixation: rigidity of five techniques compared.

    PubMed Central

    Mackechnie-Jarvis, A C

    1983-01-01

    Artificial cadaveric femoral neck fractures were internally fixed with five different devices and subjected to cyclical loading of 0-1.0 kilonewtons (approximately one body weight) whilst in an anatomical position. Displacement of the proximal fragment was detected by a transducer and charted. Bone strength was assessed by a preliminary control loading phase on the intact bone. Efficiency of each fracture fixator could then be directly compared by the relative movement in each case. Five specimens each were tested with Moore's Pins, Trifin Nail, Garden Screws and a sliding screw-plate (OEC Ltd). By the criteria of the experiment, which put a severe shearing load on the implant, none of these devices reliably bore the representative body weight. An extended barrel-plate, which supported the sliding screw almost up to the fracture line, was then made. This device, employing some of Charnley's concepts, tolerated body weight in four cases out of five. PMID:6887186

  4. 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.

  5. 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

  6. 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.

  7. 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

  8. 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.

  9. 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.

  10. 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.

  11. 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

  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.

  13. 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

  14. 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).

  15. 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%).

  16. 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

  17. 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

  18. 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

  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. 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.

  1. [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

  2. [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.

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. 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.

  8. 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.

  9. 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.

  10. 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

  11. 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.

  12. 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.

  13. 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.

  14. 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.

  15. 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.

  16. 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.

  17. 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.

  18. 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.

  19. 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.

  20. 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.

  1. 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.

  2. 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 ...

  3. 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 ...

  4. 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.

  5. 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.

  6. 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.

  7. 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.

  8. 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.

  9. [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.

  10. 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

  11. 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.

  12. [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.

  13. 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

  14. 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

  15. Femoral head cartilage disarticulation disorder

    Technology Transfer Automated Retrieval System (TEKTRAN)

    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 ...

  16. 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.

  17. 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.

  18. 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.

  19. 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.

  20. 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.

  1. 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

  2. 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

  3. 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 ...

  4. 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

  5. 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.

  6. 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

  7. 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. ...

  8. 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.

  9. 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

  10. 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.

  11. 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

  12. 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.

  13. 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

  14. 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.

  15. 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

  16. 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.

  17. 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

  18. 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.

  19. 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

  20. 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

  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. 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

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. 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

  8. 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.

  9. 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.

  10. 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.

  11. 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....

  12. 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

  13. 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

  14. 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.

  15. 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

  16. 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.

  17. 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.

  18. 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.

  19. 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.

  20. 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.

  1. 78 FR 40172 - Steel Nails From China; Institution of a Five-Year Review

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-03

    ... COMMISSION Steel Nails From China; Institution of a Five-Year Review AGENCY: United States International... whether revocation of the antidumping duty order on steel nails from China would be likely to lead to... duty order on imports of steel nails from China (73 FR 44961). The Commission is conducting a review...

  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. 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.

  5. 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

  6. 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.

  7. 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

  8. The human nail--barrier characterisation and permeation enhancement.

    PubMed

    Walters, Kenneth A; Abdalghafor, Haydar M; Lane, Majella E

    2012-10-01

    The human nail remains one of the most challenging membranes for formulation scientists to target and for clinicians to heal. Its formidable barrier properties are the primary reason that oral therapy remains the primary approach to manage ungual infections. This article considers the major structural properties underlying the excellent barrier function of the nail, with particular emphasis on the role of biophysical methods in advancing our knowledge of this appendage. Formulations currently available for management of ungual disease are discussed and their therapeutic efficacy is assessed. Finally, experimental strategies to enhance ungual permeation are reviewed and prospects for future developments in the field are considered.

  9. 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.

  10. 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

  11. 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.

  12. 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

    2017-03-13

    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.

  13. 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...

  14. 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...

  15. An unusual complication of femoral vein catheterisation: pneumoperitoneum.

    PubMed

    Yildizdas, D; Tepe, T; Parlak, M; Akcali, M

    2007-12-01

    A 2-month-old girl with severe pneumonia required a central venous line. Femoral vein catheterisation was attempted but insertion was difficult. Pneumoperitoneum developed, which is a rare complication of femoral vein catheterisation. It is important when undertaking femoral vein catheterisation to use the correct landmarks in the femoral triangle below the inguinal ligament and an appropriate size of catheter.

  16. 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.

  17. Unilateral Isolated Proximal Femoral Focal Deficiency

    PubMed Central

    Doğer, Emek; Köpük, Şule Y.; Çakıroğlu, Yiğit; Çakır, Özgür; Yücesoy, Gülseren

    2013-01-01

    Objective. To discuss a patient with a prenatal diagnosis of unilateral isolated femoral focal deficiency. Case. Antenatal diagnosis of unilateral isolated femoral focal deficiency was made at 20 weeks of gestation. The length of left femur was shorter than the right, and fetal femur length was below the fifth percentile. Proximal femoral focal deficiency was diagnosed. After delivery, the diagnosis was confirmed with skeletal radiographs and magnetic resonance imaging. In prenatal ultrasonographic examination, the early recognition and exclusion of skeletal dysplasias is important; moreover, treatment plans should be initiated, and valuable information should be provided to the family. PMID:23984135

  18. 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.

  19. 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).

  20. 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.

  1. In Vitro penetration of a novel oxaborole antifungal (AN2690) into the human nail plate.

    PubMed

    Hui, Xiaoying; Baker, Stephen J; Wester, Ronald C; Barbadillo, Sherry; Cashmore, Anne K; Sanders, Virginia; Hold, Karin M; Akama, Tsutomu; Zhang, Yong-Kang; Plattner, Jacob J; Maibach, Howard I

    2007-10-01

    Onychomycosis is a challenging fungal infection to treat topically, likely due to the unique properties of the nail plate. This seemingly impenetrable barrier has high resistance to the passage of antifungal drugs in sufficient concentrations to kill the causative fungi deep in the nail bed. Recently, a new class of antifungal agent was described, termed oxaboroles, which have broad-spectrum activity. These oxaboroles were designed with properties believed to be required to allow for easier transit through the nail plate. Herein, we report (i) the nail penetration results of four oxaboroles that led to the selection of AN2690, (ii) the results of the nail penetration of AN2690 from four vehicles, and (iii) the nail penetration of AN2690 in its chosen vehicle compared to a commercial control, ciclopirox. AN2690 has superior penetration compared to ciclopirox, and achieves levels within and under the nail plate that suggest it has the potential to be an effective topical treatment for onychomycosis.

  2. 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.

  3. 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.

  4. Meralgia Paresthetica and Femoral Acetabular Impingement: A Possible Association

    PubMed Central

    Ahmed, Aiesha

    2010-01-01

    Meralgia paresthetica consists of pain and dysesthesia in the anterolateral thigh. Etiology is divided into spontaneous and iatrogenic causes. To my knowledge this has never been attributed to femoral acetabular impingement. This case highlights the presence of lateral femoral cutaneous neuropathy in the setting of femoral acetabular impingement syndrome thus raising the possibility of an association. Keywords Femoral acetabular impingement; Lateral femoral cutaneous nerve; Dysesthesia; Nerve conduction studies PMID:22043261

  5. Managing Chemotherapy Side Effects: Skin and Nail Changes

    MedlinePlus

    ... better.” Let your doctor or nurse know if: l Your skin is itchy, dry, red, or hurts l Your nails are dark, yellow, or cracked For ... Be careful what you put on your skin. l Use only mild soaps that are gentle on ...

  6. The isolation of Botryodiplodia theobromae from a nail lesion.

    PubMed

    Restrepo, A; Arango, M; Velez, H; Uribe, L

    1976-03-01

    Botryodiplodia theobromae not known to produce onychomycosis was repeatedly recovered from a healthy woman with evident lesions in a toe nail. Mycelial fragments were observed in the scales and the fungus was isolated in cycloheximide-free culture media. The report indicates that many fungi, hitherto considered non-pathogens, may still be able to colonize a vaiety of human tissues.

  7. Osteosynthesis of the proximal femur anchorage of a cervical nail.

    PubMed

    el Banna, S; Burny, F; Bourgois, R; Donkerwolcke, M; Moulart, F

    1994-01-01

    One of the factors determining the stability of osteosynthesis is the mechanical strength of the bone fragments required for the anchorage of the implant. The aim is to study the driving of a Thornton nail in the proximal epiphysis of a human femur as a way to measure the strength of the trabecular bone and to predict the stability of the implanted system.

  8. The SIGN nail for knee fusion: technique and clinical results

    PubMed Central

    Anderson, Duane Ray; Anderson, Lucas Aaron; Haller, Justin M.; Feyissa, Abebe Chala

    2016-01-01

    Purpose: Evaluate the efficacy of using the SIGN nail for instrumented knee fusion. Methods: Six consecutive patients (seven knees, three males) with an average age of 30.5 years (range, 18–50 years) underwent a knee arthrodesis with SIGN nail (mean follow-up 10.7 months; range, 8–14 months). Diagnoses included tuberculosis (two knees), congenital knee dislocation in two knees (one patient), bacterial septic arthritis (one knee), malunited spontaneous fusion (one knee), and severe gout with 90° flexion contracture (one knee). The nail was inserted through an anteromedial entry point on the femur and full weightbearing was permitted immediately. Results: All knees had clinical and radiographic evidence of fusion at final follow-up and none required further surgery. Four of six patients ambulated without assistive device, and all patients reported improved overall physical function. There were no post-operative complications. Conclusion: The technique described utilizing the SIGN nail is both safe and effective for knee arthrodesis and useful for austere environments with limited fluoroscopy and implant options. PMID:27163095

  9. An electrochemical modeling of lithium-ion battery nail penetration

    NASA Astrophysics Data System (ADS)

    Chiu, Kuan-Cheng; Lin, Chi-Hao; Yeh, Sheng-Fa; Lin, Yu-Han; Chen, Kuo-Ching

    2014-04-01

    Nail penetration into a battery pack, resulting in a state of short-circuit and thus burning, is likely to occur in electric car collisions. To demonstrate the behavior of a specific battery when subject to such incidents, a standard nail penetration test is usually performed; however, conducting such an experiment is money consuming. The purpose of this study is to propose a numerical electrochemical model that can simulate the test accurately. This simulation makes two accurate predictions. First, we are able to model short-circuited lithium-ion batteries (LIBs) via electrochemical governing equations so that the mass and charge transfer effect could be considered. Second, the temperature variation of the cell during and after nail penetration is accurately predicted with the help of simulating the temperature distribution of thermal runaway cells by thermal abuse equations. According to this nail penetration model, both the onset of battery thermal runaway and the cell temperature profile of the test are obtained, both of which are well fitted with our experimental results.

  10. Probabilistic assessment of exposure to nail cosmetics in French consumers.

    PubMed

    Ficheux, A S; Morisset, T; Chevillotte, G; Postic, C; Roudot, A C

    2014-04-01

    The aim of this study was to assess probabilistic exposure to nail cosmetics in French consumers. The exposure assessment was performed with base coat, polish, top coat and remover. This work was done for adult and child consumers. Dermal, inhalation and oral routes were taken into account for varnishes. Exposure evaluation was performed for the inhalation route with polish remover. The main route of exposure to varnishes was the ungual route. Inhalation was the secondary route of exposure, followed by dermal and oral routes. Polish contributed most to exposure, regardless of the route of exposure. For this nail product, P50 and P95 values by ungual route were respectively equal to 1.74 mg(kg bw week)(-1) and 8.55 mg(kg bw week)(-1) for women aged 18-34 years. Exposure to polish by inhalation route was equal to 0.70 mg(kg bw week)(-1) (P50) and 5.27 mg(kg bw week)(-1) (P95). P50 and P95 values by inhalation route were respectively equal to 0.08 mg(kg bw week)(-1) and 1.14 mg(kg bw week)(-1) for consumers aged 18-34 years exposed to polish remover. This work provided current exposure data for nail cosmetics, and a basis for future toxicological studies of the uptake of substances contained in nail cosmetics in order to assess systemic exposure.

  11. 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

  12. 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 coefficients of 5-fluorouracil and flurbiprofen in the dorsal layer were the lowest of any single layer. The drug concentration in each layer was estimated using each respective permeation parameter. The drug concentration in the nail plate was observed to be dependent on the solubility and the flux of the drug. From these findings, we suggest that the human nail plate behaves like a hydrophilic gel membrane rather than a lipophilic partition membrane and that the upper layer functions as the main nail barrier to drug permeation through its low diffusivity against the drugs.

  13. Flows In Model Human Femoral Arteries

    NASA Technical Reports Server (NTRS)

    Back, Lloyd H.; Kwack, Eug Y.; Crawford, Donald W.

    1990-01-01

    Flow is visualized with dye traces, and pressure measurements made. Report describes experimental study of flow in models of human femoral artery. Conducted to examine effect of slight curvature of artery on flow paths and distribution of pressure.

  14. Detection of Drugs in Nails: Three Year Experience.

    PubMed

    Shu, Irene; Jones, Joseph; Jones, Mary; Lewis, Douglas; Negrusz, Adam

    2015-10-01

    Nails (fingernails and toenails) are made of keratin. As the nail grows, substances incorporate into the keratin fibers where they can be detected 3-6 months after use. Samples are collected by clipping of 2-3 mm of nail from all fingers (100 mg). We present drug testing results from 10,349 nail samples collected from high-risk cases during a 3-year period of time. Samples were analyzed by validated analytical methods. The initial testing was performed mostly using enzyme-linked immunosorbent assay, but by liquid chromatography-tandem mass spectrometry (LC-MS-MS) as well. Presumptive positive samples were subjected to confirmatory testing with sample preparation procedures including washing, pulverizing, digestion and extraction optimized for each drug class. The total of 7,799 samples was analyzed for amphetamines. The concentrations ranged from 40 to 572,865 pg/mg (median, 100-3,687) for all amphetamine analytes. Amphetamine and methamphetamine were present in 14% of the samples, 22 samples were positive for 3,4-methylenedioxymethamphetamine (0.3%), 7 for methylenedioxyamphetamine (0.09%) and 4 for 3,4-methylenedioxy-N-ethylamphetamine (0.05%). Cocaine and related analytes were found in 5% samples (7,787 total), and the concentration range was 20-265,063 pg/mg (median 84-1,768). Opioids overall ranged from 40 to 118,229 pg/mg (median 123-830). The most prevalent opioid was oxycodone (15.1%) and hydrocodone (11.4%) compared with 1.0-3.6% for the others, including morphine, codeine, hydromorphone, methadone, 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine and oxymorphone. Carboxy-Δ-9-tetrahydrocannabinol positivity rate was 18.1% (0.04-262 pg/mg, median 6.41). Out of 3,039 samples, 756 were positive (24.9%) for ethyl glucuronide (20-3,754 pg/mg, median 88). Other drugs found in nails included barbiturates, benzodiazepines, ketamine, meperidine, tramadol, zolpidem, propoxyphene, naltrexone and buprenorphine. Nail analyses have become a reliable way of determining

  15. Anti-infective efficacy of antiseptic-coated intramedullary nails.

    PubMed

    Darouiche, R O; Farmer, J; Chaput, C; Mansouri, M; Saleh, G; Landon, G C

    1998-09-01

    The coating of medical devices with antimicrobial agents has recently emerged as a potentially effective method for the prevention of device-related infections. We examined the anti-infective efficacy of intramedullary nails coated with an antiseptic combination of chlorhexidine and chloroxylenol in a rabbit model of device-related infection after fixation of an open tibial fracture. The rabbits were randomized to receive 2.8-by-100-millimeter stainless-steel tibial intramedullary nails that either were uncoated or were coated with antiseptic. After administration of anesthesia and preoperative antibiotic prophylaxis, a tibial fracture was created and then reduced with insertion of the intramedullary nail. A bacterial inoculum of 10(6) colony-forming units of Staphylococcus aureus was injected into the intramedullary canal, and the wound was sutured. Radiographs of the tibiae were made postoperatively, and the rabbits were monitored daily. They were killed at six weeks, or earlier if there was dehiscence of the wound, the fracture became grossly unstable, or the rabbit failed to thrive. The use of the antiseptic-coated nails was associated with a significantly lower rate of device-related osteomyelitis (two of twenty-two; 9 per cent) than the use of the uncoated nails (thirteen of twenty-one; 62 per cent) (p = 0.0003). The radiographic and histopathological findings were generally similar in the two groups of rabbits. Antiseptic agents were not detected in serum. The results suggest that antiseptic-coated fracture-fixation devices provide significant local protection against Staphylococcus aureus, which is the most common cause of infections related to orthopaedic devices.

  16. Treatment of humeral shaft fractures with antegrade intramedullary locking nail.

    PubMed

    Tsourvakas, Stefanos; Alexandropoulos, Christos; Papachristos, Ioannis; Tsakoumis, Grigorios; Ameridis, Nikolaos

    2011-12-01

    Antegrade interlocked humeral nailing for stabilization of humeral fractures was introduced many years ago, and studies on this method in the orthopedic literature have shown mixed results. The purpose of this investigation was to document the clinical outcome and complications associated with the use of an antegrade intramedullary nail (T2, Stryker) for the humeral fractures. Between 2005 and 2008, 52 fractures of the humeral shaft were treated operatively with this intramedullary nail in our department. Eight patients were polytraumatized, and four patients had an open fracture. The mean age of patients was 51.7 years. Forty-eight patients had an adequate duration of clinical follow-up (a mean of 18 months) for analysis. Complications were recorded, and the time to union was measured. Shoulder and elbow functions were assessed using the Constant Score and the Morrey Score, respectively. Forty-six fractures healed, with a mean time to clinical union of 10.3 weeks. Two patients developed pseudarthroses. There were four adverse events: two proximal screws backed out, one superficial infection at the insertion point, and one fracture at the distal end of the nail. Ninety-one percentage of patients had an excellent or good shoulder function. Five further operations were necessary: two for treatment of pseudarthroses, two for removal the backed out proximal screws, and one wound debridement for superficial infection. Antegrade humeral nailing is a valid therapeutic option for stabilization of humeral shaft fractures. By strictly adhering to the operation technique, the number and the severity of complications can be reduced. When good fracture alignment and stability are obtained, uneventful bone healing with good functional results is the rule.

  17. Femoral nerve entrapment: a new insight.

    PubMed

    Vázquez, M T; Murillo, J; Maranillo, E; Parkin, I G; Sanudo, J

    2007-03-01

    Compression of the femoral nerve in the iliac fossa has been reported as a consequence of several pathologies, but never as a result of muscular compression. Aberrant slips of iliacus, however, have occasionally been reported to cover or split the femoral nerve. This study aimed to assess such variations as potential factors in femoral nerve compression. A large and homogeneous sample of 121 embalmed cadavers (242 specimens) was studied. Statistical comparisons were made using the chi-squared test. Muscular slips from iliacus and psoas, piercing or covering the femoral nerve, were found in 19 specimens (7.9%). No significant differences by sex or side were found. The more frequent variation was piercing of the femoral nerve by a muscular slip (17 specimens, 7.0%). The nerve then entered the thigh as one or more branches. The less frequent variation found was a muscular slip or sheet covering the femoral nerve as it lay on iliacus (2 specimens, 0.8%). Each disposition may be a potential risk for nerve entrapment.

  18. Osteotomy and intramedullary nailing for the correction of progressive deformity in vitamin D-resistant hypophosphataemic rickets.

    PubMed

    Eyres, K S; Brown, J; Douglas, D L

    1993-02-01

    We have reviewed the results of surgical treatment of vitamin D-resistant hypophosphataemic rickets (VDRR) and describe a technique of corrective osteotomy and intramedullary nailing. From 1978 to 1986, epiphysiodesis (n = 4) and osteotomy (n = 8) was performed in 6 children (mean age 13, range 10-16 years) for the correction of progressive lower limb deformity. Realignment and internal fixation of a pathological fracture of the femur was performed in an adult (aged 24). Epiphysiodesis resulted in recurrent deformity in all patients and reapplication of staples for loosening was required in three. Corrective osteotomies were secured with staples (n = 3), plates (n = 4), or plaster alone (n = 1) and were complicated by non-union in one patient, and recurrent deformity in two patients. Double-plating of the femoral fracture resulted in union but recurrent deformity. Compliance to treatment with phosphate and vitamin D was variable. In order to manage progressive recurrent deformity, we have performed corrective osteotomy and closed intramedullary nailing of the tibia (n = 2) and femur (n = 3) in 4 skeletally mature patients (mean age 31). All osteotomies united and no complications were encountered. Deformity has been corrected in all cases and all patients are satisfied with the outcome at least 2 years after surgery. We conclude that rigid methods of fixation spanning the whole length of the bone are required to maintain limb alignment in skeletally mature patients with VDRR. Since the quality of bone in VDRR is variable, experience with intramedullary techniques is essential. We stress the importance of appropriate medical therapy throughout the treatment of these patients.

  19. Clinical Evidence for the Relationship between Nail Configuration and Mechanical Forces

    PubMed Central

    Ogawa, Rei

    2014-01-01

    Summary: Mechanobiology is an emerging field of science that focuses on the way physical forces and changes in cell or tissue mechanics contribute to development, physiology, and disease. As nails are always exposed to physical stimulation, mechanical forces may have a particularly pronounced effect on nail configuration and could be involved in the development of nail deformities. However, the role of mechanobiology in nail configuration and deformities has rarely been assessed. This review describes what is currently understood regarding the effect of mechanical force on nail configuration and deformities. On the basis of these observations, we hypothesize that nails have an automatic curvature function that allows them to adapt to the daily upward mechanical forces. Under normal conditions, the upward daily mechanical force and the automatic curvature force are well balanced. However, an imbalance between these 2 forces may cause nail deformation. For example, pincer nails may be caused by the absence of upward mechanical forces or a genetic propensity increase in the automatic curvature force, whereas koilonychias may occur when the upward mechanical force exceeds the automatic curvature force, thereby causing the nail to curve outward. This hypothesis is a new concept that could aid the development of innovative methods to prevent and treat nail deformities. PMID:25289309

  20. Common nail changes and disorders in older people: Diagnosis and management.

    PubMed

    Abdullah, Lina; Abbas, Ossama

    2011-02-01

    Objective To present family physicians with common nail alterations and disorders occurring in the elderly population and their management options. Quality of evidence The evidence relating to different nail conditions is mostly derived from randomized controlled trials, meta-analyses, and review articles. However, given the scarcity of evidence on some conditions, articles with weaker levels of evidence were also included in our review. Main message Given the growing elderly population and the associated demographic changes and longer lifespans, geriatric care is becoming more of a complicated and multidisciplinary effort in which the role of the family physician is increasingly important. Although common among the elderly, nail changes are often not brought to the attention of primary caregivers and are thus overlooked. These nail changes can affect various components of the nail unit and might represent normal age-related nail alterations or nail abnormalities that require immediate intervention. Knowledge and familiarity with these common nail abnormalities and their underlying causes is important for the family practitioner in order to effectively reach an accurate diagnosis and provide better care of this large and growing elderly population. Conclusion Nail changes are common in the elderly, and family physicians are best placed to diagnose and treat these common problems. It is important that family physicians also recognize less common but more serious nail problems that require immediate treatment.

  1. Automated fit quantification of tibial nail designs during the insertion using computer three-dimensional modelling.

    PubMed

    Amarathunga, Jayani P; Schuetz, Michael A; Yarlagadda, Prasad Kvd; Schmutz, Beat

    2014-12-01

    Intramedullary nailing is the standard fixation method for displaced diaphyseal fractures of the tibia. An optimal nail design should both facilitate insertion and anatomically fit the bone geometry at its final position in order to reduce the risk of stress fractures and malalignments. Due to the nonexistence of suitable commercial software, we developed a software tool for the automated fit assessment of nail designs. Furthermore, we demonstrated that an optimised nail, which fits better at the final position, is also easier to insert. Three-dimensional models of two nail designs and 20 tibiae were used. The fitting was quantified in terms of surface area, maximum distance, sum of surface areas and sum of maximum distances by which the nail was protruding into the cortex. The software was programmed to insert the nail into the bone model and to quantify the fit at defined increment levels. On average, the misfit during the insertion in terms of the four fitting parameters was smaller for the Expert Tibial Nail Proximal bend (476.3 mm(2), 1.5 mm, 2029.8 mm(2), 6.5 mm) than the Expert Tibial Nail (736.7 mm(2), 2.2 mm, 2491.4 mm(2), 8.0 mm). The differences were statistically significant (p ≤ 0.05). The software could be used by nail implant manufacturers for the purpose of implant design validation.

  2. An investigation of how fungal infection influences drug penetration through onychomycosis patient’s nail plates

    PubMed Central

    McAuley, W.J.; Jones, S.A.; Traynor, M.J.; Guesné, S.; Murdan, S.; Brown, M.B.

    2016-01-01

    The treatment of onychomycosis remains problematic even though there are several potent antifungal agents available for patient use. The aim of this investigation was to understand whether the structural modifications that arise when a patient’s nail become infected plates influences the permeation of drugs into the nail following topical application. It was hoped that through improving understanding of the nail barrier in the diseased state, the development of more effective topical treatments for onychomycosis could be facilitated. The permeation of three compounds with differing hydrophobicities, caffeine, terbinafine and amorolfine (clog D at pH 7.4 of −0.55, 3.72 and 4.49 respectively), was assessed across both healthy and onychomycosis infected, full thickness, human nail plate sections. Transonychial water loss (TOWL) measurements performed on the healthy and diseased nails supported previous observations that the nail behaves like a porous barrier given the lack of correlation between TOWL values with the thicker, diseased nails. The flux of the more hydrophilic caffeine was twofold greater across diseased in comparison with the healthy nails, whilst the hydrophobic molecules terbinafine and amorolfine showed no statistically significant change in their nail penetration rates. Caffeine flux across the nail was found to correlate with the TOWL measurements, though no correlation existed for the more hydrophobic drugs. These data supported the notion that the nail pores, opened up by the infection, facilitated the passage of hydrophilic molecules, whilst the keratin binding of hydrophobic molecules meant that their transport through the nail plate was unchanged. Therefore, in order to exploit the structural changes induced by nail fungal infection it would be beneficial to develop a small molecular weight, hydrophilic antifungal agent, which exhibits low levels of keratin binding. PMID:26969264

  3. An investigation of how fungal infection influences drug penetration through onychomycosis patient's nail plates.

    PubMed

    McAuley, W J; Jones, S A; Traynor, M J; Guesné, S; Murdan, S; Brown, M B

    2016-05-01

    The treatment of onychomycosis remains problematic even though there are several potent antifungal agents available for patient use. The aim of this investigation was to understand whether the structural modifications that arise when a patient's nail become infected plates influences the permeation of drugs into the nail following topical application. It was hoped that through improving understanding of the nail barrier in the diseased state, the development of more effective topical treatments for onychomycosis could be facilitated. The permeation of three compounds with differing hydrophobicities, caffeine, terbinafine and amorolfine (clogD at pH 7.4 of -0.55, 3.72 and 4.49 respectively), was assessed across both healthy and onychomycosis infected, full thickness, human nail plate sections. Transonychial water loss (TOWL) measurements performed on the healthy and diseased nails supported previous observations that the nail behaves like a porous barrier given the lack of correlation between TOWL values with the thicker, diseased nails. The flux of the more hydrophilic caffeine was twofold greater across diseased in comparison with the healthy nails, whilst the hydrophobic molecules terbinafine and amorolfine showed no statistically significant change in their nail penetration rates. Caffeine flux across the nail was found to correlate with the TOWL measurements, though no correlation existed for the more hydrophobic drugs. These data supported the notion that the nail pores, opened up by the infection, facilitated the passage of hydrophilic molecules, whilst the keratin binding of hydrophobic molecules meant that their transport through the nail plate was unchanged. Therefore, in order to exploit the structural changes induced by nail fungal infection it would be beneficial to develop a small molecular weight, hydrophilic antifungal agent, which exhibits low levels of keratin binding.

  4. Biomechanical investigation of titanium elastic nail prebending for treating diaphyseal long bone fractures.

    PubMed

    Chen, Yen-Nien; Lee, Pei-Yuan; Chang, Chih-Wei; Ho, Yi-Hung; Peng, Yao-Te; Chang, Chih-Han; Li, Chun-Ting

    2016-12-02

    This study numerically investigated the deformation of titanium elastic nails prebent at various degrees during implantation into the intramedullary canal of fractured bones and the mechanism by which this prebending influenced the stability of the fractured bone. Three degrees of prebending the implanted portions of the nails were used: equal to, two times, and three times the diameter of the intramedullary canal. Furthermore, a simulated diaphyseal fracture with a 5-mm gap was created in the middle shaft portion of the bone fixed with two elastic nails in a double C-type configuration. End caps were simulated using a constraint equation. To confirm that the simulation process is able to present the mechanical response of the nail inside the intramedullary, an experiment was conducted by using sawbone for validation. The results indicated that increasing the degrees of nail prebending facilitated straightening the nails against the inner aspect of canal after implantation, with increase in stability under torsion. Furthermore, reducing nail prebending caused a larger portion of the nails to move closer to the loading site and center of bone after implantation; the use of end caps prevented the nail tips from collapsing and increased axial stability. End cap use was critical for preventing the nail tips from collapsing and for increasing the stability of the nails prebent at a degree equal to the diameter of the canal with insufficient frictional force between the nail and canal. Therefore, titanium elastic nail prebending in a double C-type configuration with a degree three times the diameter of the canal represents a superior solution for treating transverse fractures without a gap, whereas that with a degree equal to the diameter of the intramedullary canal and combined with end cap use represents an advanced solution for treating comminuted fractures in a diaphyseal long bone fracture.

