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Sample records for broken femoral nails

  1. Removal of a broken intramedullary femoral nail with an unusual pattern of breakage: a case report

    Science.gov (United States)

    Rodriguez Martin, Juan; Resines Erasun, Carlos

    2009-01-01

    To the best of our knowledge, only 3 cases, including the present case, have been reported with a three part broken pattern. However, this is the first case associated with a distal locking screw broken. We report the case of a 31-year-old patient who sustained an open femoral shaft fracture . The fracture was stabilized with a Kuntcher femoral nail. After 7 months of the initial surgery he presented with a three part broken intramedullary nail and the distal locking screw broken. We used a combined technique for the removal of the nail through the nonunion fracture site; we used a pull out technique for the middle fragment and a curved thin hook for the distal fragment. Then we applied bone allograft and stabilized with a cannulated intramedullary femoral nail (Synthes, Oberdorf, Switzerland). After 2 years of follow up the nonunion was consolidated and the patient presented a good clinical outcome. This is of particular interest because it is a unique case and the association with a broken distal locking screw is reported for the first time in this study. A combination of methods through the nonunion site approach and an alternative instrumental is a good method for the removal of a hollow femoral intramedullary nail with this unusual pattern of breakage. PMID:19777163

  2. Closed retrograde retrieval of the distal broken segment of femoral cannulated intramedullary nail using a ball-tipped guide wire

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    Sreenivasulu Metikala

    2011-01-01

    Full Text Available Background: Extracting broken segments of intramedullay nails from long bones can be an operative challenge, particularly from the distal end. We report a case series where a simple and reproducible technique of extracting broken femoral cannulated nails using a ball-tipped guide wire is described. This closed technique involves no additional equipment or instruments. Materials and Methods: Eight patients who underwent the described method were included in the study. The technique involves using a standard plain guide wire passed through the cannulated distal broken nail segment after extraction of the proximal nail fragment. The plain guide wire is then advanced distally into the knee joint carefully under fluoroscopy imaging. Over this wire, a 5-millimeter (mm cannulated large drill bit is used to create a track up to the distal broken nail segment. Through the small knee wound, a ball-tipped guide wire is passed, smooth end first, till the ball engages the end of the nail. The guide wire is then extracted along with the broken nail through the proximal wound. Results: The method was successfully used in all eight patients for removal of broken cannulated intramedullary nail from the femoral canal without any complications. All patients underwent exchange nailing with successful bone union in six months. None of the patients had any problems at the knee joint at the final follow-up. Conclusion: We report a technique for successful extraction of the distal fragment of broken femoral intramedullary nails without additional surgical approaches.

  3. Retrieval of a broken guide wire transfixing the hip through the proximal femoral nail hole

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    Jain Saurabh

    2014-02-01

    Full Text Available 【Abstract】Retrieval of a broken guide wire transfixing the acetabulum or with intrapelvic migration is challenging and frustrating for surgeons. We here present a case report on a method to remove a broken guide wire transfixing the acetabulum through the proximal hole of recon nail using a grasping forceps. This method is little invasive, easy, time-saving and without need for changing the inital fixation.

  4. Retrieval of a broken guide wire transfixing the hip through the proximal femoral nail hole

    Institute of Scientific and Technical Information of China (English)

    Saurabh Jain; Abhishek Pathak; Rajeev Kant Pandey

    2014-01-01

    Retrieval of a broken guide wire transfixing the acetabulum or with intrapelvic migration is challenging and frustrating for surgeons.We here present a case report on a method to remove a broken guide wire transfixing the acetabulum through the proximal hole of recon nail using a grasping forceps.This method is little invasive,easy,time-saving and without need for changing the inital fixation.

  5. Prophylactic Nailing of Incomplete Atypical Femoral Fractures

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    Chang-Wug Oh

    2013-01-01

    Full Text Available Introduction. Recent reports have described the occurrence of low-energy subtrochanteric and femoral shaft fractures associated with long-term bisphosphonate use. Although information regarding the surgical treatment of these atypical femoral fractures is increasing, it is unclear if the preventive operation is useful in incomplete fractures. This study examined the results of preventive intramedullary nailing for incomplete atypical femoral fractures. Material and Methods. A retrospective search was conducted for patients older than 50 years receiving bisphosphonate therapy, with incomplete, nondisplaced fractures in either the subtrochanteric or diaphyseal area of the femur. Seventeen patients with a total of 20 incomplete, non-displaced lesions were included. The mean duration of bisphosphonate use was 50.5 months. Eleven of the 17 (64.7% patients had complete or incomplete fractures on the contralateral femur. All were treated with prophylactic fixation of an intramedullary (IM nail. The minimum followup was 12 months. Results. All cases healed with a mean period of 14.3 weeks. Nineteen of the 20 cases healed with the dissolution of incomplete fractures of the lateral aspect. A complete fracture developed at the time of nailing in one patient, but it healed with callus bridging. Conclusion. IM nailing appears to be a reliable way of preventing the progress of incomplete atypical femoral fractures.

  6. Retained portion of latex glove during femoral nailing. Case report.

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    Sadat-Ali, M; Marwah, S; al-Habdan, I

    1996-11-01

    A case of retained glove during Kuntscher intramedullary nailing is described. An abscess around the glove could have lead to osteomyelitis. One need to be cautious feeling the top end of the nail while femoral nailing to avoid such a complication.

  7. Persistent knee complaints after retrograde unreamed nailing of femoral shaft fractures

    NARCIS (Netherlands)

    El Moumni, Mostafa; Schraven, Pim; ten Duis, Henk Jan; Wendt, Klaus

    2010-01-01

    Retrograde nailing is an attractive method for stabilisation of femoral shaft fractures in cases of polytrauma, ipsilateral pelvic, acetabular, tibial and femoral neck fractures, bilateral femoral fractures, obese and pregnant patients. However, retrograde nailing may result in complaints about the

  8. Femoral nailing in adults : doctor and patient reported outcomes

    NARCIS (Netherlands)

    El Moumni, Mostafa

    2016-01-01

    The treatment of traumatic femoral shaft fractures using an unreamed nail is associated with good results. Both antegrade and retrograde unreamed nailing techniques result in high union rates and low rates of complications, such as non-union, deep infection and septic arthritis. These results are co

  9. Construct Failure in an Atypical Femoral Fracture treated with Intramedullary Nailing: A Case Report

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    L Bonifacio

    2014-03-01

    Full Text Available The aim of this paper is to document a rare case of construct failure in a 68-year old Filipina who sustained an atypical femoral fracture (AFF in her left subtrochanteric area. The patient previously had a 40-month history of alendronate 70mg + vitamin D 5600u therapy for osteoporosis and underwent closed intramedullary nailing for the AFF. Six months postoperatively, she began to experience progressive pain in her operated thigh. Radiographs revealed a broken nail at the proximal screw hole and non-union of the AFF. The patient was treated with exposure of the fracture site, removal of the broken device, exchange intramedullary nailing, and iliac bone grafting. She had radiographic and clinical union and was full weight bearing after three months.

  10. Femoral shaft fracture callus formation after intramedullary nailing: a comparison of interlocking and Ender nailing.