  5. Onychomatricoma in the light of the microanatomy of the normal nail unit.

    PubMed

    Perrin, Christophe; Langbein, Lutz; Schweizer, Jürgen; Cannata, Giuseppe Emilio; Balaguer, Thierry; Chignon-Sicart, Bérangère; Garzon, Jean-Marc; Benchetrit, Maxime; Michiels, Jean-François

    2011-04-01

    Onychomatricoma (OM) is an uncommon benign tumor of the nail thought to exhibit differentiation limited toward the nail matrix. Four recent articles from our laboratory have shown, in some respect, a morphological and immunohistochemical homology between the nail unit and the hair follicle at the level of the matrix and isthmus. The purposes of this article are as follows: to investigate whether the sequential pattern of hair keratin expression in the normal nail matrix is maintained in OM, to compare and contrast follicular tumors with matrix differentiation in OM, and to furnish morphological and immunohistochemical markers of the onychogenic capacity of OM. Formalin-fixed paraffin sections from 6 OM were examined using specific keratin (K) antibodies for the matrix, nail bed, and nail isthmus. Hair keratins were expressed in a sequential pattern similar to normal nail matrix. In 3 cases where the cavities were completely lined by the fibroepithelial projections, the morphological aspect and the pattern of expression of K5, K17, K6, K16, and K75 suggested a differentiation toward the nail bed and the nail isthmus. This study shows for the first time that OM can recapitulate the entire nail unit with differentiation toward the nail bed and the nail isthmus. We have identified new histopathological and immunohistochemical features in OM, and we have abridged the diversity of its histological presentation in 2 main patterns: a lobulated or foliated pattern, observed principally on transverse section, and a "glove-finger" mono- or multidigitate pattern, observed mainly on longitudinal section. We have also concluded that OM is not a nail variant of trichoblastoma, pilomatricoma, or other pilar tumors. The concept of epithelial onychogenic tumor with onychogenic mesenchyme could shed more light about the true nature of this peculiar mixed tumor. However, the term OM is short and sanctioned by usage, which justifies keeping it.

  6. Fatigue strength of common tibial intramedullary nail distal locking screws

    PubMed Central

    Griffin, Lanny V; Harris, Robert M; Zubak, Joseph J

    2009-01-01

    Background Premature failure of either the nail and/or locking screws with unstable fracture patterns may lead to angulation, shortening, malunion, and IM nail migration. Up to thirty percent of all unreamed nail locking screws can break after initial weight bearing is allowed at 8–10 weeks if union has not occurred. The primary problem this presents is hardware removal during revision surgery. The purposes of our study was to evaluate the relative fatigue resistance of distal locking screws and bolts from representative manufacturers of tibial IM nail systems, and develop a relative risk assessment of screws and materials used. Evaluations included quantitative and qualitative measures of the relative performance of these screws. Methods Fatigue tests were conducted to simulate a comminuted fracture that was treated by IM nailing assuming that all load was carried by the screws. Each screw type was tested ten times in a single screw configuration. One screw type was tested an additional ten times in a two-screw parallel configuration. Fatigue tests were performed using a servohydraulic materials testing system and custom fixturing that simulated screws placed in the distal region of an appropriately sized tibial IM nail. Fatigue loads were estimated based on a seventy-five kilogram individual at full weight bearing. The test duration was one million cycles (roughly one year), or screw fracture, whichever occurred first. Failure analysis of a representative sample of titanium alloy and stainless steel screws included scanning electron microscopy (SEM) and quantitative metallography. Results The average fatigue life of a single screw with a diameter of 4.0 mm was 1200 cycles, which would correspond roughly to half a day of full weight bearing. Single screws with a diameter of 4.5 mm or larger have approximately a 50 percent probability of withstanding a week of weight bearing, whereas a single 5.0 mm diameter screw has greater than 90 percent probability of

  7. Medial Patellofemoral Ligament Reconstruction Femoral Tunnel Accuracy

    PubMed Central

    Hiemstra, Laurie A.; Kerslake, Sarah; Lafave, Mark

    2017-01-01

    Background: Medial patellofemoral ligament (MPFL) reconstruction is a procedure aimed to reestablish the checkrein to lateral patellar translation in patients with symptomatic patellofemoral instability. Correct femoral tunnel position is thought to be crucial to successful MPFL reconstruction, but the accuracy of this statement in terms of patient outcomes has not been tested. Purpose: To assess the accuracy of femoral tunnel placement in an MPFL reconstruction cohort and to determine the correlation between tunnel accuracy and a validated disease-specific, patient-reported quality-of-life outcome measure. Study Design: Case series; Level of evidence, 4. Methods: Between June 2008 and February 2014, a total of 206 subjects underwent an MPFL reconstruction. Lateral radiographs were measured to determine the accuracy of the femoral tunnel by measuring the distance from the center of the femoral tunnel to the Schöttle point. Banff Patella Instability Instrument (BPII) scores were collected a mean 24 months postoperatively. Results: A total of 155 (79.5%) subjects had adequate postoperative lateral radiographs and complete BPII scores. The mean duration of follow-up (±SD) was 24.4 ± 8.2 months (range, 12-74 months). Measurement from the center of the femoral tunnel to the Schöttle point resulted in 143 (92.3%) tunnels being categorized as “good” or “ideal.” There were 8 failures in the cohort, none of which occurred in malpositioned tunnels. The mean distance from the center of the MPFL tunnel to the center of the Schöttle point was 5.9 ± 4.2 mm (range, 0.5-25.9 mm). The mean postoperative BPII score was 65.2 ± 22.5 (range, 9.2-100). Pearson r correlation demonstrated no statistically significant relationship between accuracy of femoral tunnel position and BPII score (r = –0.08; 95% CI, –0.24 to 0.08). Conclusion: There was no evidence of a correlation between the accuracy of MPFL reconstruction femoral tunnel in relation to the Schöttle point and

  8. Habit tic nail deformity - a rare presentation in an 8 year old boy.

    PubMed

    El-Heis, S; Abadie, Al

    2016-11-15

    Habit tic nail deformity is a nail dystrophy resulting from habitual, repetitive trauma to the nail. It is usually acquired in adulthood, however, we report a case of habit tic nail deformity in an 8 year old boy. The diagnosis was made clinically with further history revealing that the boy repeatedly rubbed his thumbnails and pushed the cuticles. Emollient cream (Balneum®) was recommended twice daily and both the patient and his mother were educated on the behavioral nature of this condition. There was marked improvement at 6 months of treatment and further improvement at 12 months.We note that habit tic nail deformity is not exclusive to adults. Diagnosis can be made clinically. History and physical examination provide valuable clues and psychosocial links must be explored and addressed. Management is challenging and compliance with treatment is variable. Patient education, barrier methods, and behavioral therapy can be helpful in preventing further trauma to the nails.

  9. Post-Traumatic Ectopic Nail: A Case Report and Review of Literature

    PubMed Central

    Mishra, Tushar Subhadarshan; Sasmal, Prakash Kumar; Rout, Bikram; Sharma, Rakesh

    2016-01-01

    Ectopic nail or Onychoheterotopia is an uncommon clinical entity. They are usually congenital; the acquired variety is very rare. The exact pathogenesis of the disease is not clear. They present as a nail like outgrowth, distinct from the classic nail units which is usually asymptomatic. The dorsal aspect of fingers and toes are mostly affected. We present a case of a 24-year-old male with post-traumatic ectopic nail of right middle finger. Complete surgical excision of the ectopic nail was done with its germinal matrix. The patient didn’t have any evidence of recurrence after one year of follow-up, with satisfactory cosmetic outcome. This article highlights the classic presentation of a case of ectopic nail with its surgical management and brief review of literature. PMID:28050430

  10. Artificial nails: are they putting patients at risk? A review of the research.

    PubMed

    Toles, Angela

    2002-01-01

    The use of artificial nails has become a popular fashion trend, and many health care workers are following this trend. There is debate whether artificial nails are putting patients at risk of nosocomial infections. Researchers have shown that the colony counts on artificial nails are greater than the colony counts on native nails. Artificial nails have also been linked to poor hand washing practices and more tears in gloves. These factors lead to an increased risk of transmitting bacteria to patients. This transmission could greatly affect patients because the hospitalized patient's risk of nosocomial infection is high. The purpose of this article is to review the data related to the bacterial and fungal contamination of artificial nails and their implications for health care workers. Most of the review describes findings of studies of surgical patients and health care workers who work in surgery departments, but the research applies to any area where there is a risk of transferring potential pathogens to immunocompromised patients.

  11. Full thickness burns caused by cyanoacrylate nail glue: A case series.

    PubMed

    Kelemen, Noemi; Karagergou, Eleni; Jones, Sarah L; Morritt, Andrew N

    2016-06-01

    Artificial (acrylic) nails are popular cosmetic enhancements that provide the user with the appearance of manicured nails, do not chip or crack, and are generally considered very safe to apply. We report three cases where full thickness thermal burns were sustained from nail glue adhesive (cyanoacrylate) during the application of artificial nails. All three cases underwent surgical debridement and split skin graft reconstruction. We carried out an experiment to characterize the exothermic reaction between nail glue and cotton leggings. The average high temperature produced was 68°C which was sustained for 12.2s which is more than sufficient to cause full thickness burns on skin. We report these cases to increase both professional and public awareness of this serious potential complication associated with the application of artificial nails.

  12. Femoral lengthening in children and adolescents.

    PubMed

    Pejin, Z

    2017-02-01

    Current lengthening techniques are still based on the Ilizarov method and the concept of callotasis. Research and progress in medical devices have led to constant improvement in results. Hexapod fixators allow more precise correction of complex deformities, with shorter learning curve. Associating lengthening by external fixation (EF) to internal fixation (K-wire, intramedullary nail or locking plate) has reduced EF times and complications rates, while improving anatomic and functional results. Lengthening nails provides faster recovery of range of motion and return to activity during lengthening and consolidation, with better psychological tolerance. Lengthening with deformity correction by retrograde nailing has no impact on consolidation. Monolateral EF is a reliable and easy-to-implement technique that is well tolerated by patients. Association to internal fixation gives promising results. Bone healing solidity assessment on plain X-ray is highly subjective, with wide inter- and intra-observer variation; bone mineralization is better assessed in terms of pixel-value ratio (PVR: ratio of pixel value of regenerate to adjacent bone) on picture archiving and communication system (PACS) digitized radiographs, providing objective assessment of callus solidity.

  13. Intramedullary Tibial Nail Fixation of Simple Intraarticular Distal Tibia Fractures.

    PubMed

    Scolaro, John A; Broghammer, Francis H; Donegan, Derek J

    2016-11-01

    The optimal treatment strategy for distal tibia fractures, especially those with intraarticular extension, remains controversial. Although open reduction and internal fixation with a plate and screw device is commonly performed for these injuries, the risk of soft tissue complications using this approach is significant. Staged treatment protocols and alternative means of fixation have been proposed to address these undesired events. Although potentially more technically demanding than fixation of diaphyseal or extraarticular tibial fractures, intramedullary nail (IMN) fixation of simple intraarticular distal tibia fractures is a viable treatment alternative with unique advantages. This article presents a review of the literature and rationale for intramedullary tibial nail fixation of simple intraarticular distal tibia fractures and a surgical approach commonly utilized for successful implementation.

  14. Nail Sarcoidosis with and without Systemic Involvement: Report of Two Cases.

    PubMed

    Noriega, Leandro; Criado, Paulo; Gabbi, Tatiana; Avancini, João; Di Chiacchio, Nilton

    2015-09-01

    The most commonly seen nail change in sarcoidosis, often associated with chronic systemic disease, is onychodystrophy. Imaging of hands, feet and chest is of paramount importance when nail sarcoidosis is suspected, for evaluation of bone cysts and pulmonary involvement, respectively. We report 2 cases of sarcoidosis that developed nail involvement - one with pulmonary disease, and the other without any evidence of systemic involvement, which is very rare.

  15. Nail Sarcoidosis with and without Systemic Involvement: Report of Two Cases

    PubMed Central

    Noriega, Leandro; Criado, Paulo; Gabbi, Tatiana; Avancini, João; Di Chiacchio, Nilton

    2015-01-01

    The most commonly seen nail change in sarcoidosis, often associated with chronic systemic disease, is onychodystrophy. Imaging of hands, feet and chest is of paramount importance when nail sarcoidosis is suspected, for evaluation of bone cysts and pulmonary involvement, respectively. We report 2 cases of sarcoidosis that developed nail involvement – one with pulmonary disease, and the other without any evidence of systemic involvement, which is very rare. PMID:27170939

  16. Dermoscopy of the nail bed and matrix to assess melanonychia striata.

    PubMed

    Hirata, Sergio H; Yamada, Sergio; Almeida, Fernando A; Tomomori-Yamashita, Jane; Enokihara, Mauro Y; Paschoal, Francisco M; Enokihara, Milvia M; Outi, Cinthia M; Michalany, Nilceo S

    2005-11-01

    Melanonychia striata represents a diagnostic dilemma for dermatologists. The use of dermoscopy to assess the nail has advantages over clinical examination. However, when compared to skin lesions, it gives fewer details. We describe two cases of melanonychia striata submitted to dermoscopic examination of the nail bed and matrix. This is a new procedure that enables observing dermoscopic characteristics that are not visualized in the nail plate, thus, providing additional information.

  17. Estimating uptake of phthalate ester metabolites into the human nail plate using pharmacokinetic modelling.

    PubMed

    Bui, Thuy T; Alves, Andreia; Palm-Cousins, Anna; Voorspoels, Stefan; Covaci, Adrian; Cousins, Ian T

    2017-03-01

    There is a lack of knowledge regarding uptake of phthalate esters (PEs) and other chemicals into the human nail plate and thus, clarity concerning the suitability of human nails as a valid alternative matrix for monitoring long-term exposure. In particular, the relative importance of internal uptake of phthalate metabolites (from e.g. blood) compared to external uptake pathways is unknown. This study provides first insights into the partitioning of phthalate-metabolites between blood and nail using pharmacokinetic (PK) modelling and biomonitoring data from a Norwegian cohort. A previously published PK model (Lorber PK model) was used in combination with measured urine data to predict serum concentrations of DEHP and DnBP/DiBP metabolites at steady state. Then, partitioning between blood and nail was assessed assuming equilibrium conditions and treating the nail plate as a tissue, assuming a fixed lipid and water content. Although calculated as a worst-case scenario at equilibrium, the predicted nail concentrations of metabolites were lower than the biomonitoring data by factors of 44 to 1300 depending on the metabolite. It is therefore concluded that internal uptake of phthalate metabolites from blood into nail is a negligible pathway and does not explain the observed nail concentrations. Instead, external uptake pathways are more likely to dominate, possibly through deposition of phthalates onto the skin/nail and subsequent metabolism. Modelling gaseous diffusive uptake of PEs from air to nail revealed that this pathway is unlikely to be important. Experimental quantification of internal and external uptake pathways of phthalates and their metabolites into the human nail plate is needed to verify these modelling results. However, based on this model, human nails are not a good indicator of internal human exposure for the phthalate esters studied.

  18. Two synchronous periungual BCC treated with Mohs surgery. Nail polish related?

    PubMed

    Dika, Emi; Patrizi, Annalisa; Fanti, Pier Alessandro; Alessandrini, Aurora; Sorci, Rita; Piraccini, Bianca Maria; Vaccari, Sabina; Misciali, Cosimo; Maibach, Howard I

    2013-06-01

    Basal cell carcinoma (BCC), the most frequent malignant skin tumor observed in Caucasian adults, especially males, occurs mainly in sun-exposed areas of the body. BCC in the periungual tissues, such as proximal nail fold, nail matrix, nail bed and hyponychium, is rarely reported. We report a patient with two synchronous BCC of the periungual tissue localized in the IV and V fingernail, effectively treated with Mohs micrographic surgery.

  19. When all you have is a dermatoscope- start looking at the nails.

    PubMed

    Haenssle, Holger A; Blum, Andreas; Hofmann-Wellenhof, Rainer; Kreusch, Juergen; Stolz, Wilhelm; Argenziano, Giuseppe; Zalaudek, Iris; Brehmer, Franziska

    2014-10-01

    Pigmented and non-pigmented nail alterations are a frequent challenge for dermatologists. A profound knowledge of clinical and dermatoscopic features of nail disorders is crucial because a range of differential diagnoses and even potentially life-threatening diseases are possible underlying causes. Nail matrix melanocytes of unaffected individuals are in a dormant state, and, therefore, fingernails and toenails physiologically are non-pigmented. The formation of continuous, longitudinal pigmented streaks (longitudinal melanonychia) may either be caused by a benign activation of matrix melanocytes (e.g., as a result of trauma, inflammation, or adverse drug reactions) or by a true melanocytic proliferation (e.g., in a nevus or melanoma). In general, non-continuous nail alterations, affecting only limited parts of the nail apparatus, are most frequently of non-melanocytic origin. Important and common differential diagnoses in these cases are subungual hemorrhage or onychomycosis. In addition, foreign bodies, bacterial infections, traumatic injuries, or artificial discolorations of the nail unit may less frequently cause non-continuous nail alterations. Many systemic diseases that may also show involvement of the nails (e.g., psoriasis, atopic dermatitis, lichen planus, alopecia areata) tend to induce alterations in numerous if not all nails of the hands and feet. A similar extensive and generalized alteration of nails has been reported after treatment with a number of systemic drugs, especially antibiotics and cytostatics. Benign or malignant neoplasms that may also affect the nail unit include glomus tumor, Bowen's disease, squamous cell carcinoma, and rare collision tumors. This review aims to assist clinicians in correctly evaluating and diagnosing nail disorders with the help of dermatoscopy.

  20. Biomechanical effects of angular stable locking in intramedullary nails for the fixation of distal tibia fractures.

    PubMed

    Augat, Peter; Hoegel, Florian; Stephan, Daniel; Hoffmann, Stephanie; Buehren, Volker

    2016-11-01

    Treatment of distal tibia shaft fractures using intramedullary nailing requires stable fixation of the distal fragment to prevent malunion. Angular stable locking for intramedullary nails pledge to provide increased mechanical stability. This study tested the hypothesis that intramedullary nails with angular stable interlocking screws would have increased construct stiffness, reduced fracture gap movement and enhanced fatigue failure compared to nails with conventional locking having the same diameter. Biomechanical experiments were performed on 24 human cadaveric tibiae which obtained a distal fracture and were fixed by three different techniques: conventional locking with 8- and 10-mm-diameter nails and angular stable locking with 8-mm nails. Stiffness of the implant-bone construct and movement of the fragments were tested under axial loading and torsion. The constructs were tested to failure under cyclic fatigue loading. Analysis of variance and Kaplan-Meier survival analysis were used for statistical assessment. Axial stiffness of the 10-mm nail was about 50% larger compared to both 8-mm nail constructs independent of the type of locking mode (p < 0.01). No differences were found in axial performance between angular stable and conventional locking neither under static nor under cyclic testing conditions (p > 0.5). Angular stability significantly decreased the clearance under torsional load by more than 50% compared to both conventionally locked constructs (p = 0.03). However, due to the larger nail diameter, the total interfragmentary motion was still smallest for the 10-mm nail construct (p < 0.01). Although the 10-mm nail constructs survived slightly longer, differences between groups were minor and not statistically significant (p = 0.4). Our hypothesis that angular stable interlocking of intramedullary nails would improve mechanical performance of distal tibia fracture fixation was not confirmed in a physiologically realistic loading

  1. The terminal branches of the medial femoral circumflex artery: the arterial supply of the femoral head.

    PubMed

    Lazaro, L E; Klinger, C E; Sculco, P K; Helfet, D L; Lorich, D G

    2015-09-01

    This study investigates and defines the topographic anatomy of the medial femoral circumflex artery (MFCA) terminal branches supplying the femoral head (FH). Gross dissection of 14 fresh-frozen cadaveric hips was undertaken to determine the extra and intracapsular course of the MFCA's terminal branches. A constant branch arising from the transverse MFCA (inferior retinacular artery; IRA) penetrates the capsule at the level of the anteroinferior neck, then courses obliquely within the fibrous prolongation of the capsule wall (inferior retinacula of Weitbrecht), elevated from the neck, to the posteroinferior femoral head-neck junction. This vessel has a mean of five (three to nine) terminal branches, of which the majority penetrate posteriorly. Branches from the ascending MFCA entered the femoral capsular attachment posteriorly, running deep to the synovium, through the neck, and terminating in two branches. The deep MFCA penetrates the posterosuperior femoral capsular. Once intracapsular, it divides into a mean of six (four to nine) terminal branches running deep to the synovium, within the superior retinacula of Weitbrecht of which 80% are posterior. Our study defines the exact anatomical location of the vessels, arising from the MFCA and supplying the FH. The IRA is in an elevated position from the femoral neck and may be protected from injury during fracture of the femoral neck. We present vascular 'danger zones' that may help avoid iatrogenic vascular injury during surgical interventions about the hip.

  2. Intramedullary Nailing for Pathological Fractures of the Proximal Humerus

    PubMed Central

    Choi, Eun-Seok; Han, Ilkyu; Cho, Hwan Seong; Park, In Woong; Park, Jong Woong

    2016-01-01

    Background Endoprosthetic reconstruction is widely applied for pathological fractures of the proximal humerus; however, functional impairment is usually unsatisfactory. The aims of the current study are to evaluate the reliability of interlocking intramedullary (IM) nailing with cement augmentation as a fixation method in proximal humeral lesions and to assess functional outcomes. Methods We reviewed 32 patients with pathological fractures of the proximal humerus who underwent interlocking IM nailing and cement augmentation. Functional scores and pain relief were assessed as outcomes. Results The mean follow-up period was 14.2 months. The mean Musculoskeletal Tumor Society functional score and Karnofsky performance status scale score were 27.7 and 75.6, respectively. Improvement of pain assessed using the visual analogue scale was 6.2 on average. Thirty-one patients (97%) experienced no pain after surgery. The mean ranges of forward flexion and abduction were 115° and 112.6°, respectively. All patients achieved stability and had no local recurrence without failure of fixation until the last follow-up. Conclusions Proximal interlocking IM nailing with cement augmentation appears to be a reliable treatment option for pathological or impending fractures of the proximal humerus in selected patients with metastatic tumors, even with extensive bone destruction. PMID:27904730

  3. [Fracture arthroplasty of femoral neck fractures].

    PubMed

    Braun, K F; Hanschen, M; Biberthaler, P

    2016-04-01

    A paradigm shift in the treatment of elderly patients has recently taken place leading to an increase in joint replacement surgery. The aim of this article is to highlight new developments and to present a treatment algorithm for femoral neck fractures. The age limit must be individually determined considering the comorbidities and perioperative risk profile. Pertrochanteric femoral fractures are nearly exclusively treated by osteosynthesis regardless of age. The situation for femoral neck fractures is more complex. Patients younger than 65 years should generally be treated by osteosynthesis but patients older than 65 years benefit from hemiarthroplasty or total hip arthroplasty. In patients aged between 65 and 75 years with high functional demands and a justifiable perioperative risk, total joint replacement is the treatment of choice. In physically less active patients older than 75 years and poor general condition, preference should be given to hemiarthroplasty.

  4. Trachyonychia and Twenty-Nail Dystrophy: A Comprehensive Review and Discussion of Diagnostic Accuracy

    PubMed Central

    Jacobsen, Audrey A.; Tosti, Antonella

    2016-01-01

    Background/Aims The term trachyonychia, also known as twenty-nail dystrophy, is used to describe thin, brittle nails with excessive longitudinal ridging. The term twenty-nail dystrophy has been incorrectly applied to other conditions that can affect all twenty nails. Therefore, we have conducted a comprehensive review of the clinical features of trachyonychia and have included a discussion regarding the diagnostic accuracy of this condition in the literature. Methods In November and December 2015, we conducted a thorough literature search using the following search terms: ‘trachyonychia', ‘twenty nail dystrophy’, and ‘sandpaper nails’. Articles that reported the epidemiology, disease associations, clinical presentation, histopathology, and treatment options for trachyonychia were included. Particular attention was given to case reports to identify misdiagnosed cases of twenty-nail dystrophy. Results Our preliminary search yielded 184 results with 72 unique articles ultimately selected for review. Excluded articles included 27 articles in languages other than English, 18 commentaries or reviews, and 67 irrelevant articles. Twelve additional articles described nail abnormalities clinically different from trachyonychia. Conclusion Many other conditions can cause widespread nail dystrophy. The specific characteristics of trachyonychia need to be considered to make the diagnosis of twenty-nail dystrophy. PMID:27843915

  5. Effects of organic solvents on the barrier properties of human nail.

    PubMed

    Smith, Kelly A; Hao, Jinsong; Li, S Kevin

    2011-10-01

    The effects of organic solvent systems on nail hydration and permeability have not been well studied. The objectives of the present study were to investigate the effects of binary aqueous organic solvent systems of ethanol (EtOH), propylene glycol (PPG), and polyethylene glycol 400 (PEG) on the barrier properties of nail plates. (3) H-water, (14) C-urea, and (14) C-tetraethylammonium ions were the probes in the nail uptake and transport experiments to study the effect(s) of organic solvents on nail hydration and permeability. Gravimetric studies were also performed as a secondary method to study nail hydration and the reversibility of the nail after organic solvent treatments. Both ungual uptake and transport were directly related to the concentration of the organic solvent in the binary systems. Partitioning of the probes into and transport across the nail decreased with an increase in the organic solvent concentration. These changes corresponded to the changes in solution viscosity and the barrier properties of the nail. In general, the effects for PPG and PEG were more pronounced than those for EtOH. Practically, these results suggest that organic solvents in formulations can increase nail barrier resistivity.

  6. Incidence of dermatophytes and cyclohexamide resistant fungi on healthy children hairs and nails in nurseries.

    PubMed

    Maghazy, S M

    2002-01-01

    In order to estimate the prevalence of dermatophytes and other fungi on healthy children hairs and nails, 92 hair samples and 85 nail samples (groups of 10 finger nails from each child) were collected from 5 nurseries (children aged 9 months up to 4 years) in Assiut city. From hair samples 22 species were collected, Trichophyton (2 species) and Microsporum (2 species) were the only recovered dermatophytes in addition to well known keratinophilic genus Chrysosporium (4 species). From nail samples, 18 species were identified, Trichophyton was represented by 4 species, Microsporum, 2 species and Chrysosporium, 4 species. Also, several other saprophytes and cycloheximide resistant fungi were isolated.

  7. Habit Reversal versus Object Manipulation Training for Treating Nail Biting: A Randomized Controlled Clinical Trial

    PubMed Central

    Ghanizadeh, Ahmad; Bazrafshan, Amir; Dehbozorgi, Gholamreza

    2013-01-01

    Objective This is a parallel, three group, randomized, controlled clinical trial, with outcomes evaluated up to three months after randomization for children and adolescents with chronic nail biting. The current study investigates the efficacy of habit reversal training (HRT) and compares its effect with object manipulation training (OMT) considering the limitations of the current literature. Method Ninety one children and adolescents with nail biting were randomly allocated to one of the three groups. The three groups were HRT (n = 30), OMT (n = 30), and wait-list or control group (n = 31). The mean length of nail was considered as the main outcome. Results The mean length of the nails after one month in HRT and OMT groups increased compared to the waiting list group (P < 0.001, P < 0.001, respectively). In long term, both OMT and HRT increased the mean length of nails (P < 0.01), but HRT was more effective than OMT (P < 0.021). The parent-reported frequency of nail biting did show similar results as to the mean length of nails assessment in long term. The number of children who completely stopped nail biting in HRT and OMT groups during three months was 8 and 7, respectively. This number was zero during one month for the wait-list group. Conclusion This trial showed that HRT is more effective than wait-list and OMT in increasing the mean length of nails of children and adolescents in long terms. PMID:24130603

  8. Lengthening over nails using the double plate system ONAS-DPS

    PubMed Central

    Antolič, Vane

    2016-01-01

    Stable insertion of large Schanz screws behind an intramedullary (IM) nail when lengthening over nails (LON) may be difficult due to the limited bone stock. Additionally, the highly probable contact between the screws and IM nail (which is difficult to avoid) increases the likelihood of infection spreading from the skin via Schanz screws directly to the IM nail. A new device for LON has been developed. Instead of inserting Schanz screws from the external fixator beside the IM nail (as in standard LON), a system of two overlaying plates was constructed. Schanz screws can be fixed to the plates without entering the bone. The plates are fixed to the bone using four angle stability screws. The holes in the plates offer stabile fixation for a chosen angle under which the screw is positioned through the cortical bone. Using the new system there is no need to place Schanz screws behind the IM nail. Instead, Schanz screws pass to the plate and not through the bone. The new system for elongation over IM nail is called “Over Nail Angle Stability-Double Plate System” (ONAS-DPS) [Antolič V (2013) Modular side device with an intramedullary nail for guiding a bone during its lengthening. World Intellectual Property Organization. International Publication number: WO 2013/176632 A1]. PMID:27163094

  9. Anatomy of the medial femoral circumflex artery with respect to the vascularity of the femoral head.

    PubMed

    Zlotorowicz, M; Szczodry, M; Czubak, J; Ciszek, B

    2011-11-01

    We performed a series of 16 anatomical dissections on Caucasian cadaver material to determine the surgical anatomy of the medial femoral circumflex artery (MFCA) and its anastomoses. These confirmed that the femoral head receives its blood supply primarily from the MFCA via a group of posterior superior nutrient arteries and the posterior inferior nutrient artery. In terms of anastomoses that may also contribute to the blood supply, the anastomosis with the inferior gluteal artery, via the piriformis branch, is the most important. These dissections provide a base of knowledge for further radiological studies on the vascularity of the normal femoral head and its vascularity after dislocation of the hip.

  10. Histopathological analysis of the progression pattern of subungual melanoma: late tendency of dermal invasion in the nail matrix area.

    PubMed

    Shin, Hyun-Tae; Jang, Kee-Taek; Mun, Goo-Hyun; Lee, Dong-Youn; Lee, Jason B

    2014-11-01

    Subungual melanoma is a rare subtype of melanoma that usually originates and spreads from the nail matrix. Because of its poor prognosis and short matrix-to-bone distance, amputation has been traditionally performed. Recently, conservative surgery has been attempted for early subungual melanoma, but the evidence supporting this practice is sparse. As little is known about the progression pattern of subungual melanoma, further advances on the subject may provide better guidance on the optimal surgical approach. Histopathology slides, clinical records, and photographs of 23 cases of subungual melanoma were reviewed. For all cases, each area of the nail unit-proximal nail fold, nail matrix, nail bed, and/or hyponychium-in longitudinal sections was available for histological examination. Growth pattern, dermal invasion, and thickness were assessed in each area of the nail unit. There were five cases of melanoma in situ. Eighteen cases showed dermal invasion in at least one area of the nail unit. There were no cases showing dermal invasion in the nail matrix area only. In four cases, dermal invasion involved areas of the nail unit other than the nail matrix. In 14 cases, dermal invasion involved the nail matrix area as well as other areas of the nail unit. Except for one case, the nail matrix area showed thinner dermal invasion compared with dermal invasion in other areas of the nail unit. In conclusion, dermal invasion of subungual melanoma in the nail matrix area tends to occur later than other areas of the nail unit. Longitudinal incisional biopsy is necessary to accurately evaluate melanoma invasion. The findings of this study suggest that conservative surgical treatment for early subungual melanoma may be justified as the nail matrix area, an area of thin dermis and close proximity to the underlying bone, appears to be more resistant to invasion.

  11. Management of femoral head osteonecrosis: Current concepts

    PubMed Central

    Tripathy, Sujit Kumar; Goyal, Tarun; Sen, Ramesh Kumar

    2015-01-01

    Osteonecrosis of femoral head (ONFH) is a disabling condition of young individuals with ill-defined etiology and pathogenesis. Remains untreated, about 70-80% of the patients progress to secondary hip arthritis. Both operative and nonoperative treatments have been described with variable success rate. Early diagnosis and treatment is the key for success in preserving the hip joint. Once femoral head collapses (>2 mm) or if there is secondary degeneration, hip conservation procedures become ineffective and arthroplasty remains the only better option. We reviewed 157 studies that evaluate different treatment modalities of ONFH and then a final consensus on treatment was made. PMID:25593355

  12. Alteration of the diffusional barrier property of the nail leads to greater terbinafine drug loading and permeation.

    PubMed

    Nair, Anroop B; Sammeta, Srinivasa M; Kim, Hyun D; Chakraborty, Bireswar; Friden, Phillip M; Murthy, S Narasimha

    2009-06-22

    The diffusional barrier property of biological systems varies with ultrastructural organization of the tissues and/or cells, and often plays an important role in drug delivery. The nail plate is a thick, hard and impermeable membrane which makes topical nail drug delivery challenging. The current study investigated the effect of physical and chemical alteration of the nail on the trans-ungual drug delivery of terbinafine hydrochloride (TH) under both passive and iontophoretic conditions. Physical alterations were carried out by dorsal or ventral nail layer abrasion, while chemical alterations were performed by defatting or keratolysis or ionto-keratolysis of the nails. Terbinafine permeation into and across the nail plate following various nail treatments showed similar trends in both passive and iontophoretic delivery, although the extent of drug delivery varied with treatment. Application of iontophoresis to the abraded nails significantly improved (P<0.05) TH permeation and loading compared to abraded nails without iontophoresis or normal nails with iontophoresis. Drug permeation was not enhanced when the nail plate was defatted. Keratolysis moderately enhanced the permeation but not the drug load. Ionto-keratolysis enhanced TH permeation and drug load significantly (P<0.05) during passive and iontophoretic delivery as compared to untreated nails. Ionto-keratolysis may be more efficient in permeabilization of nail plates than long term exposure to keratolysing agents.

  13. Iontophoresis for drug delivery into the nail apparatus: exploring hyponychium as the site of delivery.

    PubMed

    Kushwaha, Avadhesh; Shivakumar, H N; Murthy, S Narasimha

    2016-10-01

    In present studies, a hyponychium pathway (from ventral side of the nail plate) was investigated as a potential route of drug delivery into the nail apparatus using iontophoresis as an active physical method. In vitro transport studies were performed across the human nail plate using sodium fluorescein as a marker substrate for 24 h. After transport studies, the amount of sodium fluorescein extracted from an active diffusion area of the nail plate in case of iontophoresis was found to be ∼54-folds more to that of passive. The amount of sodium fluorescein retained in the peripheral area of the nail plate after application of iontophoresis was found to be ∼30-folds more relative to passive. Ex vivo transport studies were performed on excised human cadaver toe using terbinafine hydrochloride as a model drug for three days (8 h/day). The amount of terbinafine retained in the nail plate after application of iontophoresis (3.43 ± 1.34 µg/mg) was ∼20-folds more when compared with passive (0.17 ± 0.10 µg/mg). The amount of drug extracted from the nail bed and nail matrix was 1.73 ± 0.12 µg/mg and 0.55 ± 0.22 µg/mg, respectively. On the other hand, there was no detectable amount of terbinafine found in the nail bed and nail matrix in case of control (passive delivery). These studies show that the iontophoretic drug delivery through hyponychium region to other parts of the nail apparatus could be a potential way of onychomycosis treatment.

  14. Evaluation of the SMALL nail: Drive technology and behavior in situ.

    PubMed

    Dünnweber, L H; Rödl, R; Gosheger, G; Schiedel, F M

    2016-12-01

    Although clear advances have been made during the last 5 years, practical difficulties persist for patients and surgeons in procedures for intramedullary lengthening of long bones. In particular, precise adjustment of the desired amount of lengthening and technically reliable checking of the length actually achieved are problematic. An intramedullary nail with a new type of drive that exploits the shape memory effect has been constructed. The drive technology and the behavior of the intramedullary nail in situ were evaluated in a cadaver experiment. Three shape memory alloy limb lengthening (SMALL) nails were implanted in a body donor. The SMALL nail contains a spring coupled to a shape memory element consisting of a nickel-titanium alloy. This shape memory element "remembers" its initial state before the lengthening through the spring and can return to it when it is warmed. A cartridge heater inside the lengthening nail is warmed using transcutaneous induction with high-frequency energy via a subcutaneously implanted coil. For evaluation, two SMALL nails were implanted into the femora (antegrade on the left and retrograde on the right) and one SMALL nail was implanted into the left tibia. Lengthening by 50mm was attempted using repeated activation of the drive mechanism. At the same time, test parameters for temperature increases and cooling periods were continually monitored and the data were subsequently analyzed. The nail's mechanism worked in principle, but was inadequate in view of success rates (number of lengthening steps attempted versus number of lengthening steps achieved) of 21% for the SMALL nail in the tibia and left femur and 14% for the nail in the right femur. The temperature values measured during the distraction experiments show that high-frequency energy induction in the SMALL nail gives no cause for concern for patients.

  15. Femoral development in chronically centrifuged rats

    NASA Technical Reports Server (NTRS)

    Smith, S. D.

    1977-01-01

    Groups of 30-d-old male and female rats were centrifuged at 2.00 G (RE, Rotation Experimental), 1.05 G (RC, Rotation Control) or exposed to the noise and wind of the centrifuge at 1.00 G (EC, Earth Control) for periods of 1, 2, 4, 8, and 16 weeks. Measurements of their femurs indicated that exposure to centrifugation a) decreased femoral length in RE animals, b) increased femoral length in RC animals, c) reduced femoral diameter in RE and RC animals, d) increased L/D ratios in RC animals, e) decreased L/D ratios in RE animals, f) increased femur length/body weight in RE animals, g) decreased cortical thickness (CT) in RE animals, h) increased relative CT in RE animals, and decreased it in RC animals, i) accelerated ossification in RC femoral heads, j) thinned and distorted RE epiphyseal plates, and k) thickened condylar cartilage in RE females. The effects tended to be strongly sexually dimorphic, with females more severely affected by the stress than males.

  16. EPIDEMIOLOGICAL STUDY OF CHILDREN DIAPHYSEAL FEMORAL FRACTURES

    PubMed Central

    Hoffmann, Cassiano Ricardo; Traldi, Eduardo Franceschini; Posser, Alexandre

    2015-01-01

    Objective: To evaluate the personal, fracture, treatment and complication characteristics among patients with pediatric femoral shaft fractures attended at the pediatric orthopedic service of the Joana de Gusmão Children's Hospital. Methods: This was a retrospective cross-sectional study on a population consisting of patients with femoral shaft fractures, aged between birth and 14 years and 11 months, who were divided into four age groups. Information was obtained from medical records and was transferred to a survey questionnaire to present personal, fracture, treatment and complication variables. Results: The study population consisted of 96 patients. Their mean age was 6.8 years. The cases were predominantly among males, comprising closed fractures on the right side, in the middle third with a single line. Regarding fracture etiology, traffic accidents predominated overall in the sample. Most of the patients (74 to 77.1%) presented femoral fractures as their only injury. Conservative treatment predominated in the group younger than six years of age, and surgical treatment in the group aged 6 to 14 years and 11 months. The complications observed until bone union were: discrepancy, infection and movement limitation. The mean time taken for consolidation was 9.6 ± 2.4 weeks, varying with age. Conclusion: The features of these fractures were similar to those described in the literature and the treatment used showed good results. The Joana de Gusmão Children's Hospital has used the treatment proposed in the literature for pediatric femoral shaft fractures. PMID:27042619

  17. Pathologic femoral neck fractures in children.

    PubMed

    Shrader, M Wade; Schwab, Joseph H; Shaughnessy, William J; Jacofsky, David J

    2009-02-01

    Pathologic fractures in children occur in a variety of malignant and benign pathologic processes. Pediatric pathologic femoral neck fractures are particularly rare. Until now, all reported cases have been isolated cases, small series, or cases reported in series of adult pathologic hip fractures. The present article is the first report of a relatively large series of pathologic femoral neck fractures in a pediatric population. We identified pathologic femoral neck fractures, including 2 basicervical fractures, in 15 children (9 boys, 6 girls) ranging in age from 18 months to 15 years (mean age, 9 years) and treated between 1960 and 2000. The pathologic diagnoses were fibrous dysplasia (5 children), unicameral bone cyst (2), Ewing's sarcoma (2), osteomyelitis (2), leukemia (1), rhabdomyosarcoma (1), osteogenesis imperfecta (1), and osteopetrosis (1). Treatment methods, including time to reduction and fixation, were reviewed in detail. One patient was lost to follow-up. All others were followed until union; mean long-term follow-up was 7 years (range, 1-16 years). All patients ultimately went on to union. Mean time to union was 19 weeks (range, 5-46 weeks). However, 2 patients died before 2 years. There was a 40% complication rate, with limb-length discrepancy being the most common (4 children). No patient developed avascular necrosis. Pathologic femoral neck fractures are rare in children. Pediatric patients who present with a pathologic hip fracture are at significant risk for complications. Physicians and family should be alerted to the prolonged course involved in treating these fractures to union.

  18. [Femoral venous catheter: an unusual complication].

    PubMed

    Garcia, P; Mora, A; Trambert, P; Maler, E; Courant, P

    2000-08-01

    We report an erratic course of a venous femoral catheter which was in the abdominal cavity in a patient with an haemoperitoneum and an hepatic injury. This complication led to an inefficiency of the transfusion and a worsening of the haemoperitoneum.

  19. Correlation Between Femoral Neck Shaft Angle and Surgical Management in Trainees With Femoral Neck Stress Fractures.

    PubMed

    Chalupa, Robyn L; Rivera, Jessica C; Tennent, David J; Johnson, Anthony E

    2016-01-01

    The most common overuse injury leading to medical discharge of military recruits is a stress fracture. One of the high-risk stress fractures is of the lateral femoral neck which risks osteonecrosis of the femoral head, the need for arthroplasty and permanent disability. To prevent fracture progression early surgical intervention is recommended. Surgical repairs are performed in about 25% of cases of femoral neck stress fractures at military treatment facilities. Hip geometry is an important intrinsic risk for stress fractures. Loads in the average loading direction will not cause a fracture, but loads of extreme magnitude or extreme orientation may. The purpose of this study was to determine if, in the presence of femoral neck stress fracture, there is a correlation between femoral neck shaft angle, surgical treatment and outcomes. The results of this study suggest there is no correlation between return to full military duty rates, treatment, femoral neck shaft angle or fracture grade on MRI. Patients who underwent surgical fixation had greater fracture grade and pain than those that did not have surgery. Individuals who did not return to duty tended to have higher pain scores at initial evaluation.

  20. Ultrasonographic Diagnosis of Slipped Capital Femoral Epiphysis

    PubMed Central

    Palaniappan, Manikandan; Indiran, Venkatraman; Maduraimuthu, Prabakaran

    2017-01-01

    Summary Background Slipped capital femoral epiphysis (SCFE), a fracture through the physis with resultant slip of the epiphysis, is the most common hip abnormality in adolescents and is a major cause of early osteoarthritis. Plain radiograph is the initial modality used to evaluate patients with painful hip joints. Ultrasonography and magnetic resonance imaging (MRI), which do not involve radiation exposure, have also been used. This case report supports the view that ultrasound can be used as an initial, cost-effective and radiation-free modality for the evaluation of suspected SCFE. Case Report A 15-year-old male patient presented with pain in the right hip for 5 days, following a slip and fall accident while playing soccer. The patient was referred to the Department of Radio-diagnosis for ultrasound. A posterior displacement of the femoral head epiphysis with a physeal step was seen on the longitudinal section obtained over the right hip joint region. The anterior physeal step (APS) measured ~3.8 mm on the right side. The distance between the anterior rim of the acetabulum and the metaphysis measured ~20.4 mm on the affected right side and ~23.6 mm on the left side. A plain radiograph in frog leg position showed a widening of the right proximal physis below the right femoral head, with a medial and posterior slip of the right femoral head. A frontal radiograph of the pelvis taken six months before showed a widening of the proximal right femoral physis. Conclusions Although MRI appears to be the most sensitive modality for identifying slips early, ultrasound may be used as a cost-effective and radiation-free alternative before proceeding with further evaluation of suspected SCFE, especially considering the demographics of the affected population. PMID:28382187

  1. Seismic analysis of nailed vertical excavation using pseudo-dynamic approach

    NASA Astrophysics Data System (ADS)

    Sarangi, Piyush; Ghosh, Priyanka

    2016-12-01

    An attempt has been made to study the behavior of nailed vertical excavations in medium dense to dense cohesionless soil under seismic conditions using a pseudo-dynamic approach. The effect of several parameters such as angle of internal friction of soil ( ϕ), horizontal ( k h) and vertical ( k v) earthquake acceleration coefficients, amplification factor ( f a), length of nails ( L), angle of nail inclination ( α) and vertical spacing of nails ( S v) on the stability of nailed vertical excavations has been explored. The limit equilibrium method along with a planar failure surface is used to derive the formulation involved with the pseudo-dynamic approach, considering axial pullout of the installed nails. A comparison of the pseudo-static and pseudo-dynamic approaches has been established in order to explore the effectiveness of the pseudo-dynamic approach over pseudo-static analysis, since most of the seismic stability studies on nailed vertical excavations are based on the latter. The results are expressed in terms of the global factor of safety (FOS). Seismic stability, i.e., the FOS of nailed vertical excavations is found to decrease with increase in the horizontal and vertical earthquake forces. The present values of FOS are compared with those available in the literature.

  2. Size and Charge Dependence of Ion Transport in Human Nail Plate.

    PubMed

    Baswan, Sudhir M; Li, S Kevin; LaCount, Terri D; Kasting, Gerald B

    2016-03-01

    The electrical properties of human nail plate are poorly characterized yet are a key determinate of the potential to treat nail diseases, such as onychomycosis, using iontophoresis. To address this deficiency, molar conductivities of 17 electrolytes comprising 12 ionic species were determined in hydrated human nail plate in vitro. Cation transport numbers across the nail for 11 of these electrolytes were determined by the electromotive force method. Effective ionic mobilities and diffusivities at infinite dilution for all ionic species were determined by regression analysis. The ratios of diffusivities in nail to those in solution were found to correlate inversely with the hydrodynamic radii of the ions according to a power law relationship having an exponent of -1.75 ± 0.27, a substantially steeper size dependence than observed for similar experiments in skin. Effective diffusivities of cations in nail were 3-fold higher than those of comparably sized anions. These results reflect the strong size and charge selectivity of the nail plate for ionic conduction and diffusion. The analysis implies that efficient transungual iontophoretic delivery of ionized drugs having radii upward of 5 Å (molecular weight, ca. ≥ 340 Da) will require chemical or mechanical alteration of the nail plate.

  3. Size and Charge Dependence of Ion Transport in Human Nail Plate

    PubMed Central

    Baswan, Sudhir M.; Li, S. Kevin; LaCount, Terri D.; Kasting, Gerald B.

    2016-01-01

    The electrical properties of human nail plate are poorly characterized, yet are a key determinate of the potential to treat nail diseases such as onychomycosis using iontophoresis. In order to address this deficiency, molar conductivities of 17 electrolytes comprising 12 ionic species were determined in hydrated human nail plate in vitro. Cation transport numbers across the nail for 11 of these electrolytes were determined by the electromotive force method. Effective ionic mobilities and diffusivities at infinite dilution for all ionic species were determined by regression analysis. The ratios of diffusivities in nail to those in solution were found to correlate inversely with the hydrodynamic radii of the ions according to a power law relationship having an exponent of −1.75 ± 0.27, a substantially steeper size dependence than observed for similar experiments in skin. Effective diffusivities of cations in nail were three-fold higher than those of comparably sized anions. These results reflect the strong size and charge selectivity of the nail plate for ionic conduction and diffusion. The analysis implies that efficient transungual iontophoretic delivery of ionized drugs having radii upwards of 5 Å (approximately MW ≥ 340 Da) will require chemical or mechanical alteration of the nail plate. PMID:26886342

  4. 76 FR 19124 - Certain Steel Nails From the United Arab Emirates

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-06

    ... From the Federal Register Online via the Government Publishing Office INTERNATIONAL TRADE COMMISSION Certain Steel Nails From the United Arab Emirates AGENCY: United States International Trade... from The United Arab Emirates of certain steel nails, provided for in subheadings 7317.00.55,...

  5. New Polyurethane Nail Lacquers for the Delivery of Terbinafine: Formulation and Antifungal Activity Evaluation.

    PubMed

    Gregorí Valdes, Barbara S; Serro, Ana Paula; Gordo, Paulo M; Silva, Alexandra; Gonçalves, Lídia; Salgado, Ana; Marto, Joana; Baltazar, Diogo; Dos Santos, Rui Galhano; Bordado, João Moura; Ribeiro, Helena Margarida

    2017-03-03

    Onychomycosis is a fungal nail infection. The development of new topical antifungal agents for the treatment of onychomycosis has focused on formulation enhancements that optimize the pharmacological characteristics required for its effective treatment. Polyurethanes (PUs) have never been used in therapeutic nail lacquers. The aim of this work has been the development of new PU-based nail lacquers with antifungal activity containing 1.0% (wt/wt) of terbinafine hydrochloride. The biocompatibility, wettability, and the prediction of the free volume in the polymeric matrix were assessed using a human keratinocytes cell line, contact angle, and Positron Annihilation Lifetime Spectroscopy determinations, respectively. The morphology of the films obtained was confirmed by scanning electron microscopy, while the nail lacquers' bioadhesion to nails was determined by mechanical tests. Viscosity, in vitro release profiles, and antifungal activity were also assessed. This study demonstrated that PU-terbinafine-based nail lacquers have good keratinocyte compatibility, good wettability properties, and adequate free volume. They formed a homogenous film after application, with suitable adhesion to the nail plate. Furthermore, the antifungal test results demonstrated that the terbinafine released from the nail lacquer Formulation A PU 19 showed activity against dermatophytes, namely Trichophyton rubrum.

  6. Background values for essential and toxic elements in children's nails and correlation with hair levels.

    PubMed

    Carneiro, Maria Fernanda Hornos; Grotto, Denise; Batista, Bruno Lemos; Rhoden, Claudia Ramos; Barbosa, Fernando

    2011-12-01

    Human nails are an attractive matrix for assessing environmental exposures to toxic elements as well as the deficiency of essential elements since it is noninvasively collected and can be stored at room temperature. However, reference or baseline levels in nonexposed and healthy populations are not yet established. Then, the aims of this study were (a) to estimate background values for essential and toxic elements in nails from a healthy young population in southern Brazil and (b) to evaluate possible correlations between essential and toxic elements in nails. Furthermore, this report took part of a recent study of background values in the hair of a young population. Thus, correlations between chemical elements in nails and hair were also evaluated. Nails were collected from healthy children (n = 126), and element concentrations were determined by inductively coupled plasma mass spectrometry. This study provides new and reliable reference concentrations for toxic and essential elements in children's nails. The results can be used as reference values for epidemiological or clinical investigations based on trace elements in nails. Additionally, we also showed weak to strong correlations between Cu, Mg, Mn, Se, and Zn levels in nails and hair.

  7. Deformation monitoring of long GFRP bar soil nails using distributed optical fiber sensing technology

    NASA Astrophysics Data System (ADS)

    Hong, Cheng-Yu; Yin, Jian-Hua; Zhang, Yi-Fan

    2016-08-01

    This paper introduces a new measurement technology characterized by the use of distributed optical fiber sensor (OFSs) for monitoring the strain and temperature distribution of glass fiber reinforced polymer (GFRP) bar soil nails. Laboratory tension tests were used to verify the performance of the OFSs for strain and elongation monitoring of GFRP bars. The measured strain data from the OFSs agree fairly well with the data from strain gauges in calibration tests. In field monitoring tests, two GFRP bar soil nails were installed with OFSs and pure strain data were used to evaluate the performance of GFRP bar soil nails after installation in a practical slope. Both the strain and temperature distributions measured by the OFSs show symmetric features. A Brillouin optical time domain analysis (BOTDA) measurement unit was used to collect temperature and strain data from the OFSs. The monitoring data show that the accumulative elongations of the soil nails present a continuous but limited increase with time in the field. The achieved maximum elongations of soil nails were less than 0.4 mm. The measured axial elongations of the soil nails were also validated using corresponding data predicted by a theoretical model. The test results from the present study prove that BOTDA based sensors are useful for the investigation of the average strain distributions (or elongation) of long soil nails and these data are useful for the estimation of the potential sliding surface of the entire soil nailing system.

  8. Application of soil nails to the stability of mine waste slopes

    SciTech Connect

    Tant, C.R.; Drumm, E.C.; Mauldon, M.; Berry, R.M.

    1996-12-31

    The traditional soil nailed structure incorporates grouted or driven nails, and a wire mesh reinforced shotcrete facing to increase the stability of a slope or wall. This paper describes the construction and monitoring of a full-scale demonstration of nailing to stabilize coal mine spoil. The purpose of the investigation is to evaluate the performance of nailed slopes in mine spoil using methods proven for the stabilization of soil walls and slopes. The site in eastern Tennessee is a 12 meter high slope of dumped fill, composed of weathered shale chips, sandstone, and coal. The slope was formed by {open_quotes}pre-regulatory{close_quotes} contour surface mining operations and served as a work bench during mining. The material varies in size from silt to boulders, and has a small amount of cohesion. Portions of the mine spoil slope have experienced slope instability and erosion which have hampered subsequent reclamation activities. Three different nail spacings and three different nail lengths were used in the design. The 12 meter high structure is instrumented to permit measurement of nail strain, and vertical inclinometer readings and survey measurements will be used for the detection of ground movement. The results of this study will aid in the development of design recommendations and construction guidelines for the application of soil nailing to stabilize mine spoil.

  9. The spotted lunula. A neglected nail sign associated with alopecia areata.

    PubMed

    Shelley, W B

    1980-05-01

    Three patients with alopecia areata were observed to have spotty absence of t4e whiteness of the lunulae of their nails. This was ascribed to defects in the tongue of matrical epithelium which lies under the nail plate and accounts for the lunula. An analogy is drawn with Wickham's striae.

  10. Understanding Habits: A Preliminary Investigation of Nail Biting Function in Children.

    ERIC Educational Resources Information Center

    Woods, Douglas W.; Fuqua, R. Wayne; Siah, Adelene; Murray, Laura K.; Welch, Matthew; Blackman, Edward; Seif, Tory

    2001-01-01

    Traditional functional analysis procedures were combined with a functional assessment interview and etiological theories to evaluate functions of nail biting in six children. Environmental restriction in combination with other variables appeared to control nail biting. A habit reversal intervention was generally effective but was less effective…

  11. 76 FR 47146 - Certain Steel Nails From the Peoples' Republic of China: Notice of Extension of Time Limits for...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-04

    ... International Trade Administration Certain Steel Nails From the Peoples' Republic of China: Notice of Extension... review on the antidumping order on certain steel nails from the People's Republic of China (``PRC'') for..., the Department initiated the first antidumping duty administrative review on certain steel nails...

  12. 75 FR 17125 - Certain Steel Nails from the People's Republic of China: Extension of Time Limit for the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-05

    ... International Trade Administration Certain Steel Nails from the People's Republic of China: Extension of Time... order on certain steel nails from the People's Republic of China (``PRC'') was published in the Federal Register on August 1, 2008. See Notice of Antidumping Duty Order: Certain Steel Nails From the...

  13. 78 FR 68472 - Steel Nails From China; Scheduling of an Expedited Five-Year Review Concerning the Antidumping...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-14

    ... COMMISSION Steel Nails From China; Scheduling of an Expedited Five-Year Review Concerning the Antidumping Duty Order on Steel Nails From China AGENCY: United States International Trade Commission. ACTION... revocation of the antidumping duty order on steel nails from China would be likely to lead to continuation...

  14. Applying low-intensity pulsed ultrasounds (LIPUS) to a zoledronate-associated atypical femoral shaft fracture without cessation of zoledronate therapy for 3 years follow up: a case report

    PubMed Central

    Arakawa, Shoutaro; Saito, Mitsuru; Kubota, Makoto; Suzuki, Hidehiko; Tsuchida, Shigeki; Hashimoto, Kurando; Marumo, Keishi

    2015-01-01

    Summary Reports are increasing regarding atypical femoral fractures (AFFs) caused by minor trauma in patients using bisphosphonates (BPs) for long periods. Patients with malignant skeletal metastases potentially are at greater risk for these AFFs, especially considering the high dose and the duration of treatment with BPs. We evaluated a case of atypical femoral shaft fracture treated with an intramedullary nail in a patient treated for five years with zoledronate who had breast cancer with metastases to bone. Although bone union was achieved without cessation of zoledronate therapy by applying low-intensity pulsed ultrasounds (LIPUS), the remodeling phase of the fracture healing process was delayed. For BPs-associated AFFs, LIPUS is an alternative to parathyroid hormone (PTH) analogs such as teriparatide that are contraindicated in patients with malignant skeletal metastases. LIPUS is an effective treatment for fracture healing and may avoid the necessity to discontinue BP therapy. PMID:26811711

  15. Witkop tooth and nail syndrome: a report of three cases in a family.

    PubMed

    Memarpour, Mahtab; Shafiei, Fereshteh

    2011-01-01

    Witkop tooth and nail syndrome is a rare autosomal dominant ectodermal dysplasia manifested by hypodontia and nail dysplasia. Tooth shape may vary, and conical and narrow crowns are common. Mandibular incisors, second molars, and maxillary canines are the most frequently missing teeth. Nail dysplasia affects the fingernails and especially the toenails and is often more severe in childhood. Nails may be spoon-shaped, ridged, slow-growing, and easily broken. We examined an Eastern Mediterranean family in which three siblings (two girls, one boy) had this syndrome. The severity of finger and toenail anomalies varied. The children's mother had no Witkop-related abnormalities, but their father was reported to have dental and nail anomalies. Early intervention is recommended to manage orofacial disfigurement and avoid negative social consequences for these children.

  16. Self-inflicted Cardiac Injury with Nail Gun Without Hemodynamic Compromise: A Case Report

    PubMed Central

    Ho, Simon; Feranec, Nicholas

    2017-01-01

    Pneumatically powered nail guns have been used in construction since 1959. Penetrating injuries to the heart with nail guns have a wide range of presentations from asymptomatic to cardiac tamponade and exsanguination. Mortality related to cardiac nail gun injuries is similar to knife injuries, estimated at 25%. Surgical exploration is the treatment of choice. We describe a case of self-inflicted nail gun injury to the chest without hemodynamic compromise in a 51-year-old man. Computed tomography (CT) imaging confirmed nail penetrating the right ventricle, with the tip adjacent to but not violating the abdominal aorta. The patient was successfully treated with thoracotomy and foreign body removal. PMID:28191375

  17. Preliminary studies of the use of nail as a material for reconstructive or cosmetic surgery.

    PubMed

    Taylor, P; Kaakedjian, G

    1998-04-01

    The purpose of this study was to assess the biocompatibility and stability of implanted nail as a preliminary step in the assessment of its potential as a material for small scale reconstructive or cosmetic surgery. Rat nails were placed subcutaneously in the back of 12 Lewis rats, which were then sacrificed in groups of 4 at 4, 8, and 12 months for macroscopic and microscopic examination of the implants. A layer of strongly adherent connective tissue, containing inflammatory cells, had formed around the nails at 4 months, but by 8 to 12 months this reaction had subsided, leaving the nails imbedded in connective tissue adhering to the dermal wall, with no evidence of implant rejection, granuloma formation, or degradation. The results suggest that nail merits further study as a surgical implant material, because of its staying power and lack of immunogenicity.