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    Yamaji, Tetsuo; Ando, Kenichi; Nakamura, Toshiyasu; Washimi, Ohsuke; Terada, Nobuki; Yamada, Harumoto

    2002-01-01

    Intramedullary nailing is widely used for the operative treatment of femoral fractures. Recently, the biologic healing of fractures has become better understood from fundamental investigations. However, there has been no clinical comparison between the fracture healing process with these two fixation methods. The purpose of this study was to use radiographs to compare callus formation with two types of intramedullary nailing for femoral shaft fractures: reamed interlocking (IL) nails and Ender nails. Femoral shaft type A fractures (AO classification) were studied. Twenty-seven fractures were treated with reamed IL nailing, and 81 fractures were treated with Ender nailing. The callus area was calculated from the maximum cross-sectional area on the anteroposterior and lateral radiographs. The callus appeared at a mean of 3.9 weeks after surgery in the IL group, and at a mean of 2.8 weeks in the Ender group ( P Ender groups, fracture healing was noted at a mean of 3.4 and 2.0 months, respectively. The mean area of callus formation in the IL and Ender nailing groups was 439.5 mm(2) and 699.4 mm(2), respectively ( P Ender nailing results in abundant callus, which forms at an earlier stage after the procedure than in patients treated with IL nailing. Dynamization at the fracture site is reported to increase external callus formation. Our results indicate that the elasticity of the fixation obtained with Ender nailing promotes callus formation.

  11. Femoral Nailing-related Coagulopathy Determined by First-hit Magnitude: An Animal Study

    OpenAIRE

    2008-01-01

    We asked whether coagulopathy worsened during femoral intramedullary nailing in the presence of lung contusion and hemorrhagic shock and whether reamed or unreamed nailing influenced these results. In 30 Merino sheep, we induced hemorrhagic shock and/or standardized lung contusion followed by femoral nailing. Six groups of five each were assigned as follows: thoracotomy control groups treated with reamed or unreamed nailing, lung contusion groups treated with reamed or unreamed nailing, and s...

  12. Retrograde femoral nailing in elderly patients: outcome and functional results.

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    Neubauer, Thomas; Krawany, Manfred; Leitner, Lukas; Karlbauer, Alois; Wagner, Michael; Plecko, Michael

    2012-06-01

    Functional outcome after retrograde femoral intramedullary nailing was investigated in 35 patients older than 60 years (mean, 86 years) with 36 fractures, comprising 15 (41.7%) shaft and 21 (58.3%) distal fractures; overall, 7 (19.4%) periprosthetic fractures occured. Twenty-two (62.9%) of 35 patients were evaluated at a mean 16.5-month follow-up with the Lyshom-Gillquist score and the SF-8 questionaire. Primary union rate was 97.8%, with no significant differences in duration of surgery, bone healing, mobilization, and weight bearing among different fracture types; periprosthetic fractures revealed a significantly delayed mobilization (P=.03). Complications occured significantly more often among distal femoral fractures (P=.009), including all revision surgeries. The most frequently encountered complication was loosening of distal locking bolts (n=3). Lysholm score results were mainly influenced by age-related entities and revealed fair results in all fractures (mean in the femoral shaft fracture group, 78.1 vs mean in the distal femoral fracture group, 74.9; P=.69), except in the periprosthetic subgroup, which had good results (mean, 84.8; P=.23). This group also had increased physical parameters according to SF-8 score (P=.026). No correlation existed between SF-8 physical parameters and patient age or surgery delay, whereas a negative correlation existed between patient age and SF-8 mental parameters (P=.012). Retrograde femoral intramedullary nailing is commonly used in elderly patients due to reliable bone healing, minimal soft tissue damage, and immediate full weight bearing. It also offers a valid alternative to antegrade nailing in femoral shaft fractures.

  13. Pediatric femoral shaft fractures treated by flexible intramedullary nailing

    Institute of Scientific and Technical Information of China (English)