  18. In vitro nail invasion by pathogenic and non-pathogenic fungi under different culture conditions.

    PubMed

    Baudraz-Rosselet, F; Frenk, E

    1990-01-01

    Data from the literature suggest that the nutritional environment can modify major metabolic functions of fungi and possibly their aggressivity towards keratinous structures. Trichophyton rubrum (TR), Microsporum canis (MC), Scopulariopsis brevicaulis (SB), Aspergillus fumigatus (AF) and Penicillium spec. (P) were inoculated on media of different nutritional value, in presence of nail fragments. The activity of the fungi was evaluated at two and four weeks for intensity and depth of invasion of nail samples. Nail invasion was most pronounced by MC, especially when grown on rice agar or peptone agar. Nail invasion by the other fungi tested was less important, Sabourand glucose and rice agar were most favorable. Our results indicate that nutritional factors can, at least in some fungus species, alter their rate of nail invasion.

  19. A Biomechanical Comparison of Two Intramedullary Implants for Subtrochanteric Fracture in Two Healing Stages: A Finite Element Analysis

    PubMed Central

    Wu, Xinlei; Yang, Ming; Wu, Lijun; Niu, Wenxin

    2015-01-01

    Background. The biomechanical effect of two implants, namely, proximal femoral nail antirotation for Asia (PFNA-II) and Expert Asian Femoral Nail (A2FN), for treating subtrochanteric fracture during healing stages, is still unclear. Methods. A 3D finite element model of an intact femur was constructed and validated. The fractured and postoperative models were accordingly produced. The postoperative models were loaded with the peak joint forces during gait for the soft and hard callus stages. The effects of stress distribution on the implants, femoral head and callus, and the deformation of the proximal femur were examined. Results. Both implants showed similar biomechanical effect in two healing stages. As the healing duration increased, the von Mises stress of two implants and the tensile stress of the femoral head decreased, whereas the compressive stress of the femoral head increased. However, the PFNA-II operation resulted in higher stress on the implant, lower stress on the proximal femur, and lower compressive stress and higher tensile stress on the callus than A2FN operation. Conclusions. The A2FN implant may provide a biomechanically superior construct for subtrochanteric fracture healing. However, the upper screw of the A2FN implant may be more likely to be loose in the healing process. PMID:27019584

  20. Nail-like targets for laser plasma interaction experiments

    SciTech Connect

    Pasley, J; Wei, M; Shipton, E; Chen, S; Ma, T; Beg, F N; Alexander, N; Stephens, R B; MacPhee, A G; Hey, D; Pape, S L; Patel, P; Mackinnon, A J; Key, M H; Offermann, D; Link, A; Chowdhury, E; Van-Woerkom, L D; Freeman, R R

    2007-12-18

    The interaction of ultra-high power picosecond laser pulses with solid targets is of interest both for benchmarking the results of hybrid particle in cell (PIC) codes and also for applications to re-entrant cone guided fast ignition. We describe the construction of novel targets in which copper/titanium wires are formed into 'nail-like' objects by a process of melting and micromachining, so that energy can be reliably coupled to a 24 {micro}m diameter wire. An extreme-ultraviolet image of the interaction of the Titan laser with such a target is shown.

  1. Fatigue load of current tibial intramedullary nail designs: a simulated study.

    PubMed

    Wagner, Mark; Liu, Qi; Ellis, Thomas J

    2011-06-14

    Comminuted tibial shaft fractures are traditionally treated with statically locked intramedullary nailing and protected weight bearing until fracture callous is evident. The purpose of this study was to demonstrate that a simulation of immediate full weight bearing following intramedullary nailing of these fractures does not result in implant failure.A comminuted fracture model was created using 2 pieces of polyvinyl chloride (PVC) pipe. Ten-millimeter-diameter tibial nails (Synthes, Paoli, Pennsylvania; Styker, Mahwah, New Jersey; Zimmer, Warsaw, Indiana; Smith & Nephew, Memphis, Tennessee) were inserted within the PVC pipe and secured proximally and distally with 2 or 3 locking bolts. The constructs were cycled in axial compression for 500,000 cycles or until implant failure. The tests were conducted using a modified staircase method (200 N per step), and the fatigue strength was identified for each of the tibial nail designs. When 2 interlocking bolts were placed proximally and distally, the fatigue strength was between 900 and 1100 N for the Stryker nail, 1100 and 1300 N for the Zimmer nail, 1200 and 1400 N for the Synthes nail, and 1400 and 1600 N for the Smith & Nephew nail. Adding a third interlocking bolt proximally and distally to the Smith & Nephew nail increased the fatigue strength by 13% to between 1700 and 1900 N. In all cases, implant failures occurred through the proximal or distal interlocking bolts.Biomechanical tests suggest that current tibial nail designs may permit immediate full weight bearing of comminuted tibial shaft fractures with minimal risk of implant failure. This may facilitate mobilization in the early postoperative period, especially in the multiply injured patient.

  2. Femoral remodeling may influence patient outcomes in slipped capital femoral epiphysis.

    PubMed

    DeLullo, James A; Thomas, Eric; Cooney, Timothy E; McConnell, Sharon J; Sanders, James O

    2007-04-01

    Clinical studies of patients treated for slipped capital femoral epiphysis have found limited functional impairment and femoral neck deformity causing eventual coxarthrosis. Since patient-focused assessments minimize bias and reflect health-related quality of life status, we coupled their use to a clinical examination to obtain a more patient-centered picture of slipped capital femoral epiphyseal outcomes. The impact of residual deformity on outcomes also was examined. Of 78 patients treated for slipped capital femoral epiphyses between 1972 and 1998, 29 (38 hips) were evaluated at a mean followup of 7.6 years (range, 1.4-26 years). The average patient age was 21.8 years (range, 14.6-39 years), 55% were female, and the average body mass index was 28.7 (range, 16.1-50.2). Most slips were stable (92%, 35 of 38) and mild or moderate in severity (98%, 36 of 37). Followup examinations revealed slight deficits in range of motion, strength, and limb length. Radiographs showed slight improvements in head-shaft angle and reduced but persistent femoral neck deformity. Osteoarthritic changes were absent or negligible in 84% (32 of 38) of the hips. The average Iowa hip score was 90.5 (range, 51-100). Patient outcome scores for the AAOS Hip/Knee Questionnaire fell slightly below 50th percentile norms. Neither slip stability, severity, nor body mass index impacted outcome. Femoral neck deformity correlated with function, pain, and Boyer grade. Overall, patients had minor functional deficits and pain that may have been related to femoral neck deformity, but longer followup is warranted.

  3. A novel intramedullary callus distraction system for the treatment of femoral bone defects.

    PubMed

    Horas, Konstantin; Schnettler, Reinhard; Maier, Gerrit; Horas, Uwe

    2016-08-01

    An intramedullary device has some advantages over external fixation in callus distraction for bone defect reconstruction. There are difficulties controlling motorized intramedullary devices and monitoring the distraction rate which may lead to poor results. The aim of this study was to design a fully implantable and non-motorized simple distraction nail for the treatment of bone defects. The fully implantable device comprises a tube-in-tube system and a wire pulling mechanism for callus distraction. For the treatment of femoral bone defects, a traction wire, attached to the device at one end, is fixed to the tibial tubercle at its other end. Flexion of the knee joint over a predetermined angle generates a traction force on the wire triggering bone segment transport. This callus distraction system was implanted into the femur of four human cadavers (total 8 femora), and bone segment transport was conducted over 60-mm defects with radiographic monitoring. All bone segments were transported reliably to the docking site. From these preliminary results, we conclude that this callus distraction system offers an alternative to the current intramedullary systems for the treatment of bone defects.

  4. [An analysis of surgical treatment methods in femoral neck fractures based on a patent information search].

    PubMed

    Ternovyĭ, M K; Samokhin, A V; Hrebennikov, K O

    1999-01-01

    Patent inventive discoveries in the USSR over the period 1949-1989 are analyzed together with the world patent discoveries, inventions, designs (Ukraine since 1989 included) over the period 1978-1998, which are divided into several groups different in principle, criteria of analysis are singled out, new notions of "cruel", dosage, dynamic compression are determined. By making use of principles of biological low-invasive metallo-osteosynthesis and new notions of "cruel", dosage, and dynamic compression optimal options were found for fixation of fractures of the femoral neck: low-traumatic nail set in the neck at an angle of 130 degrees fit with a small-sized diaphyseal put-in lamina and a local stimulation of union or spongiosa for the neck of the femur screw with an attachment preventing caput femoris rotation, and a springy element combined with a small-sized diaphyseal put-in lamina (that is, a modified system of the dynamic screw for the neck of the femur).

  5. Harvest of cortico-cancellous intramedullary femoral bone graft using the Reamer-Irrigator-Aspirator (RIA).

    PubMed

    Masquelet, A-C; Benko, P E; Mathevon, H; Hannouche, D; Obert, L

    2012-04-01

    The "Reamer-Irrigator-Aspirator" (RIA) is a device that provides continuous irrigation and aspiration during intramedullary reaming of long bones. The RIA system is first used to collect the reaming material from medullary cavities, a thick paste of finely morselized osseous particles containing significantly elevated levels of stem cells and growth factors as reported by quantitative analyses. The volume of bone graft material available from an adult femur corresponds to the amount of cancellous bone graft obtained from both the anterior and posterior iliac crests. The assembly and technicalities of the RIA system require a training period to prevent any femoral fracture, which appears to be the major RIA-related complication. The elective indications for RIA bone grafting are filling of bone defects in the epiphyseal and metaphyseal regions. Diaphyseal defects may also be managed using the RIA system provided the graft is placed in a constrained system (induced membrane) to prevent dispersion of the graft into the surrounding soft tissues and is aerated with a porous material to promote its revascularization. Other RIA indications include debriding intramedullary infections and reaming for intramedullary nailing of long bone fractures to reduce the risk of fat embolization.

  6. [Atipic osteosarcoma in the femoral shaft case report and review of the literature].

    PubMed

    Clara-Altamirano, M A; García-Ortega, D Y; Martínez-Tlahuel, J L; Martínez-Said, H; Caro-Sánchez, C H S; García-Ruíz, G C; Mejía-Salazar, C R; Cuellar-Hubbe, M

    2016-01-01

    Osteosarcoma is the most frequent primary malignant bone tumor. It is characterized by osteoid production by tumor cells. Its most frequent location is in the metaphyses of long bones, but a purely diaphyseal presentation is reported in 10% of cases. We report the case of a female 25 year-old patient whose symptoms of pain and swelling of the right mid thigh started four months before, without an apparent cause. Femur X-rays showed a tumor in the femoral shaft. The MRI showed extension to soft tissues with no compromise of the neurovascular bundle. The histopathologic report of the incisional biopsy was osteoblastic and chondroblastic osteosarcoma, classified as Enneking IIB, AJCC IIB. Treatment consisted of three cycles of neoadjuvant chemotherapy. Then intercalary femur resection plus reconstruction with centromedullary nailing and a diaphyseal spacer were performed. The histopathologic report was 95% necrosis (Huvos grade III). Three cycles of adjuvant chemotherapy were given and now, 18 months after completing the latter, the patient has no signs of local or distant tumor activity, and she can walk unassisted. Despite the fact that osteosarcoma does not occur usually in the mid shaft of long bones, we should always bear it in mind as part of the differential diagnosis for other conditions that occur more frequently in that region. Such location allows for a broad gamut of surgical approaches that spare the adjacent joints.

  7. Surgical treatment of bilateral femoral stress fractures related with long-term alendronate therapy.

    PubMed

    Kanatlı, Ulunay; Ataoğlu, M Baybars; Özer, Mustafa; Topçu, H Nevzat; Çetinkaya, Mehmet

    2017-04-01

    A 67-year-old female patient admitted to our outpatient clinic suffering from pain in both thighs for one year without any history of trauma. Patient was receiving alendronate therapy for five years. Physical examination revealed pain increasing with weight-bearing in both thighs with full range of hip and knee movements. Radiographs showed an area of thickened cortex of middle femoral diaphysis in both femurs, but no fracture. Bone scan showed a single area of increased uptake of radioisotope. These images were compatible with stress fractures of both femurs. Dual-energy X-ray absorptiometry revealed a T-score of -3.2 for the lumbar spine and -3.5 for the hip. Alendronate treatment was ceased. Calcium and vitamin D treatment were started. Patient was performed prophylactic surgical stabilization by titanium elastic nails in May 2009. On first day after the surgery, unsupported mobilization and weight-bearing activities were started. Upon persistence of pain on left thigh, plate fixation was performed for the nonunion in June 2012. Patient is now pain-free and able to walk with full weight-bearing without any complications.

  8. Postcatheterization Femoral Arteriovenous Fistulas: Endovascular Treatment with Stent-Grafts

    SciTech Connect

    Onal, Baran Kosar, Sule; Gumus, Terman; Ilgit, Erhan T.; Akpek, Sergin

    2004-09-15

    Purpose: To report our results of stent-graft implantation for the endovascular treatment of postcatheterization femoral arteriovenous fistulas (AVFs) occurring between the deep femoral artery and the femoral vein.Methods: Endovascular treatment of iatrogenic femoral AVFs as a result of arterial puncture for coronary angiography and/or angioplasty was attempted in 10 cases. Balloon-expandable stent-grafts, one for each lesion, were used to repair the fistulas, which were between the deep femoral artery and the femoral vein in all cases. Stent-graft implantation to the deep femoral artery was performed by a contralateral retrograde approach.Results: All stent-grafts were deployed successfully. Complete closure of the fistulas was accomplished immediately in nine of 10 cases. In one case, complete closure could not be obtained but the fact that the complaint subsided was taken to indicate clinical success. In three cases, side branch occlusion of the deep femoral artery occurred. No complications were observed after implantation. Follow-up for 8-31 months (mean 18.5 months) with color Doppler ultrasonography revealed patency of the stented arterial segments without recurrent arteriovenous shunting in those nine patients who had successful immediate closure of their AVFs.Conclusion: Our results with a mean follow-up 18.5 months suggest that stent-graft implantation for the closure of postcatheterization femoral AVFs originating from the deep femoral artery is an effective, minimally invasive alternative procedure.

  9. Enhanced econazole penetration into human nail by 2-n-nonyl-1,3-dioxolane.

    PubMed

    Hui, Xiaoying; Chan, Thomas C K; Barbadillo, Sherry; Lee, Christine; Maibach, Howard I; Wester, Ronald C

    2003-01-01

    This study determines the enhancing effects of 2-n-nonyl-1,3-dioxolane on the penetration of econazole, an antifungal drug, into the deeper layers of the human nail where fungal infection resides. Aliquots (10 microL) of Econail lacquer formulation containing 0.45 mg of [(14)C]-econazole with 18% 2-n-nonyl-1,3-dioxolane (test group) or without 2-n-nonyl-1,3-dioxolane (control group) were applied twice daily for 14 days to human nails that had been washed with ethanol before each morning's application. The hydration of the nail sample was well controlled to simulate normal physiological conditions. After 14 days of dosing, the inner ventral section of the nail plate was assayed for absorbed drug content, using a micrometer-controlled drilling and nail powder removal system. The mass balance values of [(14)C]-econazole in this study were 90.8 and 96.4% for the test and control groups, respectively. The weight-normalized econazole content in the ventral/intermediate nail plate center in the test group was 6-fold greater than that in the control (p = 0.008). The total econazole absorbed into the supporting bed cotton ball in the test group was nearly 200-fold greater than that in the control group (p = 0.008) over the 14-day period. The amount of econazole after dosing in the inner part of the human nail (potential diseased area) was 11.1 +/- 2.6 (SD) microg/mg of nail powder with 2-n-nonyl-1,3-dioxolane in the lacquer and 1.78 +/- 0.32 microg/mg without 2-n-nonyl-1,3-dioxolane (p = 0.008). The surface nail contained more econazole (p = 0.004), that is, nonabsorbed drug, where 2-n-nonyl-1,3-dioxolane was not part of the dosing solution. Econazole in the support bed under the nail (the total absorbed dose) was 47.5 +/- 22.0 mg in the lacquer with 2-n-nonyl-1,3-dioxolane and 0.2 +/- 0.1 mg in the lacquer without 2-n-nonyl-1,3-dioxolane (p = 0.008). Moreover the concentration in the deep nail layer in the test group is 14,000 times higher than minimum inhibitory

  10. EPIDEMIOLOGICAL AND RADIOLOGICAL EVALUATION OF FEMORAL SHAFT FRACTURES: STUDY OF 200 CASES

    PubMed Central

    de Moraes, Frederico Barra; da Silva, Luciano Lucindo; Ferreira, Fábio Vieira; Ferro, Ademar Martins; da Rocha, Valney Luís; Teixeira, Kim-Ir-Sen Santos

    2015-01-01

    Objective: to evaluate epidemiological and radiological characteristics of the femoral shaft fractures, surgically treated from 1990 to 2005 at Hospital de Acidentados – Clínica Santa Isabel – in Goiânia, Goiás, aiming to contribute to better preventive and therapeutic measures planning to adopt on those fractures. Methods: 200 patients' files and x-rays with femoral shaft fractures have been retrospectively evaluated. Patients below the age of 10 years were not included because the treatment for this group was conservative. 25 files have been discarded for not supplying all the necessary data to the study. The patients were assessed for sex, age, side of the fracture, bone exposure, mechanisms of trauma, classification of the fractures, associated trauma, time for bone healing and types of surgical devices. Statistic analyses were made by chi-squared, Fisher and Student's-t tests, adopting as a significance level p<0.05. Results: significant results (p < 0.05) were found in: 70% of men, 80% closed fractures and 65% of women above the age of 60. Fractures resulting from simple falls were more frequent in women, above 60 years old, with simpler traces, and the ones caused by projectiles of firearm in men, from 20 to 60 years, with unstable traces. Trampling accidents were prevalent among youngsters between 10 and 19 years old. Car accidents showed all the types of fractures, mostly associated to other traumas, reaching its peak incidence in the age group of 20-30 years. The treatment with Küntscher Nail resulted in a longer mean consolidation time, as well as fractures with unstable traces (B3,C1,C2,C3). Conclusion: we found a bi-modal characteristic the femoral shaft fractures, consistently to literature data, where the high energy mechanisms (traffic accidents, high falls and wounds from firearms), have been more frequent in young adults, men, generating unstable traces of fractures, with more serious associated trauma, while the other group with low

  11. Spontaneous stress fractures of the femoral neck

    SciTech Connect

    Dorne, H.L.; Lander, P.H.

    1985-02-01

    The diagnosis of spontaneous stress fractures of the femoral neck, a form of insufficiency stress fracture, can be missed easily. Patients present with unremitting hip pain without a history of significant trauma or unusual increase in daily activity. The initial radiographic features include osteoporosis, minor alterations of trabecular alignment, minimal extracortical or endosteal reaction, and lucent fracture lines. Initial scintigraphic examinations performed in three of four patients showed focal increased radionuclide uptake in two and no focal abnormality in one. Emphasis is placed on the paucity of early findings. Evaluation of patients with persistent hip pain requires a high degree of clinical suspicion and close follow-up; the sequelae of undetected spontaneous fractures are subcapital fracture with displacement, angular deformity, and a vascular necrosis of the femoral head.

  12. Femoral bifurcation disease: balloon or knife.

    PubMed

    Bosiers, Marc; Deloose, Koen

    2009-10-01

    Arterial occlusive disease at the level of the femoral bifurcation mostly occurs in combination with inflow and/or outflow lesions. Surgical endarterectomy of the femoral bifurcation is a well-proven low-risk and easy surgical intervention with known durable success, while, although proven to be safe, evidence is lacking about the durability of the endovascular approach. Based on the evidence at hand, the surgical approach should be recommended for the vast majority of patients and the endovascular approach should only be indicated as the first strategy in selected cases presenting with factors that might compromise the outcome of surgery in the groin. If feasible, the hybrid approach with endarterectomy at the level of the bifurcation and endovascular repair of the inflow and outflow lesions is preferred in patients with multilevel disease.

  13. Intracorporeal knotting of a femoral nerve catheter.

    PubMed

    Ghanem, Mohamed; Schnoor, Jörg; Wiegel, Martin; Josten, Christoph; Reske, Andreas W

    2015-01-01

    Peripheral nerve catheters are effective and well-established tools to provide postoperative analgesia to patients undergoing orthopedic surgery. The performance of these techniques is usually considered safe. However, placement of nerve catheters may be associated with a considerable number of side effects and major complications have repeatedly been published. In this work, we report on a patient who underwent total knee replacement with spinal anesthesia and preoperative insertion of femoral and sciatic nerve catheters for postoperative analgesia. During insertion of the femoral catheter, significant resistance was encountered upon retracting the catheter. This occurred due to knotting of the catheter. The catheter had to be removed by operative intervention which has to be considered a major complication. The postoperative course was uneventful. The principles for removal of entrapped peripheral catheters are not well established, may differ from those for neuroaxial catheters, and range from cautious manipulation up to surgical intervention.

  14. Intracorporeal knotting of a femoral nerve catheter

    PubMed Central

    Ghanem, Mohamed; Schnoor, Jörg; Wiegel, Martin; Josten, Christoph; Reske, Andreas W.

    2015-01-01

    Peripheral nerve catheters are effective and well-established tools to provide postoperative analgesia to patients undergoing orthopedic surgery. The performance of these techniques is usually considered safe. However, placement of nerve catheters may be associated with a considerable number of side effects and major complications have repeatedly been published. In this work, we report on a patient who underwent total knee replacement with spinal anesthesia and preoperative insertion of femoral and sciatic nerve catheters for postoperative analgesia. During insertion of the femoral catheter, significant resistance was encountered upon retracting the catheter. This occurred due to knotting of the catheter. The catheter had to be removed by operative intervention which has to be considered a major complication. The postoperative course was uneventful. The principles for removal of entrapped peripheral catheters are not well established, may differ from those for neuroaxial catheters, and range from cautious manipulation up to surgical intervention. PMID:26504733

  15. When femoral fracture fixation fails: salvage options.

    PubMed

    Petrie, J; Sassoon, A; Haidukewych, G J

    2013-11-01

    Most hip fractures treated with modern internal fixation techniques will heal. However, failures occasionally occur and require revision procedures. Salvage strategies employed during revision are based on whether the fixation failure occurs in the femoral neck, or in the intertrochanteric region. Patient age and remaining bone stock also influence decision making. For fractures in young patients, efforts are generally focused on preserving the native femoral head via osteotomies and repeat internal fixation. For failures in older patients, some kind of hip replacement is usually selected. Disuse osteopenia, deformity, bone loss, and stress-risers from previous internal fixation devices all pose technical challenges to successful reconstruction. Attention to detail is important in order to minimise complications. In the majority of cases, good outcomes have been reported for the various salvage strategies.

  16. Linkage analysis of the Nail-patella syndrome

    SciTech Connect

    Campeau, E.; Watkins, D.; Rouleau, G.A.; Babul, R.; Der Kaloustian, V.M.; Buchanan, J.A.; Meschino, W.

    1995-01-01

    Nail-patella syndrome (NPS) is an autosomal dominant disorder characterized by dysplasia of nails and patella, decreased mobility of the elbow, iliac horns, and, in some cases, nephropathy. The disorder has been mapped to the long arm of chromosome 9, but the precise localization and identity of the NPS gene are unknown. Linkage analysis in three NPS families, using highly informative dinucleotide repeat polymorphisms on 9q33-q34, confirmed linkage of NPS to this chromosome. Recombinations were detected, by two-point linkage analysis, between NPS and the centromeric markers D9S60 and the gelsolin gene and the telomeric markers D9S64 and D9S66, in one of the families. Haplotype analysis suggested an additional recombination between NPS and the argininosuccinate synthetase (ASS) gene. These results localize the NPS gene to an interval on 9q34.1, distal to D9S60 an proximal to ASS, comprising a genetic distance of {approximately}9 cM. This represents a significant refinement in the localization of the NPS gene. 25 refs., 2 figs., 1 tab.

  17. Analysis of human nails by laser-induced breakdown spectroscopy

    NASA Astrophysics Data System (ADS)

    Hosseinimakarem, Zahra; Tavassoli, Seyed Hassan

    2011-05-01

    Laser-induced breakdown spectroscopy (LIBS) is applied to analyze human fingernails using nanosecond laser pulses. Measurements on 45 nail samples are carried out and 14 key species are identified. The elements detected with the present system are: Al, C, Ca, Fe, H, K, Mg, N, Na, O, Si, Sr, Ti as well as CN molecule. Sixty three emission lines have been identified in the spectrum that are dominated by calcium lines. A discriminant function analysis is used to discriminate among different genders and age groups. This analysis demonstrates efficient discrimination among these groups. The mean concentration of each element is compared between different groups. Correlation between concentrations of elements in fingernails is calculated. A strong correlation is found between sodium and potassium while calcium and magnesium levels are inversely correlated. A case report on high levels of sodium and potassium in patients with hyperthyroidism is presented. It is shown that LIBS could be a promising technique for the analysis of nails and therefore identification of health problems.

  18. Nail Damage (Severe Onychodystrophy) Induced by Acrylate Glue: Scanning Electron Microscopy and Energy Dispersive X-Ray Investigations

    PubMed Central

    Pinteala, Tudor; Chiriac, Anca Eduard; Rosca, Irina; Larese Filon, Francesca; Pinteala, Mariana; Chiriac, Anca; Podoleanu, Cristian; Stolnicu, Simona; Coros, Marius Florin; Coroaba, Adina

    2017-01-01

    Background Scanning electron microscopy (SEM) and energy dispersive X-ray (EDX) techniques have been used in various fields of medical research, including different pathologies of the nails; however, no studies have focused on obtaining high-resolution microscopic images and elemental analysis of disorders caused by synthetic nails and acrylic adhesives. Methods Damaged/injured fingernails caused by the use of acrylate glue and synthetic nails were investigated using SEM and EDX methods. Results SEM and EDX proved that synthetic nails, acrylic glue, and nails damaged by contact with acrylate glue have a different morphology and different composition compared to healthy human nails. Conclusions SEM and EDX analysis can give useful information about the aspects of topography (surface sample), morphology (shape and size), hardness or reflectivity, and the elemental composition of nails. PMID:28232921

  19. Infection resistance of unreamed solid, hollow slotted and cannulated intramedullary nails: an in-vivo experimental comparison.

    PubMed

    Horn, J; Schlegel, U; Krettek, C; Ito, K

    2005-07-01

    Infection continues to be a problematic complication of fracture treatment, particularly in severe open fractures. The implant design and material as well as implantation technique play an important role in the pathogenesis of local infection. The aim of our study was to determine if the local resistance to infection of a cannulated IM nail is less than that of a solid nail and more similar to that of a hollow nail. In 65 female White Zealand rabbits, the intramedullary cavity was inoculated with matching concentrations of Staphylococcus aureus, and one of the three nails was inserted. The solid nail had a greater than twofold higher resistance to infection (23%) compared to that of the other two nails (hollow, 65%; cannulated, 61%) which was statistically significant (p<0.02). No difference in infection resistance was detected between the hollow slotted and cannulated nail designs (p=1). Although these experimental results may be clinically considered, direct extrapolation to clinical infection rates is ill advised.

  20. Monitoring femoral component installation using vibration testing.

    PubMed

    Giardini, Seana; Cornwell, Phillip; Meneghini, R Michael

    2005-01-01

    With emerging minimally invasive surgical techniques in total hip arthroplasty, there has been anecdotal evidence of an increase in fractures associated with the insertion of the prosthesis into the femur. The diminished visibility associated with minimally invasive surgical techniques necessitates a greater emphasis on the surgeon's tactile and auditory senses. These senses are used to ascertain the femoral component position of maximum stability and interference fit, as well as to prevent further component impaction and subsequent fracture of the femur. The work described herein attempts to identify a means to supplement the surgeon's tactile and auditory senses by using damage identification techniques normally used in civil and mechanical structures to monitor the insertion process of the prosthesis. It is hypothesized that vibration characteristics of the impact process may be used intraoperatively to determine at what position the femoral component has reached appropriate interference fit and stability in the femur. Such information may be used to prevent further impaction of the femoral component past a threshold that could result in a periprosthetic fracture. A piezoelectric accelerometer and impact hammer will be used to monitor the impact process. The acceleration time history data were analyzed by using low and high pass filters to allow frequency analysis of the time history signals. This paper will summarize features derived from the measured data that will be used to develop an insertion process termination indicator.

  1. Lgr6 marks nail stem cells and is required for digit tip regeneration

    PubMed Central

    Lehoczky, Jessica A.; Tabin, Clifford J.

    2015-01-01

    The tips of the digits of some mammals, including human infants and mice, are capable of complete regeneration after injury. This process is reliant on the presence of the overlaying nail organ and is mediated by a proliferative blastema. Epithelial Wnt/β-catenin signaling has been shown to be necessary for mouse digit tip regeneration. Here, we report on Lgr5 and Lgr6 (leucine-rich repeat-containing G protein-coupled receptor 5 and 6), two important agonists of the Wnt pathway that are known to be markers of several epithelial stem cell populations. We find that Lgr5 is expressed in a dermal population of cells adjacent to the specialized epithelia surrounding the keratinized nail plate. Moreover, Lgr5-expressing cells contribute to this dermis, but not the blastema, during digit tip regeneration. In contrast, we find that Lgr6 is expressed within cells of the nail matrix portion of the nail epithelium, as well as in a subset of cells in the bone and eccrine sweat glands. Genetic lineage analysis reveals that Lgr6-expressing cells give rise to the nail during homeostatic growth, demonstrating that Lgr6 is a marker of nail stem cells. Moreover, Lgr6-expressing cells contribute to the blastema, suggesting a potential direct role for Lgr6-expressing cells during digit tip regeneration. This role is confirmed by analysis of Lgr6-deficient mice, which have both a nail and bone regeneration defect. PMID:26460010

  2. Lgr6 marks nail stem cells and is required for digit tip regeneration.

    PubMed

    Lehoczky, Jessica A; Tabin, Clifford J

    2015-10-27

    The tips of the digits of some mammals, including human infants and mice, are capable of complete regeneration after injury. This process is reliant on the presence of the overlaying nail organ and is mediated by a proliferative blastema. Epithelial Wnt/β-catenin signaling has been shown to be necessary for mouse digit tip regeneration. Here, we report on Lgr5 and Lgr6 (leucine-rich repeat-containing G protein-coupled receptor 5 and 6), two important agonists of the Wnt pathway that are known to be markers of several epithelial stem cell populations. We find that Lgr5 is expressed in a dermal population of cells adjacent to the specialized epithelia surrounding the keratinized nail plate. Moreover, Lgr5-expressing cells contribute to this dermis, but not the blastema, during digit tip regeneration. In contrast, we find that Lgr6 is expressed within cells of the nail matrix portion of the nail epithelium, as well as in a subset of cells in the bone and eccrine sweat glands. Genetic lineage analysis reveals that Lgr6-expressing cells give rise to the nail during homeostatic growth, demonstrating that Lgr6 is a marker of nail stem cells. Moreover, Lgr6-expressing cells contribute to the blastema, suggesting a potential direct role for Lgr6-expressing cells during digit tip regeneration. This role is confirmed by analysis of Lgr6-deficient mice, which have both a nail and bone regeneration defect.

  3. Oral carriage of enterobacteriaceae among school children with chronic nail-biting habit

    PubMed Central

    Reddy, Sushma; Sanjai, Karpagaselvi; Kumaraswamy, Jayalakshmi; Papaiah, Lokesh; Jeevan, MB

    2013-01-01

    Context: Onychophagia or habitual nail-biting is widespread among children and adolescents, between 10 and 18 years. Prevalence estimates range from 30% during childhood to 45% in adolescence. Nail-biting habit can result in autoinoculation of pathogens and transmission of infection between body parts. Aims: The purpose of the study was to evaluate the differences in prevalence of Enterobacteriaceae (E. coli and Enterobacter spp) in saliva samples from subjects with and without chronic nail-biting habit. Subjects and Methods: One hundred and twenty-two subjects with chronic nail-biting habit and 122 subjects with no oral habit were enrolled in the study. All subjects were aged 11-15 years. The saliva samples were collected by oral rinse technique, samples were studied microbiologically. Statistical Analysis Used: Two-tailed Student's t-test and Chi-square/Fisher's exact test were used to find the significance of study parameters between the groups. Results: Enterobacteriaceae were detected in the saliva samples of 80 of the 122 nail-biting subjects, whereas Enterobacteriaceae were detected in the saliva samples of only 10 of the 122 subjects who were not nail-biters. This difference in prevalence was statistically significant (P < 0.001). Conclusions: Our results suggest a higher carriage of Enterobacteriaceae in the individuals having nail-biting habits when compared to individuals with no habits. Further studies need to be done to know the prevalence of Enterobacteriaceae species in different age groups. PMID:24250072

  4. A Novel Vehicle for Enhanced Drug Delivery Across the Human Nail for the Treatment of Onychomycosis.

    PubMed

    Turner, Rob; Weaver, Sean; Caserta, Francesco; Brown, Marc B

    2016-01-01

    The aim of this study was to use in vitro nail models to investigate the potential of a novel base formulation (Recura) containing either fluconazole or miconazole for the treatment of onychomycosis in comparison to two commercial comparators (Jublia and a Penlac generic). Initially, a modified Franz cell was used, where sections of human nail served as the barrier through which drug penetrated into an agar-filled chamber infected with dermatophytes. A second study was performed using a novel infected nail model where dermatophytes grew into human nail and adenosine triphosphate levels were used as biological marker for antimicrobial activity. The novel enhancing system Recura increased the permeation of both existing drugs through human nail sections mounted in a modified Franz cell. Furthermore, the infected nail model also confirmed that the system also enhanced the permeation through infected nail resulting in a decrease in adenosine triphosphate levels superior (P ≤ 0.05) to Penlac generic and equivalent (P > 0.05) to the commercial comparator Jublia. This study demonstrated that with the use of a novel permeation-enhancing formulation base, Recura enhances delivery of miconazole and fluconazole when applied ungually such that the efficacy was equivalent or superior to commercial comparators. Such a topically applied system has the possibility of overcoming the systemic side effects of antifungals when taken orally.

  5. Hydration of nail plate: a novel screening model for transungual drug permeation enhancers.

    PubMed

    Chouhan, P; Saini, T R

    2012-10-15

    Drug delivery by topical route for the treatment of onychomycosis, a nail fungal infection, is challenging due to the unique barrier properties of the nail plate which imparts high resistance to the passage of antifungal drugs. Permeation enhancers are used in transungual formulations to improve the drug flux across the nail plate. Selection of the effective permeation enhancer among the available large pool of permeation enhancers is a difficult task. Screening the large number of permeation enhancers using conventional Franz diffusion cells is laborious and expensive. The objective of present study was to evolve a simple, accurate and rapid method for screening of transungual drug permeation enhancers based on the principle of hydration of nail plate. The permeation enhancer which affects the structural or physicochemical properties of nail plate would also affect their hydration capacity. Two screening procedures namely primary and secondary screenings were evolved wherein hydration and uptake of ciclopirox olamine by nail plates were measured. Hydration enhancement factor, HEF(24) and drug uptake enhancement factor, UEF(24) were determined for screening of 23 typical permeation enhancers. The Pearson's correlation coefficient between HEF(24) and UEF(24) was determined. A good agreement between the HEF(24) and UEF(24) data proved the validity of the proposed nail plate hydration model as a screening technique for permeation enhancers.

  6. In Vitro Nail Penetration and Antifungal Activity of Tavaborole, a Boron-Based Pharmaceutical.

    PubMed

    Coronado, Dina; Merchant, Tejal; Chanda, Sanjay; Zane, Lee T

    2015-06-01

    An effective topical antifungal medication must penetrate through the nail plate at sufficient concentrations to eradicate the fungal infection. Tavaborole topical solution, 5% is a novel boron-based pharmaceutical approved for the treatment of toenail onychomycosis due to Trichophyton rubrum or T mentagrophytes. Four in vitro studies assessed the antifungal activity and nail penetration of tavaborole. In Study 1, tavaborole demonstrated minimum inhibitory concentration (MIC) values ranging from 0.25-2 μg/mL against all fungi tested; addition of 5% keratin powder did not affect the MIC against T rubrum. The minimum fungicidal concentration (MFC) values for tavaborole against T rubrum and T mentagrophytes were 8 and 16 μg/mL, respectively. In Study 2, tavaborole effectively penetrated through the nail plate; mean concentrations in the ventral/intermediate nail layer were significantly higher than ciclopirox at day 15. In Study 3, mean cumulative tavaborole penetration through ex vivo human nails was significantly higher than ciclopirox at day 15. In Study 4, tavaborole demonstrated superior nail penetration and fungicidal activity, as measured by zones of inhibition. These studies demonstrated the superior penetration of tavaborole through the nail plate vs ciclopirox. Tavaborole demonstrated robust antifungal activity, with low MIC and MFC values, even in the presence of keratin.

  7. Comparing the Intramedullary Nailing Method Versus Dynamic Hip Screw in Treatment of Unstable Intertrochanteric Fractures

    PubMed Central

    Yeganeh, Ali; Taghavi, Roozbeh; Moghtadaei, Mehdi

    2016-01-01

    Introduction: Dynamic Hip Screw fixation is currently considered as a standard treatment for pre-trochanteric fractures; however, due to the long-term hospitalization and some other complications, some researchers have proposed intramedullary nailing as the alternative surgical treatment. The aim of this study was to compare and examine the consequences of the using intramedullary nailing method versus Dynamic Hip Screw. Methods: In this study 114 patients with unstable Intertrochanteric fracture refer to Rasoul Akram hospital during 2011 to 2013 has been selected. After reduction, fixation surgery with PFN nail (60 patients) and Dynamic Hip Screw (54 patients) has been performed. All patients were screen during surgery and six months after surgery and some parameters like, bleeding, union, as well as complications such as collapse, varus and medialization of the distal fragment were record and patients. Results: About some parameters like cutting length, surgery duration, bleeding there were significant differences between two groups. In six months follow up period 2 patinas from nail and 8 patients from DHS group had non-union. Also from the point of radiologic and clinical parameters, like anterior thigh pain, cut out, medialization of the distal fragment, collapse of the neck, walking recovery and daily activities were significant between two groups. Conclusion: Due to the reduced hospital stay in intramedullary nailing method and the necessity of doing repeated surgery and applying intramedullary nailing when the patients are not treated with external fixation, the researchers recommend intramedullary nailing as the first option in treating such patients. PMID:26980933

  8. Onychopharmacokinetics of terbinafine hydrochloride penetration from a novel topical formulation into the human nail in vitro.

    PubMed

    Hui, Xiaoying; Lindahl, Åke; Lamel, Sonia; Maibach, Howard I

    2013-09-01

    This study determined the onychopharmacokinetics, nail absorption, distribution, and penetration of [¹⁴C]-terbinafine HCl in a new topical formulation into/through the human finger nail using the in vitro finite dose model. This study determined the penetration rate of terbinafine HCl from multiple doses of topical formulation applied daily for 14 days. Results showed that the total dose recovery (mass balance) was almost 100%. The concentration of terbinafine HCl in the deeper nail plate (ventral/intermediate layers) and the cotton-pad nail bed samples after the 14-day treatment were 613 ± 145 and (±S.D.) and 27 ± 1.2 µg/cm³ (or 1.9 ± 0.6 µg/cm³ daily) on average, respectively. In comparison with nail concentration data from the literature for other topical terbinatine formulations, our results show that higher amounts of terbinafine HCl reached the deep nail plate and/or the nail bed after a 14-day topical treatment with this topical formulation in vitro.

  9. Breakage of a Third Generation Gamma Nail: A Case Report and Review of the Literature

    PubMed Central

    Iwakura, Takashi; Lee, Sang Yang; Nishida, Kotaro; Kuroda, Ryosuke; Kurosaka, Masahiro

    2013-01-01

    The use of intramedullary nails to treat trochanteric fractures of the femur has increased with the increasing size of the elderly population. The third generation Gamma nail is currently one of the most popular devices for the treatment of trochanteric fractures. Nail breakage is a rare complication, possibly resulting from fatigue fracture of the implant. We present the first reported case of breakage of a third generation Gamma nail that was not used to treat a pathological fracture. An 83-year-old woman with an unstable trochanteric fracture of the femur was treated using a third generation Gamma nail. She was referred to our hospital 14 months postoperatively with nail breakage at the opening for the lag screw. The breakage was secondary to nonunion, which was thought to be mainly due to insufficient reduction of the fracture. The broken nail was removed, and the patient underwent cemented bipolar hemiarthroplasty. At followup 18 months later, she was mobile with a walker and asymptomatic with no complications. This case shows that inadequate operation such as insufficient reduction of the trochanteric fracture may result in nonunion and implant breakage, even when using a high-strength, well-designed implant. PMID:23762698

  10. Effects of human hair and nail proteins and their films on rat mast cells.

    PubMed

    Fujii, Toshihiro; Murai, Shinya; Ohkawa, Kousaku; Hirai, Toshihiro

    2008-06-01

    Human hair and nail are valuable materials for producing individual corresponding biocompatible materials. A rapid and convenient protein extraction method (Shindai method) and novel procedures for preparing their protein films from their extracts have been developed using human hair and nail. The effects of the human hair and nail proteins and their films on histamine release from rat peritoneal mast cells were investigated. Both protein solutions and their films, mainly consisting of keratins and matrix proteins, did not induce histamine release from the mast cells. Scanning electron microscopy (SEM) also showed that the mast cells were only slightly affected by adding the human hair and nail proteins or by incubating on their protein films. The IgE-dependent histamine release was inhibited by the hair and nail proteins and their films. Incubation of the mast cells with the hair and nail proteins prior to the addition of the IgE serum resulted in a high inhibition (50%) of the histamine release, while the inhibition was approximately 10% when the protein solutions were mixed with the mast cells after incubation with the IgE serum. These results suggest that the human hair and nail proteins and their films will be useful materials for antiallergic actions.

  11. Hybrid approach to limb salvage in the setting of an infected femoral-femoral bypass graft.

    PubMed

    Jones, Douglas W; Meltzer, Andrew J; Schneider, Darren B

    2014-08-01

    Prosthetic vascular graft infection in patients with advanced peripheral arterial disease can lead to multiple additional procedures, including extra-anatomic bypass or even amputation. We report the case of an 88-year-old woman with critical limb ischemia and an infected prosthetic femoral-femoral bypass graft. Using a planned hybrid 2-stage approach, we performed endovascular recanalization of the native left iliac arterial system using remote access via the superficial femoral artery to avoid infected groin wounds. Recanalization of the patient's Trans-Atlantic Inter-Society Consensus II D chronic iliac occlusion allowed for removal of the infected graft and placement of a profunda femoris artery to proximal posterior tibial artery bypass, thereby restoring inflow and avoiding the infected left groin. Newer endovascular techniques coupled with open surgical options may lead to limb salvage in patients with previously unreconstructable peripheral arterial disease.

  12. Femoral stem fracture and in vivo corrosion of retrieved modular femoral hips.

    PubMed

    Huot Carlson, J Caitlin; Van Citters, Douglas W; Currier, John H; Bryant, Amber M; Mayor, Michael B; Collier, John P

    2012-08-01

    A series of 78 retrieved modular hip devices were assessed for fretting and corrosion. Damage was common at both the head-neck junction (54% showing corrosion; 88% showing fretting) and at the stem-sleeve junction (88% corrosion; 65% fretting). Corrosion correlated to in vivo duration, patient activity, and metal (vs ceramic) femoral heads but did not correlate to head carbon content. Femoral stem fatigue fracture was observed in seven retrievals; all had severe corrosion, were under increased stress, and were in vivo longer than the non-fractured cohort. This study emphasizes the potential for stem fracture when small diameter femoral stems with large offsets are used in heavy and active patients. Designs which reduce fretting and corrosion in modular implants is warranted as patients demand longer lasting implants.

  13. Molecular diffusion in the human nail measured by stimulated Raman scattering microscopy.

    PubMed

    Chiu, Wing Sin; Belsey, Natalie A; Garrett, Natalie L; Moger, Julian; Delgado-Charro, M Begoña; Guy, Richard H

    2015-06-23

    The effective treatment of diseases of the nail remains an important unmet medical need, primarily because of poor drug delivery. To address this challenge, the diffusion, in real time, of topically applied chemicals into the human nail has been visualized and characterized using stimulated Raman scattering (SRS) microscopy. Deuterated water (D2O), propylene glycol (PG-d8), and dimethyl sulphoxide (DMSO-d6) were separately applied to the dorsal surface of human nail samples. SRS microscopy was used to image D2O, PG-d8/DMSO-d6, and the nail through the O-D, -CD2, and -CH2 bond stretching Raman signals, respectively. Signal intensities obtained were measured as functions of time and of depth into the nail. It was observed that the diffusion of D2O was more than an order of magnitude faster than that of PG-d8 and DMSO-d6. Normalization of the Raman signals, to correct in part for scattering and absorption, permitted semiquantitative analysis of the permeation profiles and strongly suggested that solvent diffusion diverged from classical behavior and that derived diffusivities may be concentration dependent. It appeared that the uptake of solvent progressively undermined the integrity of the nail. This previously unreported application of SRS has permitted, therefore, direct visualization and semiquantitation of solvent penetration into the human nail. The kinetics of uptake of the three chemicals studied demonstrated that each altered its own diffusion in the nail in an apparently concentration-dependent fashion. The scale of the unexpected behavior observed may prove beneficial in the design and optimization of drug formulations to treat recalcitrant nail disease.

  14. Molecular diffusion in the human nail measured by stimulated Raman scattering microscopy

    PubMed Central

    Chiu, Wing Sin; Belsey, Natalie A.; Garrett, Natalie L.; Moger, Julian; Delgado-Charro, M. Begoña; Guy, Richard H.

    2015-01-01

    The effective treatment of diseases of the nail remains an important unmet medical need, primarily because of poor drug delivery. To address this challenge, the diffusion, in real time, of topically applied chemicals into the human nail has been visualized and characterized using stimulated Raman scattering (SRS) microscopy. Deuterated water (D2O), propylene glycol (PG-d8), and dimethyl sulphoxide (DMSO-d6) were separately applied to the dorsal surface of human nail samples. SRS microscopy was used to image D2O, PG-d8/DMSO-d6, and the nail through the O-D, -CD2, and -CH2 bond stretching Raman signals, respectively. Signal intensities obtained were measured as functions of time and of depth into the nail. It was observed that the diffusion of D2O was more than an order of magnitude faster than that of PG-d8 and DMSO-d6. Normalization of the Raman signals, to correct in part for scattering and absorption, permitted semiquantitative analysis of the permeation profiles and strongly suggested that solvent diffusion diverged from classical behavior and that derived diffusivities may be concentration dependent. It appeared that the uptake of solvent progressively undermined the integrity of the nail. This previously unreported application of SRS has permitted, therefore, direct visualization and semiquantitation of solvent penetration into the human nail. The kinetics of uptake of the three chemicals studied demonstrated that each altered its own diffusion in the nail in an apparently concentration-dependent fashion. The scale of the unexpected behavior observed may prove beneficial in the design and optimization of drug formulations to treat recalcitrant nail disease. PMID:26056283

  15. [Infections of finger and toe nails due to fungi and bacteria].

    PubMed

    Nenoff, P; Paasch, U; Handrick, W

    2014-04-01

    Infections of the finger and the toe nails are most frequently caused by fungi, primarily dermatophytes. Causative agents of tinea unguium are mostly anthropophilic dermatophytes. Both in Germany, and worldwide, Trichophyton rubrum represents the main important causative agent of onychomycoses. Yeasts are isolated from fungal nail infections, both paronychia and onychomycosis far more often than generally expected. This can represent either saprophytic colonization as well as acute or chronic infection of the nail organ. The main yeasts causing nail infections are Candida parapsilosis, and Candida guilliermondii; Candida albicans is only in third place. Onychomycosis due to molds, or so called non-dermatophyte molds (NDM), are being increasingly detected. Molds as cause of an onychomycosis are considered as emerging pathogens. Fusarium species are the most common cause of NDM onychomycosis; however, rare molds like Onychocola canadensis may be found. Bacterial infections of the nails are caused by gram negative bacteria, usually Pseudomonas aeruginosa (recognizable because of green or black coloration of the nails) but also Klebsiella spp. and gram positive bacteria like Staphylococcus aureus. Treatment of onychomycosis includes application of topical antifungal agents (amorolfine, ciclopirox). If more than 50 % of the nail plate is affected or if more than three out of ten nails are affected by the fungal infection, oral treatment using terbinafine (in case of dermatophyte infection), fluconazole (for yeast infections), or alternatively itraconazole are recommended. Bacterial infections are treated topically with antiseptic agents (octenidine), and in some cases with topical antibiotics (nadifloxacin, gentamicin). Pseudomonas infections of the nail organ are treated by ciprofloxacin; other bacteria are treated according to the results of culture and sensitivity testing.

  16. External lead contamination of women's nails by surma in Pakistan: Is the biomarker reliable?

    PubMed

    Ikegami, Akihiko; Takagi, Mai; Fatmi, Zafar; Kobayashi, Yayoi; Ohtsu, Mayumi; Cui, Xiaoyi; Mise, Nathan; Mizuno, Atsuko; Sahito, Ambreen; Khoso, Aneeta; Kayama, Fujio

    2016-11-01

    Adverse health effects of heavy metals are a public health concern, especially lead may cause negative health impacts to human fetal and infantile development. The lead concentrations in Pakistani pregnant women's nails, used as a biomarker, were measured to estimate the lead exposure. Thirteen nail samples out of 84 nails analyzed contained lead higher than the concentration (13.6 μg/g) of the fatal lead poisoning case, raising the possibility of an external contamination. Eye cosmetics such as surma are recognized as one of the important sources of lead exposure in Pakistan. We collected in Pakistan 30 eye cosmetics made in Pakistan, Saudi Arabia and western countries. As the metal composition analysis by energy dispersive X-ray fluorescence spectrometry revealed that some surma samples contained lead more than 96%, the surma might contaminate the nail specimen. Scanning electron microscopy observations showed that lead-containing surma consists of fine particle of galena (ore of lead sulfide) in respirable dust range (less than 10 μm). In addition, relative in vitro bioavailability of lead in the surma was determined as 5.2%. Thus, lead-containing surma consists of inhalable and bioavailable particles, and it contributes an increased risk of lead exposure. Moreover, the relationship between the surma and the lead-contaminated nails by lead isotope ratios analysis indicated the potential of lead contamination in nails by surma. These results suggest that lead in the nails was derived both from body burden of lead and external contamination by lead-containing surma. Therefore, nail is not suited as a biomarker for lead exposure in the countries where surma used, because we may overestimate lead exposure by surface lead contamination in the nail by surma.

  17. Permeation studies of novel terbinafine formulations containing hydrophobins through human nails in vitro.

    PubMed

    Vejnovic, Ivana; Huonder, Cornelia; Betz, Gabriele

    2010-09-15

    Existing treatments of onychomycosis are not satisfactory. Oral therapies have many side effects and topical formulations are not able to penetrate into the human nail plate and deliver therapeutical concentrations of active agent in situ. The purpose of the present study was to determine the amount of terbinafine, which permeates through the human nail plate, from liquid formulations containing enhancers, namely hydrophobins A-C in the concentration of 0.1% (w/v). The used reference solution contained 10% (w/v) of terbinafine in 60% (v/v) ethanol/water without enhancer. Permeability studies have been performed on cadaver nails using Franz diffusion cells modified to mount nail plates and filled with 60% (v/v) ethanol/water in the acceptor chamber. Terbinafine was quantitatively determined by HPLC. The amount of terbinafine remaining in the nail was extracted by 96% ethanol from pulverized nail material after permeation experiment and presented as percentage of the dry nail weight before the milling test. Permeability coefficient (PC) of terbinafine from reference solution was determined to be 1.52E-10 cm/s. Addition of hydrophobins improved PC in the range of 3E-10 to 2E-9 cm/s. Remaining terbinafine reservoir in the nail from reference solution was 0.83% (n=2). An increase of remaining terbinafine reservoir in the nail was observed in two out of three tested formulations containing hydrophobins compared to the reference. In all cases, known minimum inhibitory concentration of terbinafine for dermatophytes (0.003 microg/ml) has been exceeded in the acceptor chamber of the diffusion cells. All tested proteins (hydrophobins) facilitated terbinafine permeation after 10 days of permeation experiment, however one of them achieved an outstanding enhancement factor of 13.05 compared to the reference. Therefore, hydrophobins can be included in the list of potential enhancers for treatment of onychomycosis.

  18. [Slipped capital femoral epiphysis associated with hyperparathyroidism. A case report].

    PubMed

    Khiari, Karima; Cherif, Lotfi; Ben Abdallah, Nejib; Maazoun, Imen; Hadj Ali, Insaf; Bentaarit, Chokri; Turki, Sami; Ben Maïz, Hedi

    2003-12-01

    Slippage of the upper femoral epiphysis can occur in association with multiple endocrine imbalances. A case of slipped femoral epiphysis with primary hyperparathyroidism is reported. The patient was an adolescent, 16 Years of age, who presented bilateral slipped epiphysis. Investigation showed that he had hypercalcemia (3.1 mmol/l) related to primary hyperparathyroidism. A parathyroid adenoma was removed. Outcome was favorable and the slipped femoral epiphyses did not require a specific treatment.

  19. Femoral neck structure and function in early hominins.

    PubMed

    Ruff, Christopher B; Higgins, Ryan

    2013-04-01

    All early (Pliocene-Early Pleistocene) hominins exhibit some differences in proximal femoral morphology from modern humans, including a long femoral neck and a low neck-shaft angle. In addition, australopiths (Au. afarensis, Au. africanus, Au. boisei, Paranthropus boisei), but not early Homo, have an "anteroposteriorly compressed" femoral neck and a small femoral head relative to femoral shaft breadth. Superoinferior asymmetry of cortical bone in the femoral neck has been claimed to be human-like in australopiths. In this study, we measured superior and inferior cortical thicknesses at the middle and base of the femoral neck using computed tomography in six Au. africanus and two P. robustus specimens. Cortical asymmetry in the fossils is closer overall to that of modern humans than to apes, although many values are intermediate between humans and apes, or even more ape-like in the midneck. Comparisons of external femoral neck and head dimensions were carried out for a more comprehensive sample of South and East African australopiths (n = 17) and two early Homo specimens. These show that compared with modern humans, femoral neck superoinferior, but not anteroposterior breadth, is larger relative to femoral head breadth in australopiths, but not in early Homo. Both internal and external characteristics of the australopith femoral neck indicate adaptation to relatively increased superoinferior bending loads, compared with both modern humans and early Homo. These observations, and a relatively small femoral head, are consistent with a slightly altered gait pattern in australopiths, involving more lateral deviation of the body center of mass over the stance limb.

  20. Comparison of human hair and nail low-sulfur protein compositions on two-dimensional electrophoresis.

    PubMed

    Dekio, S; Jidoi, J

    1989-08-01

    Compositions of human normal hair and nail low-sulfur proteins were compared using two-dimensional electrophoresis of their S-carboxymethylated (SCM) derivatives. Six SCM low-sulfur protein components with molecular weights (MWs) of 76,000, 73,000, 72,000, 64,000, 61,000 and 55,000 were common to the hair and nail. One component with a MW of 61,000 was specific to hair, and two components, both with a MW of 50,000, were specific to nail.

  1. Self-administered behavior modification to reduce nail biting: incorporating simple technology to ensure treatment integrity.

    PubMed

    Craig, Andrew R

    2010-01-01

    Habitual behaviors, such as problematic nail biting, are a common target for self-managed behavior-modification programs. The current self-experiment used self-monitoring in conjunction with a self-managed differential-reinforcement procedure for the treatment of problematic nail biting. A simple picture-comparison procedure allowed an independent observer to assist in monitoring treatment progress and outcomes and to ensure treatment integrity. Results provide support that the overall treatment package was successful in decreasing the occurrence of nail biting. Moreover, the treatment-integrity procedure enabled full-day monitoring to take place with limited requirement of a secondary observer.

  2. Randomized Trial of Reamed and Unreamed Intramedullary Nailing of Tibial Shaft Fractures

    PubMed Central

    2008-01-01

    Background: There remains a compelling biological rationale for both reamed and unreamed intramedullary nailing for the treatment of tibial shaft fractures. Previous small trials have left the evidence for either approach inconclusive. We compared reamed and unreamed intramedullary nailing with regard to the rates of reoperations and complications in patients with tibial shaft fractures. Methods: We conducted a multicenter, blinded randomized trial of 1319 adults in whom a tibial shaft fracture was treated with either reamed or unreamed intramedullary nailing. Perioperative care was standardized, and reoperations for nonunion before six months were disallowed. The primary composite outcome measured at twelve months postoperatively included bone-grafting, implant exchange, and dynamization in patients with a fracture gap of <1 cm. Infection and fasciotomy were considered as part of the composite outcome, irrespective of the postoperative gap. Results: One thousand two hundred and twenty-six participants (93%) completed one year of follow-up. Of these, 622 patients were randomized to reamed nailing and 604 patients were randomized to unreamed nailing. Among all patients, fifty-seven (4.6%) required implant exchange or bone-grafting because of nonunion. Among all patients, 105 in the reamed nailing group and 114 in the unreamed nailing group experienced a primary outcome event (relative risk, 0.90; 95% confidence interval, 0.71 to 1.15). In patients with closed fractures, forty-five (11%) of 416 in the reamed nailing group and sixty-eight (17%) of 410 in the unreamed nailing group experienced a primary event (relative risk, 0.67; 95% confidence interval, 0.47 to 0.96; p = 0.03). This difference was largely due to differences in dynamization. In patients with open fractures, sixty of 206 in the reamed nailing group and forty-six of 194 in the unreamed nailing group experienced a primary event (relative risk, 1.27; 95% confidence interval, 0.91 to 1.78; p = 0

  3. Minimizing the complications of intramedullary nailing for distal third tibial shaft and metaphyseal fractures

    PubMed Central

    Yaligod, Vishwanath; Rudrappa, Girish H.; Nagendra, Srinivas; Shivanna, Umesh M.