    K.C.Kapil Mani; R.C.Dirgha Raj; Acharya Parimal

    2015-01-01

    Background:Nowadays pediatric femoral fractures are more commonly managed with operative treatment rather than conservative treatment because of more rapid recovery and avoidance of prolonged immobilization.Children between the ages of 5-13 years are treated either by traction plus hip spica and flexible/elastic stable retrograde intramedullary nail,or external fixators in the case of open fractures.The aim of this study is to evaluate the outcome of pediatric femoral shaft fractures treated by stainless steel flexible intramedullary nail in children between 5 and 13 years of age.Methods:There were 32 cases of femoral shaft fractures which were all fixed with stainless steel flexible intramedullary nail under fluoroscopy.Long leg cast was applied at the time of fixation.Partial weight bearing was started 2 weeks after surgery.Patients were evaluated in follow-up study to observe the alignment of fracture,infection,delayed union,nonunion,limb length discrepancy,motion of knee joint,and time to unite the fracture.Results:We were able to follow up 28 out of 32 patients.The patients were 8.14 years of age on average.The mean hospital stay after operation was 4 days and fracture union time was 9.57 weeks.There were 3 cases of varus angulation,2 cases of anterior angulation,and 4 cases of limb lengthening.Conclusion:Patients aged between 5 and 13 years treated with flexible intramedullary nail for closed femoral shaft fracture have rapid union and recovery,short rehabilitation period,less immobilization and psychological impact,and cost-effective.

  14. Titanium elastic nailing in pediatric femoral diaphyseal fractures

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    Singh Roop

    2006-01-01

    Full Text Available Background: The need for operative fixation of pediatric femoral fractures is increasingly being recognised in the present decade. The conventional traction and casting method for management of pediatric femoral fractures is giving way for the operative stabilisation of the fracture. Methods : Thirty five pediatric patients in age group 6-14 years with diaphyseal femoral fractures were stabilised with two titanium nails. Patients were followed up clinically and radiologically for two years. The final results were evaluated using the criteria of Flynn et al. Technical problems and complications associated with the procedure were also analysed. Results : Overall results observed were excellent in 25, satisfactory in 8 and poor in 2 patients. Hospital time averaged 12.30 days in the series. All the fractures healed with an average time to union of 9.6 (6-14.4 weeks. Return to school was early with an average of 7.8 weeks. The soft tissue discomfort near the knee produced by the nails ends was the most common problem encountered. Shortening was observed in three cases and restriction of knee flexion in 5 patients. There was no delayed union, infection or refractures. Per operative technical problems included failure of closed reduction in 2 cases and cork screwing of nails in one case. Conclusion : We believe that with proper operative technique and aftercare TENs may prove to be an ideal implant for pediatric femoral fracture fixation. The most of the complication associated with the procedure are infact features of inexact technique and can be eliminated by strictly adhering to the basic principles and technical aspects.

  15. Treatment of subtrochanteric femoral fracture with long proximal femoral nail antirotation

    Institute of Scientific and Technical Information of China (English)

    WANG Wen-yue; YANG Tian-fu; FANG Yue; LEI Ming-ming; WANG Guang-lin; LIU Lei

    2010-01-01

    Objective:Subtrochanteric femoral fractures are severe injuries.Although many treatment methods have been developed,controversy exists regarding the optimal management of these fractures.This study evaluated the clinical outcome of subtrochanteric femoral fractures fixed with long proximal femoral nail antirotation(PFNA-long).Methods:Between October 2006 and February 2008,25 patients with traumatic subtrochanteric fractures of the femur were treated with PFNA-long.Closed reduction and fixation were performed in 20 cases.In the remaining 5 cases,closed reduction was difficult,so limited open reduction was performed,with bone grafting in 4 cases and circumferential wiring in 4 cases.Results:The average follow-up time was 16.1 months.All subtrochanteric femoral fractures healed uneventfully except one case of delayed union.The mean union time was 26.2 weeks.Technical difficulties with nail insertion were encountered in 3 cases.No implant failure was observed.Conclusion:PFNA-long is effective in treatment of subtrochanteric femoral fractures,with a high rate of bone union,minor soft tissue damage,early return to functional exercise and few implant-related complications.