    2013-01-01

    Background The complications of intramedullary nailing of distal third tibial shaft and metaphyseal fractures have a direct impact on ankle and hind foot function. Methods We retrospectively evaluated 28 patients. Unreamed nail was negotiated across the well reduced fracture till subchondral bone and fixed with 2 to 3 distal locking screws in different planes. Results Fracture union rate was 85%. Three out of 28 patients had malalignment. Mean ankle, hindfoot functional score was 85. Conclusion Complications can be minimized by impacting the unreamed nail till the subchondral bone while maintaining the fracture well reduced and by using multiple distal locking screws in different planes. PMID:24719527

  4. [Isolated true aneurysm of the deep femoral artery].

    PubMed

    Salomon du Mont, L; Holzer, T; Kazandjian, C; Saucy, F; Corpataux, J M; Rinckenbach, S; Déglise, S

    2016-07-01

    Aneurysms of the deep femoral artery, accounting for 5% of all femoral aneurysms, are uncommon. There is a serious risk of rupture. We report the case of an 83-year-old patient with a painless pulsatile mass in the right groin due to an aneurysm of the deep femoral artery. History taking revealed no cardiovascular risk factors and no other aneurysms at other localizations. The etiology remained unclear because no recent history of local trauma or puncture was found. ACT angiography was performed, revealing a true isolated aneurysm of the deep femoral artery with a diameter of 90mm, beginning 1cm after its origin. There were no signs of rupture or distal emboli. Due to unsuitable anatomy for an endovascular approach, the patient underwent open surgery, with exclusion of the aneurysm and interposition of an 8-mm Dacron graft to preserve deep femoral artery flow. Due to their localization, the diagnosis and the management of aneurysms of the deep femoral artery can be difficult. Options are surgical exclusion or an endovascular approach in the absence of symptoms or as a bridging therapy. If possible, blood flow to the distal deep femoral artery should be maintained, the decision depending also on the patency of the superficial femoral artery. In case of large size, aneurysms of the deep femoral artery should be treated without any delay.

  5. Long-term Bisphosphonate Therapy-induced Periprosthetic Femoral Stress Fracture in a Sliding Hip Screw Implant: A Unique Case Report

    PubMed Central

    Adams, Mark R; Dunn, Conor; Sirkin, Michael S; Reilly, Mark C

    2016-01-01

    Introduction: Long-term bisphosphonate therapy for osteoporosis is associated with an increased risk of low-to-no energy atypical subtrochanteric and femoral shaft fractures with characteristic radiologic findings. There are few reports of patients with long-term bisphosphonate-induced periprosthetic fractures, all of them had a hip arthroplasty prosthesis. In this report, we present a unique case of a 90-year-old Caucasian female on long-term bisphosphonate therapy with a sliding hip screw implant who sustained a periprosthetic fracture of the femoral shaft at the distal aspect of the plate. Case Report: In April 2014, a 90-year-old female presented with left thigh pain after a fall from standing height. She had a previous fixation of a left intertrochanteric hip fracture with a sliding hip screw in 1999 and a 9-year history of bisphosphonate therapy. Radiographs obtained in the emergency department revealed a left-sided femoral shaft fracture at the distal aspect of the previously applied five-hole side plate. Of note, the periprosthetic fracture demonstrated cortical thickening at the fracture site of the lateral femoral cortex, lack of comminution as well as a transverse appearance. The patient was taken to the operating room the next day for retrograde placement of an intramedullary nail of the left femur with revision of left intertrochanteric femur fracture fixation. By 3 months postoperatively, she had obtained full radiographic union. Conclusion: This case report highlights the possibility of an atypical fracture distal to the sliding hip screw implant after open reduction internal fixation of an intertrochanteric hip fracture in patients on long-term bisphosphonates. PMID:28164053

  6. Correlation Between Residual Displacement and Osteonecrosis of the Femoral Head Following Cannulated Screw Fixation of Femoral Neck Fractures.

    PubMed

    Wang, Chen; Xu, Gui-Jun; Han, Zhe; Jiang, Xuan; Zhang, Cheng-Bao; Dong, Qiang; Ma, Jian-Xiong; Ma, Xin-Long

    2015-11-01

    The aim of the study was to introduce a new method for measuring the residual displacement of the femoral head after internal fixation and explore the relationship between residual displacement and osteonecrosis with femoral head, and to evaluate the risk factors associated with osteonecrosis of the femoral head in patients with femoral neck fractures treated by closed reduction and percutaneous cannulated screw fixation.One hundred and fifty patients who sustained intracapsular femoral neck fractures between January 2011 and April 2013 were enrolled in the study. All were treated with closed reduction and percutaneous cannulated screw internal fixation. The residual displacement of the femoral head after surgery was measured by 3-dimensional reconstruction that evaluated the quality of the reduction. Other data that might affect prognosis were also obtained from outpatient follow-up, telephone calls, or case reviews. Multivariate logistic regression analysis was applied to assess the intrinsic relationship between the risk factors and the osteonecrosis of the femoral head.Osteonecrosis of the femoral head occurred in 27 patients (18%). Significant differences were observed regarding the residual displacement of the femoral head and the preoperative Garden classification. Moreover, we found more or less residual displacement of femoral head in all patients with high quality of reduction based on x-ray by the new technique. There was a close relationship between residual displacement and ONFH.There exists limitation to evaluate the quality of reduction by x-ray. Three-dimensional reconstruction and digital measurement, as a new method, is a more accurate method to assess the quality of reduction. Residual displacement of the femoral head and the preoperative Garden classification were risk factors for osteonecrosis of the femoral head. High-quality reduction was necessary to avoid complications.

  7. Tibial lengthening over humeral and tibial intramedullary nails in patients with sequelae of poliomyelitis: a comparative study.

    PubMed

    Chen, Daoyun; Chen, Jianmin; Jiang, Yao; Liu, Fanggang

    2011-06-01

    Leg discrepancy is common after poliomyelitis. Tibial lengthening is an effective way to solve this problem. It is believed lengthening over a tibial intramedullary nail can provide a more comfortable lengthening process than by the conventional technique. However, patients with sequelae of poliomyelitis typically have narrow intramedullary canals allowing limited space for inserting a tibial intramedullary nail and Kirschner wires. To overcome this problem, we tried using humeral nails instead of tibial nails in the lengthening procedure. In this study, we used humeral nails in 20 tibial lengthening procedures and compared the results with another group of patients who were treated with tibial lengthening over tibial intramedullary nails. The mean consolidation index, percentage of increase and external fixation index did not show significant differences between the two groups. However, less blood loss and shorter operating time were noted in the humeral nail group. More patients encountered difficulty with the inserted intramedullary nail in the tibial nail group procedure. The complications did not show a statistically significant difference between the two techniques on follow-up. In conclusion, we found the humeral nail lengthening technique was more suitable in leg discrepancy patients with sequelae of poliomyelitis.

  8. Characteristics of patients with yellow nail syndrome and pleural effusion.

    PubMed

    Valdés, Luis; Huggins, John T; Gude, Francisco; Ferreiro, Lucía; Alvarez-Dobaño, José M; Golpe, Antonio; Toubes, María E; González-Barcala, Francisco J; José, Esther San; Sahn, Steven A

    2014-10-01

    Yellow nail syndrome (YNS) can be associated with a pleural effusion (PE) but the characteristics of these patients are not well defined. We performed a systematic review across four electronic databases for studies reporting clinical findings, PE characteristics, and most effective treatment of YNS. Case descriptions and retrospective studies were included, unrestricted by year of publication. We reviewed 112 studies (150 patients), spanning a period of nearly 50 years. The male/female ratio was 1.2/1. The median age was 60 years (range: 0-88). Seventy-eight percent were between 41-80 years old. All cases had lymphoedema and 85.6% had yellow nails. PEs were bilateral in 68.3%. The appearance of the fluid was serous in 75.3%, milky in 22.3% and purulent in 3.5%. The PE was an exudate in 94.7% with lymphocytic predominance in 96% with a low count of nucleated cells. In 61 of 66 (92.4%) of patients, pleural fluid protein values were >3 g/dL, and typically higher than pleural fluid LDH. Pleurodesis and decortication/pleurectomy were effective in 81.8% and 88.9% of cases, respectively, in the treatment of symptomatic PEs. The development of YNS and PE occurs between the fifth to eighth decade of life and is associated with lymphoedema. The PE is usually bilateral and behaves as a lymphocyte-predominant exudate. The most effective treatments appear to be pleurodesis and decortication/pleurectomy.

  9. Candida Parapsilosis and Candida Guillermondii: Emerging Pathogens in Nail Candidiasis

    PubMed Central

    Fich, Felix; Abarzúa-Araya, Alvaro; Pérez, Mario; Nauhm, Yalile; León, Eugenia

    2014-01-01

    Background: Onychomycosis of the fingernails and toenails is generally caused by dermatophytes and yeasts. Toenail mycoses involve mainly dermatophytes but when Candida is also involved, the strain most commonly isolated worldwide is C. albicans. Aims: To determine Candida strains prevailing in onychomycosis. Materials and Methods: A retrospective, observational and descriptive study of fungal cultures retrieved from the registry of the microbiology laboratory of the Pontificia Universidad Católica was performed. Specimens obtained from patients attending the healthcare network between December 2007 and December 2010 was analyzed. Statistical Analysis: A descriptive statistical analysis was performed. Results: Candida was retrieved from 467 of 8443 specimens (52% fingernails and 48% toenails). Cultures were negative in 5320 specimens (63.6%). Among Candida-positive cultures, parapsilosis was the most commonly isolated strain with 202 cases (43.3%). While isolates of Candida guillermondii were 113 (24.2%), those of Candida albicans were 110 (23.6%), those of spp. were 20 (4.3%) and there were 22 cases of other isolates (4.71%). Among the 467 patients with positive cultures for Candida, 136 (29,1%) were men and 331 (70,9%) were women. All patients were older than 18 years old. Clinical files were available for only 169 of the 467 patients with positive cultures for Candida. For those, age, gender, underlying illnesses and use of immunossupresive agents during the trial was reviewed. Conclusions: The present study shows that both C. parapsilosis as well as C. guillermondii appear as emerging pathogens that would be in fact taking the place of C. albicans as the most commonly isolated pathogen in patients with Candida onychomycosis. The relative percentage of C parapsilosis increases every year. Identification of Candida strains as etiological agents of nail candidiasis becomes relevant to the management both nail as well as systemic candidiasis, in view of the

  10. Hidrotic ectodermal dysplasia of hair, teeth, and nails: case reports and review.

    PubMed Central

    Chitty, L S; Dennis, N; Baraitser, M

    1996-01-01

    We report two families with the Witkop "tooth and nail syndrome". This term is a misnomer, as the hair was mildly involved in the original case reports and in the families reported here. Images PMID:8863167

  11. Different physicochemical properties of antimycotic agents are relevant for penetration into and through human nails.

    PubMed

    Neubert, R H H; Gensbügel, C; Jäckel, A; Wartewig, S

    2006-07-01

    This article reports the characterization of the physicochemical properties of two important antifungal topical drugs, amorolfine and ciclopirox. Furthermore, the release of the drugs from commercial lacquer formulations for treatment of onychomycosis was studied using the online FTIR-ATR technique. Based on the physicochemical background of these two drugs and their release from commercial lacquer formulations for treatment of onychomycosis, the suitability of these drugs for optimized local antifungal therapy to human nails is discussed. Amorolfine appears to be more suitable for drug delivery to human nails because it penetrates into the nails via the hydrophilic pathway. Furthermore amorolfine penetrates very well into fungal cells, due to the pH value of the nail, as well as the pKa value of this antimycotic agent and the lipophilic properties of its base form.

  12. Medically important fungi found in hallux nails of university students from Cali, Colombia.

    PubMed

    Alvarez, María Inés; Caicedo, Luz Dary

    2007-06-01

    The presence of medically important fungi was studied in hallux nails scrapings obtained from 504 students (204 males, 300 females) of three universities in Cali. Specimens were examined by direct microscopic examination and fungal culture. Medically important fungi were found in 49 (9.7%) students, 24 (4.8%) had onychomycosis while the rest did not have nail lesions. Trichophyton rubrum was the most commonly isolated fungi in students with lesions, where as T. mentagrophytes predominated in healthy nails. Most of the students with fungi were males. The prevalence of fungi was higher in individuals between 26 and 35 years. No association was observed between fungi and practicing sports or undergoing pedicures. These results suggest that dermatophytes can be found in healthy hallux nails, which can be reservoirs of pathogenic fungi.

  13. Comparison between lengthening over nail and conventional Ilizarov lengthening: a prospective randomized clinical study.

    PubMed

    El-Husseini, Timour F; Ghaly, Nabil A M; Mahran, Mahmoud A; Al Kersh, Mohamed Ahmed; Emara, Khaled M

    2013-08-01

    The aim of this study is to compare lengthening over an intramedullary nail to the conventional Ilizarov method with regard to percentage length increase, external fixation index, consolidation index and incidence of complications. This is a prospective randomized controlled study. Thirty-one limbs in 28 patients were included in the study; 15 were lengthened over an intramedullary nail, and 16 limbs were lengthened conventionally. The mean duration of external fixation in the lengthening over nail group was 52.2 days compared to 180.4 days in the conventional group. There was higher incidence of complications in the conventional method group. In comparison with conventional Ilizarov lengthening, lengthening over an intramedullary nail offers a shorter period of external fixation and fewer complications overall, but there is a high incidence of deep intramedullary infection which is serious.

  14. Refractures of the paediatric forearm with the intramedullary nail in situ

    PubMed Central

    van Egmond, Pim W; van der Sluijs, Hans A; van Royen, Barend J; Saouti, Rachid

    2013-01-01

    Forearm fractures in children are common. When conservative treatment fails, internal fixation with Elastic Stable Intramedullary Nailing (ESIN) become the first choice in the operative treatment of diaphyseal forearm shaft fractures. Refractures with the intramedullary nail in situ are known to occur but formal guidelines to guide management in such fractures are lacking. We present a well-documented case of a radius midshaft refracture in a 12-year-old boy with the intramedullary nail in situ, managed by closed reduction. Literature is reviewed for this type of complication, the treatment of 30 similar cases is discussed and a treatment strategy is defined. The refracture of the paediatric forearm fracture with the intramedullary nail in situ is a rare, but probably under recognised complication which is observed in approximately 2.3% of the study population. Closed reduction may be considered in these cases. PMID:24068378

  15. A Biomechanical Assessment of Hand/Arm Force with Pneumatic Nail Gun Actuation Systems.

    PubMed

    Lowe, Brian D; Albers, James; Hudock, Stephen D

    2014-09-01

    A biomechanical model is presented, and combined with measurements of tip press force, to estimate total user hand force associated with two pneumatic nail gun trigger systems. The contact actuation trigger (CAT) can fire a nail when the user holds the trigger depressed first and then "bumps" the nail gun tip against the workpiece. With a full sequential actuation trigger (SAT) the user must press the tip against the workpiece prior to activating the trigger. The SAT is demonstrably safer in reducing traumatic injury risk, but increases the duration (and magnitude) of tip force exertion. Time integrated (cumulative) hand force was calculated for a single user from measurements of the tip contact force with the workpiece and transfer time between nails as inputs to a static model of the nail gun and workpiece in two nailing task orientations. The model shows the hand force dependence upon the orientation of the workpiece in addition to the trigger system. Based on standard time allowances from work measurement systems (i.e. Methods-Time Measurement - 1) it is proposed that efficient application of hand force with the SAT in maintaining tip contact can reduce force exertion attributable to the sequential actuation trigger to 2-8% (horizontal nailing) and 9-20% (vertical nailing) of the total hand/arm force. The present model is useful for considering differences in cumulative hand/arm force exposure between the SAT and CAT systems and may explain the appeal of the CAT trigger in reducing the user's perception of muscular effort.

  16. Permanent antibiotic impregnated intramedullary nail in diabetic limb salvage: a case report and literature review.

    PubMed

    Woods, Jason B; Lowery, Nicholas J; Burns, Patrick R

    2012-01-01

    Managing complications after attempted hind foot and ankle arthrodesis with intramedullary nail fixation is a challenge. This situation becomes more problematic in the patient with diabetes mellitus and multiple comorbidities. Infection and subsequent osteomyelitis can be a devastating, limb threatening complication associated with these procedures. The surgeon must manage both the infectious process and the skeletal instability concurrently. This article provides a literature review and detailed management strategies for a modified technique of employing antibiotic impregnated polymethylmethacrylate-coated intramedullary nailing.

  17. A Biomechanical Assessment of Hand/Arm Force with Pneumatic Nail Gun Actuation Systems

    PubMed Central

    Lowe, Brian D.; Albers, James; Hudock, Stephen D.

    2015-01-01

    A biomechanical model is presented, and combined with measurements of tip press force, to estimate total user hand force associated with two pneumatic nail gun trigger systems. The contact actuation trigger (CAT) can fire a nail when the user holds the trigger depressed first and then “bumps” the nail gun tip against the workpiece. With a full sequential actuation trigger (SAT) the user must press the tip against the workpiece prior to activating the trigger. The SAT is demonstrably safer in reducing traumatic injury risk, but increases the duration (and magnitude) of tip force exertion. Time integrated (cumulative) hand force was calculated for a single user from measurements of the tip contact force with the workpiece and transfer time between nails as inputs to a static model of the nail gun and workpiece in two nailing task orientations. The model shows the hand force dependence upon the orientation of the workpiece in addition to the trigger system. Based on standard time allowances from work measurement systems (i.e. Methods-Time Measurement - 1) it is proposed that efficient application of hand force with the SAT in maintaining tip contact can reduce force exertion attributable to the sequential actuation trigger to 2–8% (horizontal nailing) and 9–20% (vertical nailing) of the total hand/arm force. The present model is useful for considering differences in cumulative hand/arm force exposure between the SAT and CAT systems and may explain the appeal of the CAT trigger in reducing the user’s perception of muscular effort. PMID:26321780

  18. Pregnancy-associated acquired arteriovenous malformation of the nail unit: a novel cause of localized erythronychia.

    PubMed

    Rutnin, Suthinee; Nguyen, Jennifer V; Miller, Christopher J; DeHoratius, Danielle; Rubin, Adam I

    2012-11-01

    Localized longitudinal erythronychia describes a solitary red streak limited to a single nail unit. Localized longitudinal erythronychia can be caused by both benign and malignant entities. Most commonly, the cause is a benign process, such as an onychopapilloma. We report a case of an acquired subungual arteriovenous malformation that presented as localized longitudinal erythronychia during pregnancy. To our knowledge, this is the first report of localized longitudinal erythronychia arising from a pregnancy-associated arteriovenous malformation of the nail unit.

  19. In-vitro permeability of the human nail and of a keratin membrane from bovine hooves: penetration of chloramphenicol from lipophilic vehicles and a nail lacquer.

    PubMed

    Mertin, D; Lippold, B C

    1997-03-01

    Lipophilic vehicles and especially nail lacquers are more appropriate for topical application on the nail than aqueous systems because of their better adhesion. This work has, therefore, studied the penetration through the human nail plate of the model compound chloramphenicol from the lipophilic vehicles medium chain triglycerides and n-octanol and from a lacquer based on quaternary poly(methyl methacrylates) (Eudragit RL). The results were compared with data obtained with a keratin membrane from bovine hooves. If the swelling of the nail plate or the hoof membrane is not altered by use of lipophilic vehicles, the maximum flux of the drug is independent of its solubility in the vehicle and is the same as that from a saturated aqueous solution. These vehicles are not able to enter the hydrophilic keratin membrane because of their non-polar character and so cannot change the solubility of the penetrating substance in the barrier. If the concentration of the drug in the nail lacquer is sufficiently high, the maximum flux through both barriers equals that from aqueous vehicles or even exceeds it because of the formation of a supersaturated system. Penetration through the nail plate follows first order kinetics after a lag-time of 400 h. The course of penetration through the hoof membrane is initially membrane-controlled and later becomes a matrix-controlled process because of the membrane's greater permeability. Chloramphenicol is dissolved in the lacquer up to a concentration of 31%. The relative release rates from these solution matrices are independent of the drug concentration but they decrease on changing to a suspension matrix. These results show that drug flux is independent of the character of the vehicle and that penetration of the drug is initially membrane-controlled and changes to being matrix-controlled as the drug content of the lacquer decreases.

  20. Evaluation of Laser-Assisted Trans-Nail Drug Delivery with Optical Coherence Tomography

    PubMed Central

    Tsai, Meng-Tsan; Tsai, Ting-Yen; Shen, Su-Chin; Ng, Chau Yee; Lee, Ya-Ju; Lee, Jiann-Der; Yang, Chih-Hsun

    2016-01-01

    The nail provides a functional protection to the fingertips and surrounding tissue from external injuries. The nail plate consists of three layers including dorsal, intermediate, and ventral layers. The dorsal layer consists of compact, hard keratins, limiting topical drug delivery through the nail. In this study, we investigate the application of fractional CO2 laser that produces arrays of microthermal ablation zones (MAZs) to facilitate drug delivery in the nails. We utilized optical coherence tomography (OCT) for real-time monitoring of the laser–skin tissue interaction, sparing the patient from an invasive surgical sampling procedure. The time-dependent OCT intensity variance was used to observe drug diffusion through an induced MAZ array. Subsequently, nails were treated with cream and liquid topical drugs to investigate the feasibility and diffusion efficacy of laser-assisted drug delivery. Our results show that fractional CO2 laser improves the effectiveness of topical drug delivery in the nail plate and that OCT could potentially be used for in vivo monitoring of the depth of laser penetration as well as real-time observations of drug delivery. PMID:27973451

  1. An innovative polysaccharide nanobased nail formulation for improvement of onychomycosis treatment.

    PubMed

    Flores, Fernanda C; Rosso, Roberta S; Cruz, Letícia; Beck, Ruy C R; Silva, Cristiane B

    2017-03-30

    Tioconazole-loaded nanocapsule suspensions and its coating with a cationic polymer were developed for nail drug delivery. The colloidal systems presented a nanometric size around 155nm for uncoated nanoparticles and 162nm for those with the cationic coating, with negative and positive zeta potential values, respectively. Both nanosuspensions showed drug content close to theoretical values (1mgmL(-1)), association efficiency close to 100% (HPLC) and were able to control tioconazol release. The developed formulations showed in vitro antifungal activity (agar diffusion method) against C. albicans. The cationic nanocapsules were considered bioadhesive, showed higher viscosity and were chosen to be incorporated into an ungueal formulation. Pullulan nanobased nail formulation showed adequate viscosity for nail application and drug content close to the theoretical values. It was equivalent to the commercial formulation Trosid(®) in preventing nail infection by T. rubrum in an in vitro onychomycosis model. The nanocapsule suspensions and Pullulan nanobased nail formulation showed lower irritant potential than the commercial formulation and than free drug in an in vitro evaluation. Pullulan nanobased nail formulation is promising for the treatment of onychomycosis.

  2. Investigation of different formulations for drug delivery through the nail plate.

    PubMed

    Vejnovic, Ivana; Simmler, Linda; Betz, Gabriele

    2010-02-15

    Topical therapies for nail diseases are limited by keratinized cells in the human nail plate. An optimal permeation enhancer would not only improve drug delivery through the nail plate, but would also open new possibilities for treating neighboring target sites if systemic circulation is reached. The aim of the present work was to identify permeation enhancers and to improve the understanding of physicochemical parameters that influence drug permeation. Caffeine served as the model drug, and formulations were prepared in water and 20% (v/v) ethanol/water solutions. Tested enhancers were urea, dimethyl sulfoxide (DMSO), methanol, N-acetyl-L-cysteine (NAC), docusate sodium salt (DSS), boric acid, and fungal proteins, such as hydrophobins. Permeability studies employed cadaver nails in modified Franz-type diffusion cells. The permeability coefficient of caffeine in ethanol/water was determined to be 1.56 E-08 cm/s and was improved to 2.27 E-08 cm/s by the addition of NAC. Formulations containing either methanol or DMSO showed the highest permeability coefficients in the range of 5-7.5 E-08 cm/s. Enhancers could be classified according to their permeation enhancement: methanol>class II hydrophobins>DMSO>followed by class I hydrophobins and urea. Ethanol at a concentration of 20% (v/v) in water did not influence swelling of nail samples. Hydrophobins are suggested to be efficient in drug delivery through the nail plate.

  3. Routine femoral head fluoroscopy to reduce complications in coronary catheterization

    PubMed Central

    Jacobi, Joshua A.; Schussler, Jeffrey M.

    2009-01-01

    We tested whether routine preprocedure fluoroscopy of the femoral head would improve sheath placement or reduce the incidence of groin complications. Patients were randomized to receive either fluoroscopy or “blind” sheath placement using palpation alone. The location of the femoral sheath was established by femoral artery angiography. Sheath placement in relation to the femoral head, arterial location, and complication rates were compared. Placement was considered “ideal” if the sheath was in the common femoral artery and in the top or middle third of the femoral head. A total of 256 patients were enrolled. There was no difference in average age, body mass index (BMI), or rate of anticoagulation between the groups. There was no major bleeding in either group. The overall risk of minor bleeding was not statistically different. The treatment group showed higher “ideal” placement relative to the femoral head. In patients who had a BMI ≥30 kg/m2, the difference between the groups was statistically significant (treatment 69% vs control 50%). In conclusion, routine femoral fluoroscopy prior to sheath placement in coronary angiography and angioplasty did not significantly alter bleeding or complication rates but did increase the likelihood of ideal placement, especially in obese patients. PMID:19169390

  4. Compressive femoral neuropathy: a rare complication of anticoagulation.

    PubMed

    Ong, H S

    2007-03-01

    The most common coagulation disorder associated with warfarin use is bleeding, but compressive femoral neuropathy is an unusual presentation. A 63-year-old man with compressive femoral neuropathy from an iliacus haematoma is reported. The diagnosis was confirmed on magnetic resonance imaging and treated conservatively with good clinical response and radiological evidence of resolution.

  5. Low-Velocity Nail-Gun Injuries to the Interventricular Septum: Report of Two Cases, One in a Child

    PubMed Central

    Michalsen, Kara L.; Iguidbashian, John P.; Kyser, James P.

    2015-01-01

    Nail-gun injury to the heart is rare. Nail-gun injury to the interventricular septum is rarer: we could find only 5 reported cases, and none involving a child. We report 2 additional cases, in which nails penetrated the interventricular septum without causing acute pericardial tamponade, heart block, or shunt across the septum. Transesophageal echocardiography provides a dynamic way to evaluate the patient preoperatively, intraoperatively, and postoperatively. In the cases reported here, both the adult with multiple interventricular nails and the child with a single nail underwent foreign-object removal via median sternotomy. The child needed cardiopulmonary bypass for removal of the nail. There were no short-term or long-term sequelae from these interventricular septal injuries. PMID:26413027

  6. Femoral head banking: NUH tissue bank experience.

    PubMed

    Nather, Aziz; David, Vikram

    2007-04-01

    National University Hospital Tissue Bank protocol follows guidelines recommended by the American Association of Tissue Banks and the European Association of Tissue Banks using donor selection criteria: medical history, clinical examination, chart review and laboratory tests for acquired immunodeficiency syndrome (AIDS), hepatitis B, hepatitis C, syphilis, and specimen for culture/sensitivity tests. For living donors, repeat testing is performed for AIDS and hepatitis C approximately 180 days after procurement. Femoral heads are procured using the "sterile double jar technique" and stored at -80 degrees C. Our first study of 273 consecutive potential donors undergoing hemiarthroplasty from 1989 to 1994 showed that a high percentage (42.5%) was unsuitable for use. A second study involving 175 potential donors was conducted from 1995 to 2003 after hepatitis C screening was introduced. The bacterial contamination rates in both studies (3.5% and 5.7%) are low. The incidence of other diseases also are low: hepatitis B, 2.3% and syphilis, 1.8% in the first study and hepatitis B, 5.7%; hepatitis C, 0.6%; and syphilis, 5.1% in the second cohort. No cases of AIDS were reported in either study. By 2003, femoral heads were transplanted in 205 patients with a low complication rate of 2.9%.

  7. Continuous blood gas monitoring in femoral arteries

    NASA Astrophysics Data System (ADS)

    Schlain, Les A.; Spar, Steven M.; Dellinger, Bart

    1995-05-01

    Continuous intra-arterial blood gas monitoring is a potentially valuable tool in the surgical and intensive care arenas. Patient oxygenation and acid base status can change rapidly and without warning. The ability to monitor pHa, PaCO2 and PaO2 in arterial blood will be a major medical advance for the anesthesiologist and intensivist. Intra-arterial blood gas sensors are typically placed in radial arteries. In certain patient populations accurate monitoring is not possible in radial arteries due to arterial environmental factors such as hypotension, vasoconstriction and atherosclerotic disease. These same factors can make radial cannulation difficult resulting in traumatic catheter insertion, thereby further compromising flow conditions. In situations where radial artery flow is expected to be compromised, selecting a large vessel for sensor placement is desirable. We report an initial feasibility study of our blood gas monitoring system using the femoral artery as the sensing site. Clinical results are presented as well as potential advantages and disadvantages associated with monitoring in the femoral artery.