  16. Removal of a Broken Cannulated Intramedullary Nail: Review of the Literature and a Case Report of a New Technique

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    Amr A. Abdelgawad

    2013-01-01

    Full Text Available Nonunion of long bones fixed with nails may result in implant failure. Removal of a broken intramedullary nail may be a real challenge. Many methods have been described to allow for removal of the broken piece of the nail. In this paper, we are reviewing the different techniques to extract a broken nail, classifying them into different subsets, and describing a new technique that we used to remove a broken tibial nail with narrow canal. Eight different categories of implant removal methods were described, with different methods within each category. This classification is very comprehensive and was never described before. We described a new technique (hook captured in the medulla by flexible nail introduced from the locking hole which is a valuable technique in cases of nail of a small diameter where other methods cannot be used because of the narrow canal of the nail. Our eight categories for broken nail removal methods simplify the concepts of nail removal and allow the surgeon to better plan for the removal procedure.

  17. Biomechanical performance of locked intramedullary nail systems in comminuted femoral shaft fractures.

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    Johnson, K D; Tencer, A F; Blumenthal, S; August, A; Johnston, D W

    1986-05-01

    The biomechanical properties of commercially available locked nail systems designed for use in comminuted femoral shaft fractures were compared and evaluated. Ender nails as well as three forms of interlocking nails, Brooker-Wills (B-W), Klenm-Schellman (K-S), and Grosse-Kempf (G-K), were implanted in cadaver femora. The femora were tested in torsion, bending, and axial loading to failure. Two fracture models were tested--a 3 cm subtrochanteric defect and an 8 cm midshaft defect. Results of the testing revealed the three interlocking nails to be comparable to each other and superior to Ender nails in bending and torsion. However, the distally bolted locked nails (K-S, G-K) resisted significantly higher loads than either the distally bladed locked nail (B-W) or Ender nails when tested to failure by axial loading.

  18. Outcomes of trochanteric femoral fractures treated with proximal femoral nail: an analysis of 100 consecutive cases

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    Korkmaz MF

    2014-04-01

    Full Text Available Mehmet Fatih Korkmaz,1 Mehmet Nuri Erdem,2 Zeliha Disli,3 Engin Burak Selcuk,4 Mustafa Karakaplan,1 Abdullah Gogus5 1Department of Orthopedics and Traumatology, Inonu University School of Medicine, Malatya, Turkey; 2Department of Orthopedics and Traumatology, Nisantasi University School of Medicine, Istanbul, Turkey; 3Department of Anesthesiology, Malatya Government Hospital, Malatya, Turkey; 4Department of Family Medicine, Inonu University School of Medicine, Malatya, Turkey; 5Department of Orthopedics and Traumatology, Florence Nightingale Hospital, Istanbul, Turkey Purpose: In this study, we aimed to report the results of a retrospective study carried out at our institute regarding cases of patients who had suffered proximal femoral fractures between January 2002 and February 2007, and who were treated with a proximal femoral nail. Materials and methods: One hundred consecutive cases were included in the study. A case documentation form was used to obtain intraoperative data including age, sex, mechanism of injury, type of fracture according to Association for Osteosynthesis/Association for the Study of Internal Fixation (AO/ASIF classification and the American Society of Anesthesiologists' (ASA physical status classification (ASA grade. Clinical and radiographic examinations were performed at the time of admission and at the 6th week; subsequent visits were organized on the 3rd month, 6th month, and 12th month, and in patients with longer follow-up and annually postoperatively. The Harris score of hip function was used, and any change in the position of the implants and the progress of the fracture union, which was determined radiologically, was noted. Results: The mean age of the patients was 77.66 years (range: 37–98 years, and the sex distribution was 32 males and 68 females. Seventy-three fractures were reduced by closed means, whereas 27 needed limited open reduction. The mean follow-up time for the study group was 31.3 months (range

  19. Expert tibia nail for subtrochanteric femoral fracture to prevent thermal injury

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    Kyung-Jae Lee

    2015-01-01

    Conclusion: Expert tibia nail may be considered one of the treatment options for subtrochanteric femoral fracture with narrow medullary canal. We also emphasize the importance of preoperative evaluation of the medullary canal size for these risky fractures.