  8. Distal femoral osteotomy using a novel deformity reduction device.

    PubMed

    Panichi, Enrico; Cappellari, Fulvio; Olimpo, Matteo; Piras, Lisa A; Radasch, Robert; Ferretti, Antonio; Peirone, Bruno

    2016-09-20

    Distal femoral osteotomy is a surgical procedure used to correct patellar luxation, secondary to a femoral deformity. A distal femoral osteotomy using the tibial plateau levelling osteotomy-jig to temporarily provide stability of the distal femoral osteotomy, maintaining limb alignment in the frontal and axial planes prior to internal plate fixation of the osteotomy, has been described. This report describes a novel jig named Deformity Reduction Device (DRD). This device was developed with the specific aim of increasing precision and predictability during corrective osteotomy execution in order to be consistent with the preoperative planning. The distal femoral osteotomy DRD-assisted procedure is described in detail, discussing the theoretical and practical principles of the application.

  9. Pigmented Onychomatricoma: A Rare Pigmented Nail Unit Tumor Presenting as Longitudinal Melanonychia That Has Potential for Misdiagnosis as Melanoma.

    PubMed

    Wynes, Jacob; Wanat, Karolyn A; Huen, Auris; Mlodzienski, Alan J; Rubin, Adam I

    2015-01-01

    Pigmented onychomatricoma is a rare nail unit tumor that can clinically mimic nail unit melanoma. We report the case of a 63-year-old male with new-onset longitudinal melanonychia involving his right second toe. An excisional biopsy was performed and demonstrated pigmented onychomatricoma. We present this case to alert clinicians of this rare nail unit tumor and the importance of clinicopathologic correlation to avoid misdiagnosis.

  10. Distal femoral physeal growth arrest secondary to a cemented proximal femoral endoprosthetic replacement.

    PubMed

    Gaston, C L; Tillman, R M; Grimer, R J

    2011-05-01

    We report a case of spontaneous physeal growth arrest of the distal femur in a nine-year-old child with Ewing's sarcoma of the proximal femur treated with chemotherapy and endoprosthetic replacement. Owing to the extent of disuse osteoporosis at the time of surgery, the entire intramedullary canal up to the distal femoral physis was filled with cement. Three years later, the femur remained at its pre-operative length of 19 cm. Pre-operative calculations of further growth failed to account for the growth arrest, and the initial expandable growing prosthesis inserted has been revised to a longer one in order to address the leg-length discrepancy. To our knowledge, this is the only reported case of distal femoral physeal growth arrest following cemented endoprosthetic replacement of the proximal femur.

  11. Use of Protective Gloves in Nail Salons in Manhattan, New York City

    PubMed Central

    2016-01-01

    Objectives: Nail salon owners in New York City (NYC) are required to provide their workers with gloves and it is their responsibility to maintain healthy, safe working spaces for their employees. The purpose of this study was to determine the frequency with which nail salon workers wear protective gloves. Methods: A Freedom of Information Law request was submitted to New York Department of State’s Division of Licensing Services for a full list of nail salons in Manhattan, NYC. A sample population of 800 nail salons was identified and a simple random sample (without replacement) of 30% (n=240) was selected using a random number generator. Researchers visited each nail salon from October to December of 2015, posing as a potential customer to determine if nail salon workers were wearing gloves. Results: Among the 169 salons in which one or more workers was observed providing services, a total of 562 workers were observed. For 149 salons, in which one or more worker was observed providing services, none of the workers were wearing gloves. In contrast, in six of the salons observed, in which one or more workers was providing services, all of the workers (1 in 2 sites, 2 in 1 site, 3 in 2 sites, and 4 in 1 site) were wearing gloves. Almost three-quarters of the total number of workers observed (n=415, 73.8%) were not wearing gloves. Conclusions: The findings of this study indicate that, despite recent media attention and legislation, the majority of nail salon workers we observed were not wearing protective gloves when providing services. PMID:27499167

  12. Nail involvement in adult patients with plaque-type psoriasis: prevalence and clinical features*

    PubMed Central

    Schons, Karen Regina Rosso; Beber, André Avelino Costa; Beck, Maristela de Oliveira; Monticielo, Odirlei André

    2015-01-01

    BACKGROUND: Psoriasis is a disease of worldwide distribution with a prevalence of 1 to 3%. Nail psoriasis is estimated in 50% of patients with psoriasis, and in the presence of joint involvement, it can reach 80%. OBJECTIVE: To study the nail changes - and their clinical implications - presented by patients with psoriasis vulgaris under surveillance in a university hospital from the south of Brazil. METHODS: his cross-sectional study evaluated 65 adult patients from January 2012 to March 2013. Cutaneous severity was assessed according to the Psoriasis Area and Severity Index (PASI). The Nail Psoriasis Severity Index (NAPSI) was used to evaluate patient's nails. The diagnosis of psoriatic arthritis was established according to the Classification Criteria for Psoriatic Arthritis (CASPAR). RESULTS: The prevalence of NP was 46.1%. These patients had a median [interquartilic range (IQR)] NAPSI of 1 (0-15). A total of 63.3% of patients reported aesthetic discomfort or functional impairment related to their nails. Onycholysis was the most common feature (80%). When compared with patients without nail involvement, patients with NP had lower mean age at psoriasis onset [21 (18-41) vs. 43 (30-56) years, p=0,001]; longer disease duration [15.5 (10-24) vs. 6 (2-12) years, p=0.001]; higher PASI [9.2 (5-17) vs. 3.7 (2-10), p=0.044], higher frequency of psoriatic arthritis (43.3 vs. 3.7, p = 0.002) and more often reported family history of psoriasis (40% vs. 7.4%, p = 0.011). CONCLUSION: Onycholysis was the most frequent finding and most patients feel uncomfortable with the psoriatic nail changes that they experience. PMID:26131859

  13. Drug delivery to the nail: therapeutic options and challenges for onychomycosis.

    PubMed

    Barot, Bhavesh S; Parejiya, Punit B; Patel, Hetal K; Mehta, Dharmik M; Shelat, Pragna K

    2014-01-01

    Onychomycosis is one of the most common nail disorders. It affects 10-30% of the world population and is caused by dermatophytes, non-dermatophytes, molds, and yeasts. Present treatment methods of onychomycosis include oral therapy, topical therapy, and a combination of both; they have mild-to-moderate efficacy, with a relapse and reinfection rate of 20-25%. For oral therapy, newer antifungal compounds (azole class and allylamine class) are being investigated to increase efficacy and minimize side effects. Oral therapy with antifungal agents have severe side effects, with lesser bioavailability and longer duration of treatment. By contrast, topical therapy of onychomycosis is associated with greater patient compliance and fewer systemic side effects and drug interactions. Current topical treatment options of onychomycosis are nail lacquers, ointments, lotions, solutions, and gels, but these formulations have been unsuccessful due to poor penetration and distribution of drugs at the infected site. Therefore, novel therapeutic options are constantly being researched to improve the efficacy of onychomycosis treatment by enhancing the permeation of the drug across the nail to reach the infected site. Various physical and chemical enhancement methods have been studied to increase the permeation of drugs across the nail plate to the nail bed. Device-based therapeutic options have also been investigated to increase the antifungal drug concentration and its effects in the onychomycotic nail. Randomized clinical trials of these novel therapies have demonstrated better efficacy. The present review discusses the anatomy of the human nail, onychomycosis and its types, onycholysis, and conventional and novel therapies. We also review patents granted as well as design challenges facing optimal drug formulation for onychomycosis treatment.

  14. Intestinal Obstruction due to Bilateral Strangulated Femoral Hernias

    PubMed Central

    Nikolopoulos, Ioannis; Oderuth, Eshan; Ntakomyti, Eleni; Kald, Bengt

    2014-01-01

    Introduction. Femoral hernias are at high risk of strangulation due to the narrow femoral canal and femoral ring. This can lead to symptoms of obstruction or strangulation requiring emergency surgery and possible bowel resection. To our knowledge, there is only one previous published report of bilateral strangulated femoral hernia. We present our case of this phenomenon. Case Report. An 86-year-old woman presented with symptoms of small bowel obstruction. Examination revealed two tender lumps in the area of the femoral triangle. CT scan revealed bilateral femoral hernias. Both hernias were repaired and a small bowel resection on the right side was performed with side to side anastomosis. She made an uneventful recovery. Conclusion. Bilateral femoral hernias are a rare occurrence with only one reported case of bilateral strangulation. Our case highlights the importance of meticulous history taking and clinical examination as any delay in diagnosis will increase the risk of mortality and morbidity for the patient. Hernias should always be considered as a cause if one presents with symptoms of abdominal pain or obstruction. PMID:25057426

  15. Painful Spastic Hip Dislocation: Proximal Femoral Resection

    PubMed Central

    Albiñana, Javier; Gonzalez-Moran, Gaspar

    2002-01-01

    The dislocated hip in a non-ambulatory child with spastic paresis tends to be a painful interference to sleep, sitting upright, and perineal care. Proximal femoral resection-interposition arthroplasty is one method of treatment for this condition. We reviewed eight hips, two bilateral cases, with a mean follow-up of 30 months. Clinical improvement was observed in all except one case, with respect to pain relief and sitting tolerance. Some proximal migration was observed in three cases, despite routine post-operative skeletal traction in all cases and careful soft tissue interposition. One case showed significant heterotopic ossification which restricted prolonged sitting. This patient needed some occasional medication for pain. PMID:12180614

  16. Cortical bone allografting in femoral head necrosis.

    PubMed

    Delloye, C; Cornu, O

    1999-01-01

    Ten femoral heads (six patients) with avascular necrosis were operated on using a fibular allograft. The procedure included core decompression followed by insertion of a cortical bone graft in order to relieve mechanical stresses from the overlying subchondral bone. The presence of the supporting graft should avoid an expected collapse or prevent its worsening if already present. A freeze-dried and processed cortical bone allograft was preferred to an autograft. Weightbearing was normally and fully resumed at the second postoperative month. There were three failures within the first year, four satisfactory results, in which the hip was replaced after 4 years while there are still 3 hips that have been preserved from arthroplasty in young patients after 5 years. The technique is easy and able to substantially delay an arthroplasty in an active patient.

  17. Our Experience with Patello femoral joint replacement

    PubMed Central

    Ramos, Pablo; Arteaga, Gonzalo; Vargas, Medardo; Naranjo, Juan

    2017-01-01

    Background: Ten to fifteen percent of knee arthritis is reported to be isolated patellofemoral arthritis. Total knee arthroplasty is not recommended for isolated patella femoral arthritis particularly in young patients. We present the retrospective review our series in 7 years. Objectives: The aim of this presentation is to describe our experience in the management of patellofemoral osteoarthritis with the use of the partial patellofemoral arthroplasty, as well as to delineate the pitfalls and causes of revision in our initial series of 153 cases. Methods: between 2009 and 2016, our group performed 157 patellofemoral arthroplasties (PFA) 74% being in women, and 26% in men, the mean age for women was 58 yrs. And 38 yrs. for men, our initial 13 cases were managed with the Avon prosthesis (Stryker Corporation Kalamazoo, Michigan), and then we switched to the Vanguard PF (Zimmer-Biomet Warsaw In), both systems are an On-Lay design that is more flexible for addressing dysplastic trochleas that are more common in our population. Results: We performed a Knee Osteoarthritis Outcome Score (KOOS) for the assessment of the success of the procedure and obtained 87% of patients with excellent results (95 to 100), 10% with fair results (70 to 90) and 3% with poor outcomes (50), we performed a total of 3 revisions due to pain or progress to global arthritis. Conclusion: The PFA is a successful, safe and reproducible surgery that can be used in the group of patients that have isolated patellofemoral osteoarthritis. It requires a thorough knowledge of the patello femoral joint biomechanics, and physiopathology.

  18. Trichophyton onychocola sp. nov. isolated from human nail.

    PubMed

    Hubka, Vit; Cmokova, Adela; Skorepova, Magdalena; Mikula, Peter; Kolarik, Miroslav

    2014-04-01

    A previously undescribed Trichophyton species was isolated from the nail of a 33-year-old man with a history of probable distal lateral subungual onychomycosis (without confirmation by mycological examination). The infection occurred for the first time five years earlier (in 2006) and affected the right great toenail, with complete clinical remission after treatment with ciclopirox olamine. This undescribed species was isolated during probable relapse in 2011, but its etiological significance was not confirmed, that is, direct microscopy was negative and additional clinical samples were not collected. The species is probably geophilic based on phylogenetic analysis (internal transcribed spacer [ITS] rDNA) and is most closely related to the anamorphic T. thuringiense, homothallic Arthroderma ciferrii (anamorph T. georgiae), and heterothallic A. melis. The new species is characterized by yellowish colonies, red reverse on several media, positive urease test, negative hair-perforation test, absence of growth at 34°C, absence of macroconidia, formation of one-celled clavate microconidia, and spiral hyphae. The species grows well on sterilized human hairs placed on agar medium without any additional nutrients and forms gymnothecium-like structures covered by peridial hyphae. The combination of unique micro- and macromorphological features and physiological and sequence data from four unlinked loci (ITS, benA, RPB2, and act1 gene) justified the proposal of a new species T. onychocola sp. nov.

  19. Radiation-free drill guidance in interlocking of intramedullary nails.

    PubMed

    Diotte, Benoit; Fallavollita, Pascal; Wang, Lejing; Weidert, Simon; Thaller, Peter-Helmut; Euler, Ekkehard; Navab, Nassir

    2012-01-01

    Intramedullary nailing is a technically demanding procedure which involves an excessive amount of x-ray acquisitions; one study lists as many as 48 to successfully complete the procedure. In this work, a novel low cost radiation-free drilling guide is designed to assist surgeons in completing the distal locking procedure without any x-ray acquisitions. Using an augmented reality fluoroscope that coregisters optical and x-ray images, we exploit solely the optical images to detect the drilling guide in order to estimate the tip position in real-time in x-ray. We tested over 200 random drill guide poses showing a mean tip-estimation error of 1.72 +/- 0.7mm which is significantly robust and accurate for the interlocking. In a preclinical study on dry bone phantom, three expert surgeons successfully completed the interlocking 56 out of 60 trials with no x-ray acquisition for guidance and an average time of 2 min.

  20. Bilateral Femoral Neck Stress Fracture in Child: A Case Report

    PubMed Central

    Lee, Gun-Woo; Yoon, Taek-Rim; Eshnazarovich, Eshnazarov Kamolhuja

    2016-01-01

    A femoral neck stress fracture in child is rare, particularly in bilateral case. It is easy to miss initially or may be misdiagnosed. The authors experienced a case of bilateral femoral neck stress fracture in a 10-year-old boy with bilateral hip. The patient was successfully healed by conservative treatment. We report this rare case with a review of the literature. A femoral neck stress fracture should be included in the differential diagnosis in children who present with sustained hip or groin pain. PMID:27777920

  1. Iliopsoas tendonitis caused by overhang of a collared femoral prosthesis.

    PubMed

    Brew, Christopher J; Stockley, Ian; Grainger, Andrew J; Stone, Martin H

    2011-04-01

    Pain after total hip arthroplasty can be due to a variety of causes, one of the less common being iliopsoas tendonitis. We report an unusual case of iliopsoas tendonitis caused by overhang of the femoral calcar by a collared femoral prosthesis resulting in impingement on the iliopsoas tendon. An ultrasound-guided corticosteroid and local anesthetic diagnostic injection to the site of impingement confirmed the diagnosis with temporary symptom relief. Revision of the femoral stem to a collarless prosthesis resulted in immediate and complete resolution of symptoms.

  2. Bilateral impacted femoral neck fracture in a renal disease patient.

    PubMed

    Devkota, Pramod; Ahmad, Shiraz

    2013-09-01

    Spontaneous bilateral femoral neck facture in a renal disease patient is not common. We report a case of 47-year-old female patient with chronic renal failure and on regular hemodialysis for the past 5 years who sustained bilateral impacted femoral neck fracture without history of trauma and injury and refused any surgical intervention. The patient was mobilised on wheel chair one year after the fractures. The cause of the fracture and the literature review of the bilateral femoral neck fracture in renal disease are discussed.

  3. Neurapraxia of the femoral nerve in a modern dancer.

    PubMed

    Sammarco, G J; Stephens, M M

    1991-01-01

    We have presented a case of an acute onset femoral nerve neurapraxia in a pure modern dancer. Repeated mild stretching of the femoral nerve during an established dance routine over a period of several months is implicated as the etiology. The thigh muscles quickly weakened, but regained strength within 3 months. Electromyographic evidence of specific femoral nerve injury initially was negative, but was evident 6 weeks following injury. Overuse syndrome in dancers can cause rapid loss of strength. Other conditions such as herniated intervertebral disc, acute hemorrhage, trauma, iliopsoas rupture, and acute stretching must be ruled out. Complete recovery was the natural outcome.

  4. A meta-analysis of reamed versus unreamed intramedullary nailing for the treatment of closed tibial fractures.

    PubMed

    Xia, Liheng; Zhou, Jian; Zhang, Yongtao; Mei, Gang; Jin, Dan

    2014-04-01

    Controversy exists regarding the clinical outcomes of reamed vs unreamed intramedullary nailing in the treatment of closed tibial fractures. This study assessed the effects of reamed vs unreamed intramedullary nailing for closed tibial fractures. The authors searched PubMed, EMBASE, BIOSIS, and the Cochrane Controlled Trials Register for randomized and quasi-randomized controlled clinical trials from January 1980 to June 2012 comparing reamed with unreamed intramedullary nailing for closed tibial fracture in adults. Primary outcomes were nonunion, delayed union, malunion, secondary procedure, failure of implants, compartment syndrome, infection, and knee pain. Eight randomized and 1 quasi-randomized clinical trials (1229 fractures) were included. No statistically significant differences were found between reamed and unreamed nailing groups in delayed union (P=.20), malunion (P=.28), infection (P=.36), compartment syndrome (P=.36), and knee pain (P=.93). The unreamed group had a higher rate of fracture nonunion than the reamed group (P=.02). The subgroup analysis of implant failures (broken screws vs broken nails) indicated that reamed nailing significantly reduced the risk of screw breakage (P<.001); however, there was no significant difference between reamed and unreamed intramedullary nailing in nail breakage (P=.94). The subgroup analysis of a secondary procedure showed that the reamed intramedullary nailing resulted in significantly lower risks of implant exchange (P=.01) and dynamization (P=.04); however, there was no significant difference in bone grafting rate (P=.73). Evidence comparing reamed with unreamed intramedullary nailing for closed tibial fractures indicates that reamed intramedullary nailing may lead to significantly lower risks of nonunion, screw failure, implant exchange, and dynamization without increasing operative complications.

  5. A Clinical Trial to Investigate the Effect of Cynatine HNS on Hair and Nail Parameters

    PubMed Central

    Veghte, Robert H.

    2014-01-01

    Objective. A new, novel product, Cynatine HNS, was evaluated for its effects as a supplement for improving various aspects of hair and nails in a randomized, double-blind, placebo-controlled clinical trial. Methods. A total of 50 females were included and randomized into two groups. The active group (n = 25) received 2 capsules containing Cynatine HNS, comprised of Cynatine brand keratin (500 mg) plus vitamins and minerals, per day, and the placebo group (n = 25) received 2 identical capsules of maltodextrin per day for 90 days. End points for hair loss, hair growth, hair strength, amino acid composition, and hair luster were measured. End points were also measured for nail strength and the appearance of nails. Results. The results show that subjects taking Cynatine HNS showed statistically significant improvements in their hair and nails when compared to placebo. Conclusion. Cynatine HNS is an effective supplement for improving hair and nails in 90 days or less. EudraCT number is 2014-002645-22. PMID:25386609

  6. Ingenious method of external fixator use to maintain alignment for nailing a proximal tibial shaft fracture.

    PubMed

    Behera, Prateek; Aggarwal, Sameer; Kumar, Vishal; Kumar Meena, Umesh; Saibaba, Balaji

    2015-09-01

    Fractures of the tibia are one of the most commonly seen orthopedic injuries. Most of them result from a high velocity trauma. While intramedullary nailing of tibial diaphyseal fractures is considered as the golden standard form of treatment for such cases, many metaphyseal and metaphyseal-diaphyseal junction fractures can also be managed by nailing. Maintenance of alignment of such fractures during surgical procedure is often challenging as the pull of patellar tendon tends to extend the proximal fragment as soon as one flexes the knee for the surgical procedure. Numerous technical modifications have been described in the literature for successfully nailing such fractures including semi extended nailing, use of medial plates and external fixators among others. In this study, it was aimed to report two cases in which we used our ingenious method of applying external fixator for maintaining alignment of the fracture and aiding in the entire process of closed intramedullary nailing of metaphyseal tibial fractures by the conventional method. We were able to get good alignment during and after the closed surgery as observed on post-operative radiographs and believe that further evaluation of this technique may be of help to surgeons who want to avoid other techniques.

  7. Antegrade Unreamed Locked Intramedullary Nailing in Open Fractures of Shaft of Humerus

    PubMed Central

    Singh, Jasbir; Lal, Mukand; Chandel, Desh Raj

    2016-01-01

    Introduction Open fractures of shaft of humerus have been treated conservatively as well as operatively. Plate osteosynthesis has been considered as the gold standard treatment. Intramedullary nailing also has same success rate in closed fractures. The results of 30 open fractures of shaft humerus fixed with locked unreamed antegrade intramedullary nailing were evaluated. Aim The purpose of the study was to evaluate the role of locked intramedullary nailing in open fractures of shaft humerus in terms of bone union, secondary procedure required, complication, shoulder dysfunction and infection. Materials and Methods Of consecutive 365 humeral shaft fractures, 63 fractures were open. Thirty-two patients were operated with plate osteosynthesis, while 31 patients who were treated with locked unreamed intramedullary nails fulfilling the inclusion criteria entered the study. Results Twenty eight of thirty patients united in mean duration of 10.5 weeks. There were two non-unions both of them united with bone grafting and plate osteosynthesis. Seven patients had superficial infection which healed with antibiotic course, while two patients had deep infection, which healed with repeat debridement. Eleven patients had preoperative radial nerve palsy, nine of which healed completely in average of six months. Twenty eight patients had excellent functional outcome at final follow-up while two patients had good outcome. Conclusion Antegrade nailing is associated with good union rates and low infection rates and is a good option in open fractures and in polytrauma patients. PMID:27790533

  8. Overcoming the nail barrier: A systematic investigation of ungual chemical penetration enhancement.

    PubMed

    Brown, M B; Khengar, R H; Turner, R B; Forbes, B; Traynor, M J; Evans, C R G; Jones, S A

    2009-03-31

    This study investigated the in vitro nail permeability of penetrants of varying lipophilicity-caffeine (CF, logP -0.07), methylparaben (MP, logP 1.96) and terbinafine (TBF, logP 3.3) and the effect of 2 novel penetration enhancers (PEs), thioglycolic acid (TA) and urea hydrogen peroxide (urea H(2)O(2)) on their permeation. Studies were conducted using full thickness human nail clippings and ChubTur((R)) diffusion cells and penetrants were applied as saturated solutions. The rank order of steady-state penetrant flux through nails without PE application (MP>CF>TBF) suggested a greater sensitivity to penetrant molecular weight rather than logP. TA increased the flux of CF and MP approximately 4- and approximately 2-fold, respectively, whilst urea H(2)O(2) proved ineffective at enhancing permeability. The sequential application of TA followed by urea H(2)O(2) increased TBF and CF flux ( approximately 19- and approximately 4-fold, respectively) but reversing the application order of the PEs was only mildly effective at increasing just MP flux ( approximately 2-fold). Both nail PEs are likely to function via disruption of keratin disulphide bonds and the associated formation of pores that provide more 'open' drug transport channels. Effects of the PEs were penetrant specific, but the use of a reducing agent (TA) followed by an oxidising agent (urea H(2)O(2)) dramatically improved human nail penetration.

  9. Investigation of nail permeation enhancement by chemical modification using water as a probe.

    PubMed

    Malhotra, Gouri G; Zatz, Joel L

    2002-02-01

    Our objective was to screen molecules that could interact with keratin in the human nail and thereby improve the topical penetration of actives into and through the nail plate. We used specialized Franz-type diffusion cells for our permeation experiments and water as a marker molecule. Aqueous/hydroalcoholic gels containing the enhancers were spiked with tritiated water and compared with a control (without enhancer). We computed the normalized water flux (defined as a product of flux and nail thickness) for each gel. We defined an enhancement factor for water as the ratio of the normalized water flux from a gel containing enhancer to that of the control. Our results indicate that the chemical structure of the modifier is most important in determining its ability to enhance penetration. The best enhancement effect was obtained using N-(2-mercaptopropionyl) glycine, a mercaptan derivative of an amino acid, in combination with urea. The concentration of each chemical modifier was linearly related to normalized water flux and mercaptan levels were more important that urea levels in penetration enhancement. Barrier integrity of nails was compromised after treatment with effective chemical modifiers. Thus, we have developed a suitable technique to screen nail penetration enhancers using water as a probe.

  10. Effects of Ionic Strength on Passive and Iontophoretic Transport of Cationic Permeant Across Human Nail

    PubMed Central

    Smith, Kelly A.; Hao, Jinsong; Li, S. Kevin

    2010-01-01

    Purpose Transport across the human nail under hydration can be modeled as hindered transport across aqueous pore pathways. As such, nail permselectivity to charged species can be manipulated by changing the ionic strength of the system in transungual delivery to treat nail diseases. The present study investigated the effects of ionic strength upon transungual passive and iontophoretic transport. Methods Transungual passive and anodal iontophoretic transport experiments of tetraethylammonium ion (TEA) were conducted under symmetric conditions in which the donor and receiver had the same ionic strength in vitro. Experiments under asymmetric conditions were performed to mimic the in vivo conditions. Prior to the transport studies, TEA uptake studies were performed to assess the partitioning of TEA into the nail. Results Permselectivity towards TEA was inversely related to ionic strength in both passive and iontophoretic transport. The permeability and transference number of TEA were higher at lower ionic strengths under the symmetric conditions due to increased partitioning of TEA into the nail. Transference numbers were smaller under the asymmetric conditions compared with their symmetric counterparts. Conclusions The results demonstrate significant ionic strength effects upon the partitioning and transport of a cationic permeant in transungual transport, which may be instrumental in the development of transungual delivery systems. PMID:19267187

  11. Allergic contact dermatitis from sculptured acrylic nails: special presentation with an airborne pattern.

    PubMed

    Maio, Paula; Carvalho, Rodrigo; Amaro, Cristina; Santos, Raquel; Cardoso, Jorge

    2012-01-02

    Methylmethacrylate was first reported in 1941 as a cause of contact dermatitis. Since then, occupational contact allergies to acrylates in dentistry, orthopedic surgery, printing industry and industry have been reported, but few reports are found in the literature as a consequence of the contact with sculptured artificial acrylic nails which are increasingly popular. We describe here 3 patients with contact allergy to acrylates in artificial sculptured nails. Patch tests were performed with the Portuguese baseline series of contact allergens and an extended series of acrylates were applied. In particular, we tested three female patients with allergic contact dermatitis from sculptured acrylic nails. Two of these patients were both customers and also technical nail beauticians. Two patients developed periungual eczema; one presented only with face and eyelid dermatitis had no other lesions. The tests showed positive reaction to 2-hydroxyethylmethacrylate (2-HEMA) and 2-hydroxypropylmethacrylate (2-HPMA) in all the three patients. Our cases demonstrate the variety of clinical presentations of allergic contact dermatitis from acrylic sculptured nails. They show the need to warn patients of persistent and sometimes permanent side effects of these products. They also emphasize the importance of cosmetic ingredient labeling.

  12. New Technique for Tibiotalar Arthrodesis Using a New Intramedullary Nail Device: A Cadaveric Study

    PubMed Central

    Eisenstein, Emmanuel D.; Rodriguez, Mario

    2016-01-01

    Introduction. Ankle arthrodesis is performed in a variety of methods. We propose a new technique for tibiotalar arthrodesis using a newly designed intramedullary nail. Methods. We proposed development of an intramedullary device for ankle arthrodesis which spared the subtalar joint using a sinus tarsi approach. Standard saw bones models and computer assisted modeling and stress analysis were used to develop different nail design geometries and determine the feasibility of insertion. After the final design was constructed, the device was tested on three cadaveric specimens. Results. Four basic nail geometries were developed. The optimal design was composed of two relatively straight segments, each with a different radius of curvature for their respective tibial and talar component. We successfully implemented this design into three cadaveric specimens. Conclusion. Our newly designed tibiotalar nail provides a new technique for isolated tibiotalar fusion. It utilizes the advantages of a tibiotalar calcaneal nail and spares the subtalar joint. This design serves as the foundation for future research to include compression options across the tibiotalar joint and eventual transition to clinical practice. PMID:27818800

  13. Role of HLA-DR Alleles to Increase Genetic Susceptibility to Onychomycosis in Nail Psoriasis

    PubMed Central

    Carrillo-Meléndrez, Hilda; Ortega-Hernández, Esteban; Granados, Julio; Arroyo, Sara; Barquera, Rodrigo; Arenas, Roberto

    2016-01-01

    Background Patients with nail psoriasis have an increased risk of onychomycosis. Previous studies suggest it may be due to structural changes of the nails. However, a genetic predisposition seems to be also at play. Objective To determine a genetic susceptibility for onychomycosis in nails with changes of psoriasis. Methods This is a prospective case-control study of patients with suggestive changes of nail psoriasis with onychomycosis (cases) and without onychomycosis (controls) confirmed by mycological tests. HLA typing was performed in all of them by sequence-specific primers. Results Twenty-five patients and 20 controls with a mean age of 50 years (range 37-72 years) were studied. HLA-DRB1*08 was found in 12 cases (48%) and only 3 controls (15%) [p < 0.033, odds ratio (OR) = 3.8, 95% confidence interval (CI): 0.9-19]. HLA-DR1 was found in 9 cases (36%) and only 1 control (5%) (p < 0.023, OR = 8.5, 95% CI: 1-188). Conclusion HLA-DR*08 and HLA-DR*01 probably increase the susceptibility to fungal infection in psoriasis-affected nails, but larger studies are required to confirm this observation. PMID:27843918

  14. Giant cell tumor of the femoral neck: case report.

    PubMed

    Silva, Paulo; Amaral, Rogério Andrade do; Oliveira, Leandro Alves de; Moraes, Frederico Barra de; Chaibe, Eduardo Damasceno

    2016-01-01

    The authors present the case of a patient with a giant cell tumor of the left femoral neck, with adjacent progressive invasion of bone tissue. Initial treatment was done with local curettage and autologous bone graft from fibula, electrocauterization and filling with methyl methacrylate. A local tumoral relapse was present after one year; therefore a new surgical procedure was necessary, with proximal femoral wide resection and unconventional endoprosthesis fixation. The article discusses the clinical aspects and surgical treatment. This report aimed to demonstrate the necessity to perform wide resection for giant cell tumor of the femoral neck, prioritizing total resection of the tumor and its local extension, preserving limb integrity and demonstrating the complete failure of preserving surgery in cases of femoral neck involvement.