  20. New Technique: A Novel Femoral Derotation Osteotomy for Malrotation following Intramedullary Nailing

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    S. Jagernauth

    2012-01-01

    Full Text Available A 19-year-old female patient sustained a closed spiral midshaft femoral fracture and subsequently underwent femoral intramedullary nail insertion. At followup she complained of difficulty in walking and was found to have a unilateral in-toeing gait. CT imaging revealed 30 degrees of internal rotation at the fracture site, which had healed. A circumferential osteotomy was performed distal to the united fracture site using a Gigli saw with the intramedullary femoral nail in situ. The static distal interlocking screws were removed and the malrotation was corrected. Two further static distal interlocking screws were inserted to secure the intramedullary nail in position. The osteotomy went on to union and her symptoms of pain, walking difficulty, and in-toeing resolved. Our paper is the first to describe a technique for derotation osteotomy following intramedullary malreduction that leaves the intramedullary nail in situ.

  1. Femoral shaft fractures in children: elastic stable intramedullary nailing in 31 cases

    DEFF Research Database (Denmark)

    Houshian, Shirzad; Gøthgen, Charlotte Buch; Pedersen, Niels Wisbech;

    2004-01-01

    We report our experience with elastic stable intramedullary titanium nailing (ESIN) of femoral shaft fractures in children. From 1998 to 2001, we treated 31 children (20 boys), median age 6 (4-11) years, with ESIN for 29 closed and 2 grade I open femoral shaft fractures. We reviewed 30 children c...... in 6 children and 10 degrees of internal rotational deformity in 1 child. No angular deformity had occurred. Elastic stable intramedullary nailing seems to be a safe method for the treatment of femoral shaft fractures in children between 4 and 11 years of age....

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

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    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.

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

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    Pedro Luciano Teixeira Gomes

    2016-08-01

    Full Text Available ABSTRACT 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.

  4. Comparison of two kinds of intramedullary nails in the treatment of femoral shaft fractures in adults

    Institute of Scientific and Technical Information of China (English)

    CHEN Wei; WANG Juan; SU Yan-ling; ZHAGN Qi; WANG Bo; LI Zhi-yong; ZHANG Ying-ze

    2011-01-01

    Background Intramedullary nails have been widely used in treating femoral shaft fractures.However,end caps falling into soft tissue intraoperatively may cause trouble to surgeons,prolong operative time and increase radiation exposure.Additionally,difficulties may be encountered when removing nails because of callus formation over the nail tip.We performed a prospective study to compare two types of nails in managing femoral shaft fractures.Methods Group I consisted of seventy-four patients with unilateral femoral shaft fractures treated with cannulated interlocking anatomical femoral intramedullary nails.Group Ⅱ consisted of seventy-eight patients treated with cannulated interlocking anatomical femoral intramedullary nails with tail wires.The patients' ages,fracture severity,duration of operation,fluoroscopy time,blood loss and falls of end caps into soft tissue were recorded.Nails were removed after fracture healing.The duration of operation and blood loss during nail removal were recorded.Results There were no significant differences between groups with respect to age and fracture severity (P>0.05).End caps fell into soft tissue 17 times in 15 cases in group Ⅰ and 21 times in 16 cases in group Ⅱ.An average of seven minutes was spent recovering a lost cap in group Ⅰ.In group Ⅱ,all lost caps were recovered immediately.The duration of operation and fluoroscopy time in group Ⅱ was significantly less than in group Ⅰ (P <0.05).Asymptomatic palpable nodules were detected in 4 cases in group Ⅱ.Nail removals were performed on 58 patients in group Ⅰ and 69 patients in group Ⅱ.The duration of operation,blood loss and complications in group Ⅱ were less than in group Ⅰ (P<0.05).Conclusion Intramedullary nails with tail wires facilitate both fracture fixation and nail removal,which can be used to treat femoral shaft fractures with less radiation exposure,shorter surgical time and fewer complications.