  15. Acute femoral neuropathy secondary to an iliacus muscle hematoma.

    PubMed

    Seijo-Martínez, M; Castro del Río, M; Fontoira, E; Fontoira, M

    2003-05-15

    We present a patient with a spontaneous iliacus muscle hematoma, appearing immediately after a minor physical maneuver, presenting with pain and femoral neuropathy initially evidenced by massive quadriceps muscle fasciculations. A magnetic resonance imaging (MRI) study of the pelvic area confirmed the diagnosis, showing a hematoma secondary to a partial muscle tear. The patient was managed conservatively, and the continuous muscle activity ceased in 3 days, with progressive improvement of the pain and weakness. The recovery was complete. Femoral neuropathy is uncommon and usually due to compression from psoas muscle mass lesions of diverse nature, including hematomas. Usually subacute, femoral neuropathy may present acutely in cases of large or strategically placed compressive femoral nerve lesions, and may require surgical evacuation. The case presented herein is remarkable since the muscle hematoma appeared after a nonviolent maneuver, fasciculations were present at onset, and conservative management was sufficient for a full recovery.

  16. Mechanisms of stem subsidence in femoral impaction allografting.

    PubMed

    Albert, Carolyne; Frei, Hanspeter; Duncan, Clive; Fernlund, Goran

    2011-01-01

    Failure of the femoral component of total hip arthroplasty is often accompanied by bone loss that can pose a significant challenge to the orthopaedic surgeon. Femoral impaction allografting has attractive potential for restoring bone stock in deficient femurs. However, there have been reports of problematic postoperative stem subsidence with this procedure. Subsidence is highly variable among patients, and there is disagreement over the mechanisms that cause it. This article reviews the various mechanisms that can contribute to subsidence in femoral impaction allografting. Variables such as graft density, cement penetration profile, use of synthetic graft substitutes, or other graft additives are discussed, as well as their potential impact on subsidence. Finally, recommendations are made for future studies aiming to reduce the risk of excessive subsidence in femoral impaction allografting.

  17. Abnormalities of proximal femoral growth after severe Perthes' disease.

    PubMed

    Sponseller, P D; Desai, S S; Millis, M B

    1989-08-01

    We studied the pattern of proximal femoral growth after severe Perthes' disease (Catterall grade III or IV) by retrospective analysis of serial radiographs in 52 hips (46 patients). Our aim was to determine the relationship between proximal femoral growth abnormalities and metaphyseal cysts, epiphyseal extrusion, physeal narrowing, and extensive epiphyseal necrosis. The average follow-up after treatment was 9.8 years (range 4 to 16 years), and 37 of the hips were followed to skeletal maturity. Slowing of proximal femoral growth was common: symmetrical abnormality was seen in 26 hips and asymmetrical abnormality in nine. However, definite premature closure of the proximal femoral physis was seen in only three hips. Abnormality seemed to be due to altered growth velocity rather than to bar formation in most cases. Metaphyseal cysts, epiphyseal extrusion and physeal narrowing during the active stage of the disease, alone or in combination, were found to be neither sensitive nor specific predictors of the subsequent growth pattern.

  18. 77 FR 46686 - Steel Nails From the People's Republic of China: Notice of Court Decision Not in Harmony With...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-06

    ... \\1\\ as including steel nails found within Target Corporation's toolkits from the People's Republic of... contained within toolkits. See Final Scope Ruling: Certain Steel Nails from the People's Republic of China... Department issued a final scope ruling on toolkits from the PRC ] imported by Target Corporation. See...

  19. Identifying and understanding the role of key stakeholders in promoting worker health and safety in nail salons.

    PubMed

    Quach, Thu; Tsoh, Janice Y; Le, Gem; Le, Minhthu; Pham, Alene; Fu, Lisa; Luu, Vinh; Ngo, Kim; Reynolds, Peggy

    2015-05-01

    The nail salon sector is booming, predominantly with Vietnamese immigrant workers who regularly handle nail care products containing harmful chemicals. Based on lessons learned from an ongoing randomized controlled trial, occupational interventions need to incorporate inputs from different stakeholders, including salon owners, workers, and customers as well as governmental regulatory agencies.

  20. 75 FR 38080 - Certain Steel Nails From the People's Republic of China: Rescission of New Shipper Review

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-01

    ... International Trade Administration Certain Steel Nails From the People's Republic of China: Rescission of New.... DATES: Effective Date: July 1, 2010. SUMMARY: In response to a request from Maanshan Leader Metal... antidumping duty order on certain steel nails from the People's Republic of China (``PRC'') covering...

  1. 75 FR 43149 - Certain Steel Nails from the Peoples' Republic of China: Notice of Partial Rescission of the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-23

    ... International Trade Administration Certain Steel Nails from the Peoples' Republic of China: Notice of Partial... review on the antidumping order on certain steel nails from the People's Republic of China (``PRC'') for..., the Department ] initiated the first antidumping duty administrative review on certain steel...

  2. Speckled variance optical coherence tomography for the assessment of nail involvement in acrodermatitis continua of Hallopeau: A case study.

    PubMed

    Conti, Andrea; Ciardo, Silvana; Mandel, Victor Desmond; Bigi, Laura; Pellacani, Giovanni

    2016-09-01

    Noninvasive techniques for nail imaging would be useful for confirming diagnosis and monitoring treatment response at the microscopic level in patients with nail psoriasis. However, the use of ultrasound and high-resolution magnetic resonance imaging in nail evaluation is limited. Optical coherence tomography (OCT) produces high-resolution images of transversal tissue sections and represents an optimal approach to the study of the nail. This study used a multibeam OCT instrument to produce speckled variance OCT (SV-OCT) blood-flow images, which were used to measure the degree of change over successive scans. Nail changes, inflammation and response to therapy were evaluated in a 75-year-old female patient with psoriasis who had severe acrodermatitis continua of Hallopeau of the hands, treated for 4 weeks with 40 mg adalimumab (administered subcutaneously every other week) and 25 mg prednisone (administered orally, daily). SV-OCT provided a detailed assessment of the nail structures in relation to inflammation of psoriatic tissues. Restoration of the normal anatomy of the nail apparatus was apparent following adalimumab treatment; SV-OCT evaluation correlated with clinical appearance. SV-OCT may have a diagnostic role and provide an objective tool to assess clinical and subclinical inflammation in nail psoriasis.

  3. Sufficient penetration of peracetic acid into drilled human femoral heads.

    PubMed

    Brosig, H; Jacker, H-J; Borchert, H-H; Kalus, U; Dörner, T; von Versen, R; Pruss, A

    2005-01-01

    Chemical sterilisation methods for musculoskeletal transplants have the problem of penetration into all tissue strata. The present study examined if a peracetic acid/ethanol solution penetrated to a sufficient extent into specifically prepared femoral heads. To this effect, 10 femoral heads have been provided with drillings (diameter 2 mm, depth 10 mm) at a distance of 15 mm (series B) and placed in a diffusion chamber with sterilisation solution. From an additional central drilling at the femoral neck junction, the sample drawing was made after 30 min each over a period of 4 h for the iodometric determination of peracetic acid (PAA) concentration. Ten femoral heads, which did contain only the central drilling, served as controls (series A). In 9 of the examined femoral heads of series A the defined minimum concentration of PAA of 0.2% (inactivation of bacteria, spores, fungi) has been clearly exceeded over the complete period of measurement. About 0.8% PAA (inactivation of viruses) was achieved within 4 h only with six femoral heads. Nine out of the 10 examined femoral heads in series B show a clearly improved penetration behaviour which was expressed in smaller standard deviations, a faster increase in concentration, as well as in higher starting and final concentrations (approx. 0.9%) of PAA. Previous drying in air leads to a faster penetration into the centre of the bone. Standardised drilling of de-cartilaged femoral heads creates favourable conditions for the penetration of the PAA sterilisation solution into the whole tissue and guarantees a sufficient inactivation of microorganisms.

  4. Identification of Noise Sources and Design of Noise Reduction Measures for a Pneumatic Nail Gun.

    PubMed

    Jayakumar, Vignesh; Kim, Jay; Zechmann, Edward

    An experimental-analytical procedure was implemented to reduce the operating noise level of a nail gun, a commonly found power tool in a construction site. The procedure is comprised of preliminary measurements, identification and ranking of major noise sources and application of noise controls. Preliminary measurements show that the impact noise transmitted through the structure and the exhaust related noise were found to be the first and second major contributors. Applying a noise absorbing foam on the outside of the nail gun body was found to be an effective noise reduction technique. One and two-volume small mufflers were designed and applied to the exhaust side of the nail gun which reduced not only the exhaust noise but also the impact noise. It was shown that the overall noise level could be reduced by as much as 3.5 dB, suggesting that significant noise reduction is possible in construction power tools without any significant increase of the cost.

  5. Surgical treatment of complex proximal humeral fractures with a technique of nail and osteosuture: "NOS".

    PubMed

    Garret, J; Houdré, H; Cievet-Bonfils, M; Godenèche, Arnaud; Duparc, Fabrice; Roussignol, Xavier

    2017-03-14

    Open reduction and internal fixation of complex proximal humeral fracture represents a surgical challenge. The main objective of this procedure is to anatomically reduce the tuberosities. We propose a standardized and reproducible technique that we apply to all complex displaced 3- and 4-part fractures of patients under 50 years. We use an antero-lateral trans-deltoid approach; the humeral head and the tuberosities are reduced under fluoroscopic control. The tuberosities are stabilized with an inter-tuberosity osteosuture, and we then introduce a thin and straight intra-medullary nail (Telegraph IV FH Orthopedics) at the hinge point of the humeral head. The osteosynthesis of the tuberosities is completed by 3- or 4-self-stable divergent screws in the nail. A dynamic distal locking stabilizes the humeral shaft in rotation and facilitates consolidation thanks to micro movements. The removal of the nail with an arthroscopic shoulder arthrolysis in case of stiffness is possible secondarily.

  6. Tibial lengthening using a reamed type intramedullary nail and an Ilizarov external fixator.

    PubMed

    Kim, Hayoung; Lee, Sang Ki; Kim, Kap Jung; Ahn, Jae Hoon; Choy, Won Sik; Kim, Yong In; Koo, Jea Yun

    2009-06-01

    The aim of this study was to evaluate the efficacy of tibial lengthening using a reamed type intramedullary nail and an Ilizarov external fixator for the treatment of leg length discrepancy or short stature. This retrospective study was performed on 18 tibiae (13 patients) in which attempts were made to reduce complications. We used an Ilizarov external fixator and a nail (10 mm diameter in 17 tibiae and 11 mm in one tibia) in combination. Average limb lengthening was 4.19 cm (range, 2.5-5.5). The mean duration of external fixation was 12.58 days per centimetre gain in length, and the mean consolidation index was 40.53 (range, 35.45-51.85). All distracted segments healed spontaneously without refracture or malalignment. Gradual limb lengthening using a reamed type intramedullary nail and circular external fixation in combination was found to be reliable and effective and reduced external fixation time with fewer complications.

  7. Statistical definition of nail fold capillary pattern in patients with systemic sclerosis.

    PubMed

    Ohtsuka, T; Ishikawa, H

    1994-01-01

    Image analysis of videographs of nail fold capillaries was performed in patients with systemic sclerosis (SS), and the capillary patterns were defined by canonical discriminant analysis. Forty-eight of 55 SS patients were significantly differentiated from patients with systemic lupus erythematosus and normal controls. Normal controls and patients with systemic lupus erythematosus showed identical nail fold capillary patterns; in patients with dermatomyositis the pattern was similar to that of SS. The canonical discriminant analysis revealed that only 5 of 55 (9%) SS patients showed a normal capillary pattern. The abnormal capillary pattern in SS patients correlated with microvascular disturbances such as Raynaud's phenomenon, digital pitting scars and low finger temperature. Our results indicate that quantitative analysis of the nail fold capillaries is useful in evaluating the microvascular disturbances in SS patients.

  8. Retrospective Evaluation of Nail Trimming as a Conservative Treatment for Ulcerative Dermatitis in Laboratory Mice

    PubMed Central

    Alvarado, Cynthia G; Franklin, Craig L; Dixon, Lonny W

    2016-01-01

    Ulcerative dermatitis (UD) is an idiopathic disease that affects C57BL/6 mice and those having a B6 background. The hallmark of UD is pruritus, which leads to self-mutilation and epidermal ulceration typically in the intrascapular region. Although several treatments for UD have been published, some involve the use of pharmacologic agents that might confound research results. In this retrospective study, we evaluated nail trimming to determine whether this conservative treatment approach improved the resolution rate of UD at our institution compared with that of untreated mice or those that received oral or topical antibiotics. Our findings show that the incidence of resolution of UD was significantly greater and that the time to resolution was shorter in mice treated with nail trimming compared with other groups. These findings support the use of nail trimming as an effective conservative treatment option for UD in B6 mice. PMID:27423154

  9. Current Evidence: Plate Versus Intramedullary Nail for Fixation of Distal Tibia Fractures in 2016.

    PubMed

    Vallier, Heather A

    2016-11-01

    Displaced distal tibia shaft fractures are effectively treated with standard plates and intramedullary nails. Plate fixation performed with meticulous soft tissue handling results in minimal risks of infection and poor wound healing. Standard plates have high rates of primary union, whereas locking plates may delay union because of increased stiffness. Tibial healing may also be delayed after plating of the fibula, although fibula reduction and fixation may aid accuracy of reduction of the tibia. Malalignment occurs more often with infrapatellar intramedullary nailing versus plates, and early results of suprapatellar nailing appear promising in minimizing intraoperative malalignment. Long-term function after fixation of the distal tibia is good for most, with poor outcomes often associated with baseline social and mental health issues.

  10. Characterization of natural and irradiated nails by means of the depolarization metrics

    NASA Astrophysics Data System (ADS)

    Savenkov, Sergey; Priezzhev, Alexander; Oberemok, Yevgen; Sholom, Sergey; Kolomiets, Ivan; Chunikhina, Kateryna

    2016-07-01

    Mueller polarimetry is applied to study the samples of nails: natural (or reference) and irradiated to 2 Gy ionizing radiation dose. We measure the whole Mueller matrices of the samples as a function of the scattering angle at a wavelength of 632.8 nm. We apply depolarization analysis to measured Mueller matrices by calculating the depolarization metrics [depolarization index, Q(M)-metric, first and second Lorenz indices, Cloude and Lorenz entropy] to quantify separability of the different samples of nails under study based on differences in their Mueller matrix. The results show that nail samples strongly depolarize the output light in backscattering, and irradiation in all cases results in increasing of depolarization. Most sensitive among depolarization metrics are the Lorenz entropy and Q(M)-metric.

  11. [Interlocking medullary nailing. Indications, technic with a new guiding instrument. Analysis of the 1st 50 operations].

    PubMed

    Berentley, G

    1976-01-01

    After a review of Küntsher's intramedullary nailing, the author resumed the informations about the interlocking medullary nail and its technique. A new device, as a guide instrument for easier application of the transverse bolts was constructed on the basis of authors concept. Using the new technique and guide instrument X-ray television controll is not necessary for placing the bolts in their right places through a small incision. The time of operation and the risk of infection was also diminished by the new technique. The indications for the interlocking medullary nailing have been completed by the author with the pathologic fractures. The first 50 cases, treated by the new technique of the interlocking medullary nailing are analysed and a few cases are reported in detail. Good results have been obtained as regards both the bone union and the functional results. Based on the good results the new technique of the interlocking medullary nailing is recommended by the author.

  12. The accuracy of femoral intramedullary guides in total knee arthroplasty.

    PubMed

    Reed, S C; Gollish, J

    1997-09-01

    Of the technical factors important in achieving a successful total knee arthroplasty, limb alignment has been demonstrated to be most influential in determining implant survival. Intramedullary femoral guide systems rely on placement of the intramedullary rod along the anatomic axis of the femur. In this article, the accuracy of the femoral intramedullary guide is investigated using radiographs and a mathematical model. The femoral anatomic axis was drawn on 40 consecutive, preoperative, 3-ft standing radiographs. Using a mathematical model, the potential angular error in the distal femoral cut from aberrant placement of the intramedullary rod was estimated. Calculated values correlated with measured values from plain radiographs and an intramedullary guide template. The anatomic axis was found to exit the distal femur at an average of 6.6 mm medial to the center of the femoral notch. Substantial malalignment error resulted from minor malposition of the intramedullary rod. Most books and diagrams demonstrating the use of intramedullary guides indicate that the entry point is at the center of the femoral notch. These results show that the true entry point is medial to the center of the notch, and rod placement error results in excessive valgus alignment. Preoperative drawing of the anatomic axis on a 3-ft or 18-inch anteroposterior radiograph is recommended. The results both demonstrate the importance of correct use of the guide and heighten cognizance among surgeons performing total knee arthroplasty as to the limitations of the intramedullary guides.

  13. Elastic stable intramedullary nailing of midclavicular fractures in athletes

    PubMed Central

    Jubel, A; Andemahr, J; Bergmann, H; Prokop, A; Rehm, K; Fay, M

    2003-01-01

    Background: Intramedullary fixation of midclavicular fractures may be a better option than non-operative treatment for high performance/professional athletes because of the potential reduction in recovery time. Objectives: To evaluate the effectiveness of intramedullary fixation in high performance athletes and the time required to return to sporting activity. Methods: Data were taken from a prospective study on intramedullary fixation techniques using the elastic stable Ti nail (TEN, Synthes) for the treatment of displaced midclavicular fractures, initiated in 1996. The patients in 12 cases were classified as high performance/professional athletes. These cases were used to evaluate the technique specifically in this population. Fractures were classified according to the Orthopaedic Trauma Association (OTA) system. Patients were evaluated before and after surgery for shoulder function and subjective pain. After the operation, radiological assessments documented fracture healing, and clinical outcomes scores were obtained. Time required to return to training and competition was documented. Results: All fractures were transverse or oblique. Mean (SD) shoulder abduction increased from 36.3 (8)° before surgery to 154.2 (17)° afterwards (p<0.001). Mean subjective pain score using a visual analogue scale (0–100) decreased from 71.7 (18) points before surgery to 19.2 (6) points (p<0.001) three days after. There were no complications. Hospital stay averaged 2.9 (1) days. Mean delay to resumption of training was 5.9 (1) days, and to resumption of competition it was 16.8 (5) days. The mean Constant clinical outcomes score one year after hardware removal was 98.3 (2) points. Conclusions: Intramedullary fixation of displaced midclavicular fracture was successful in terms of clinical outcome and rapid resumption of sporting activities. This treatment should be offered to athletes as an alternative to non-operative treatment. PMID:14665582

  14. Titanium elastic nailing radius and ulna fractures in adolescents.

    PubMed

    Wall, Lindley; O'Donnell, June C; Schoenecker, Perry L; Keeler, Kathryn A; Dobbs, Matthew B; Luhmann, Scott J; Gordon, J Eric

    2012-09-01

    Over the last 40 years, anatomic reduction with plate stabilization has become the standard in adult patients with diaphyseal fractures of the radius and ulna. When operative fixation has been indicated in skeletally immature patients with these fractures, a variety of techniques have been reported, with intramedullary fixation becoming increasingly accepted. There is currently significant variability in the treatment of adolescents with forearm fractures. The purpose of this study was to investigate the clinical and radiographic outcomes in the adolescent population after intramedullary fixation of both bone forearm fractures. A retrospective review identified 32 patients 12-18 years of age who had undergone intramedullary fixation of both forearm bones in the past 20 years at our institution. Galeazzi, Monteggia, radial head, and distal metaphyseal fractures were excluded. Radiographic evaluation was performed to determine union and postoperative radial bow. Clinical follow-up was carried out for postoperative complications and range of motion of the wrist, forearm, and elbow. The mean age of the patients was 14.1 years. A total of 19 fractures were closed injuries, nine were grade 1, three were grade 2, and one fracture was a grade 3b. Of the patients, 15.6% had limited postoperative range of motion. All patients in the older age group, 15-18 years of age, had a normal range of motion. A decrease in radial bow was not associated with limitation in motion. There was a 98% union rate, and all unions occurred by 7.5 months. Only three major complications occurred, two refractures and one ulnar hardware migration, and subsequent radius nonunion occurred in the one grade 3b injury. Flexible intramedullary nailing of both bone forearm fractures provides reliable bony union and excellent postoperative clinical results in adolescents. Level of evidence, IV.

  15. Clinical application of a pedicle nail system with polymethylmethacrylate for osteoporotic vertebral fracture

    PubMed Central

    Tanaka, Masato; Sugimoto, Yoshihisa; Takigawa, Tomoyuki; Ozaki, Toshifumi; Konishi, Hitoshi

    2010-01-01

    The instrumentation of the osteoporotic spine may sometimes result in failure due to the loosening or pullout of the conventional pedicle screw. Moreover, augmentation of screws with polymethylmethacrylate (PMMA) has risks of complications. We developed a new and original pedicle nail system with PMMA for osteoporotic vertebral fractures. A clinical evaluation of this novel pedicle nail system utilized in patients with an osteoporotic vertebral collapse was performed to determine the effectiveness and safety of this technique. Thirty-four elderly patients who suffered from osteoporotic compression fractures were treated by posterolateral fusion using the pedicle nail system. The mean follow-up period was 37 months. Of the 25 patients with neurological symptoms, two patients improved two stages at the Frankel level. Fifteen patients improved one stage at the Frankel level, and eight other patients improved, however, their improvement did not exceed a Frankel level. Nine cases with neuralgia symptoms improved from 4.4 to 2.2 points on average on the Denis pain scale (p < 0.01). The fusion rate was 94% as determined by X-rays of flexion and extension, and the correction of the compression fracture site was maintained well. A pedicle nail system stabilizes the spinal column with osteoporosis and reduces the instrumentation failure. The technique for the insertion of the pedicle nail reduces complication from cement augmentation. The authors speculate that the strategy using the pedicle nail system for osteoporotic spine may be effective and safe when the surgery is performed through a posterior approach. PMID:20414689

  16. Method development for assessing the human exposure to organophosphate flame retardants in hair and nails.

    PubMed

    Alves, Andreia; Covaci, Adrian; Voorspoels, Stefan

    2017-02-01

    In the present study, a new extraction method based on acid digestion and SPE clean-up (Oasis Wax) was developed for measuring four PFR metabolites (i.e. dibutyl phosphate (DBP), diphenyl phosphate (DPhP), bis(1,3-dichloro-2-propyl)phosphate (BDCPP) and bis(2-butoxy ethyl) phosphate (BBEP)) in hair and nails. The method optimization was done according to a combinatorial design (Taguchi) where several parameters were efficiently optimized. Precision was lower for hair than for nails (RSD % 18 and 28%). Recoveries were >74%. High DBP levels in procedural blanks were traced back to the use of SPE cartridges. Therefore a new SPE pre-treatment was tested, reducing significantly DBP levels (<1 ng). Levels of the PFR metabolites were measured in scalp hair, finger, and toe nails collected over two months in two volunteers (female and male). DPhP levels were extremely high (in μg/g range) in both finger and toe nails in the female. BDCPP and BBEP were the minor metabolites detected in nails (average levels of 28-64 ng/g and <2.2-4.1 ng/g, respectively). DPhP was the only metabolite detected in hair (0.23-0.25 ng/g). Results showed that there is a possible contribution from both an external (via deposition) and an internal exposure, however it was not possible to fully understand their extent. Since there were no records of lifestyle and due to the small sample size, the major exposure source could not be addressed here. Nevertheless, there is evidence that hair and nails (finger and toe) might be good indicators of human exposure to PFRs, especially to TPhP.

  17. [Residue of organic fluorine pollutants in hair and nails collected from Tianjin].

    PubMed

    Yao, Dan; Zhang, Hong; Chai, Zhi-Fang; Shen, Jin-Can; Yang, Bo; Wang, Yan-Ping; Liu, Guo-Qing

    2013-02-01

    In order to explore the residue and distributions of organic fluorine pollutants in hair and nails, the residue levels of total fluorine (TF), extractable organic fluorine (EOF) and perfluorinated chemicals (PFCs) in hair and nails collected from Tianjin adults were measured by the cyclic neutron activation analysis (CNAA) combined with the high performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). The results showed that inorganic fluorine (mean: 2.0 mg.kg-1, 4.5 mg.kg-1) was the primary fluorine in TF while EOF(mean: 0.7 mg.kg-1, 1.8 mg.kg-1) was minor. The average amount of identified fluorine (IF) was 0.038 mg.kg-1 in hair and 0.047 mg.kg-1 in nails, accounting or 7.1% (2.6%-16%) and 3.5% (1.1%-11%) of EOF, respectively, which indicated that more than 84% of EOF was unknown. The major residue in hair and nails were medium-and short-chain PFCs,in which perfluorooctane sulfonate, perfluorooctanoic acid and perfluorononanoic acid were the main species. TF, EOF and IF levels in dyed and permed hair were significantly higher than untreated hair (P <0.05), and the concentrations of Sigma PFCs in hair and nails showed no difference between genders. With significantly higher levels of sigma PFCs and PFOS residues than hair (P <0.01), nails could potentially become a more sensitive bioindicator for the exposure level of PFCs in human.

  18. Nineteen year results of THA using modular 9 mm S-ROM femoral component in patients with small femoral canals.

    PubMed

    Drexler, Michael; Dwyer, Tim; Marmor, Meir; Abolghasemian, Mansour; Chakravertty, Rajesh; Chechik, Ofir; Cameron, Hugh U

    2013-10-01

    A retrospective analysis was undertaken of 30 consecutive THA performed in 25 patients with hypoplastic proximal femurs, who had received a 9-mm uncemented modular S-ROM stem. The mean patient age was 42 years (17-69 years), mean height was 152.5 cm (130-170.5 cm), mean weight was 63 kg (39-90 kg), and mean follow-up period was 19 years (range, 12-23 years). Subsidence was seen in 2 hips, with asymptomatic femoral osteolysis present in 11 hips; overall survival of the femoral stem was 93.3%, with two revisions of the femoral component required for aseptic loosening. After a mean follow-up of 19 years, the use of the S-ROM 9 mm femoral stem in the patient with the small femur was associated with a low revision rate due to aseptic loosening of the stem.

  19. [Treatment of beginning juvenile detachment of the femoral head, taking growth of the femoral neck into account (author's transl)].

    PubMed

    Engelhardt, P

    1979-10-01

    Prevention of further detachment is the primary aim in the immediate treatment of beginning juvenile detachment of the femoral head. Screwing of the epiphysis of the head, first introduced by M. E. Mueller (1965), has proved successful. Besides providing immediate mechanical stability, this method, however, results in premature ossification of the joint of the femoral neck. Epiphysiodesis has a particularly unfavourable effect in early childhood, because it inhibits proper growth of the leg and development of the mechanism of the hip joint on account of the shortened femoral neck. Spiking of the epiphysis with Krischner screw wires guarantees safe fixation of the epiphyseal head on the one hand, and sufficient freedom of femoral neck growth on the other. Surgical treatment requires knowledge of the changed hip joint anatomy of the child. Preoperative planning via drawing to determine the length and position of the implantate on the basis of standardised x-ray films, will help to prevent operative failures.

  20. Osteoid Osteoma of the Femoral Neck in Athletes: Two Case Reports Differentiating From Femoral Neck Stress Injuries.

    PubMed

    Cordova, Christopher B; Dembowski, Scott C; Johnson, Michael R; Combs, John J; Svoboda, Steven J

    2016-01-01

    The diagnosis of an intra-articular osteoid osteoma can be a challenging and lengthy process, with reports of delayed diagnosis of greater than 2 years. In the young, athletic patient with an atraumatic onset of groin pain, an overuse injury or muscle strain is the most likely etiology. However, an overuse injury of femoral neck stress fracture must be identified because of the potentially disastrous outcome of fracture completion. The similar clinical presentation of a femoral neck stress fracture and intra-articular osteoid osteoma of the femoral neck can further delay the diagnosis of the osteoid osteoma. In a patient with these differential diagnoses that do not improve with a period of nonweightbearing activity, a more intensive workup must ensue. The purpose of this case report is to describe the initial presentations, subsequent follow-up, and imaging findings leading to the diagnosis of osteoid osteoma as well as to differentiate an osteoid osteoma from femoral neck stress injuries.