  5. Failure of intramedullary femoral nail with segmental breakage of distal locking bolts: a case report and review of the literature

    Institute of Scientific and Technical Information of China (English)

    Sameer Aggerwal; Nitesh Gahlot; Uttam C. Saini; Kamal Bali

    2011-01-01

    Breakage of locking bolts is an important cause of interlocking nail failure in femoral fractures. It usually occurs in the form of single breakage in one of the distal bolts of the nail or nail breakage around the distal locking hole. Here we report an unusual case of intramedullary femoral nail failure with segmental breakage of both the distal locking bolts. Such a scenario usually complicates further management. We successfully managed this case with exchange nailing without bone grafting. Here we briefly reviewed the literature regarding such an unusual presentation and discussed in detail the possible etiology of such a presentation and the management options when facing such a complex situation.

  6. Treatment of ipsilateral hip and femoral shaft fractures with reconstructive intramedullary interlocking nail

    Institute of Scientific and Technical Information of China (English)

    吴立东; 吴琼华; 严世贵; 潘志军

    2004-01-01

    Objective: To evaluate the results of reconstructive intramedullary interlocking nail in the treatment of ipsilateral hip and femoral shaft fractures. Methods: From August 1997 to November 2001, 13 patients were treated with the reconstructive intramedullary interlocking nail. Nine patients were associated with ipsilateral femoral neck fractures, three with ipsilateral intertrochanteric fractures, and one with subtrochanteric fracture. Results: The follow-up time was from 6 to 38 months with an average of 14 months. All the femoral shaft and hip fractures healed up well. There was no nonunion of the femoral neck, and only one varus malunion. No patient had avascular necrosis of the femoral head. The average healing time for femoral neck fracture was 4.6 months and for shaft fracture 5.8 months. The joint movement and other functions were fairly resumed. Conclusions: The reconstructive intramedullary interlocking nail, with less trauma, reliable fixation, and high rate of fracture healing, is an ideal method of choice in the treatment of ipsilateral hip and femoral shaft fractures.

  7. 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.

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    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.

  8. Treatment of Pediatric Open Femoral Fractures with External Fixator Versus Flexible Intramedullary Nails

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    Hossein Aslani

    2013-12-01

    Full Text Available   Background: In children, inappropriate treatment of open femoral fractures may induce several complications. A few studies have compared the external fixator with flexible intramedullary nails in high-grade open femoral fractures of children. The present study aims at comparing results of these two treatment methods in open femoral fractures. Methods: In this descriptive analytical study, 27 patients with open femoral fractures, who were treated using either the external fixator (n=14 or TEN nails (n=13 method from 2006-2011, were studied. Some patients were treated with a combination method of TEN and pin. The results were evaluated considering infection, union, malunion, and refracture and the patients were followed up for two years. Results: Mean time required for fracture union was 3.89 (range: 2-5.8 and 3.61 (range: 2-5.6 months for the external fixator and TEN groups, respectively. The difference was not statistically significant and there was not any significant difference between the two groups considering infection of the fractured area. Osteomyelitis was not observed in any group. There was an infection surrounding the external fixator pin in 4 cases (28.5% and so this required changing the location of the pin. In the TEN group, one case (7.6% of painful bursitis was observed at the entry point of TEN and so the pin was removed earlier than usual. There were two cases (14.2% of femoral refracture in the external fixator group. Malunion requiring correction was not observed in any of the groups. There were no complications observed in five patients treated with a combined method of pin and flexible intramedullary nails. Conclusion: Both external fixator and intramedullary nail methods are effective ways in treating high grade open femoral fractures in children and final treatment results are similar. Combining pins and flexible intramedullary nails is effective in developing more stability and is not associated with more

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

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    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

  10. Fracture of the femoral shaft in children: advantages of the descending medullary nailing.

    Science.gov (United States)

    Bourdelat, D

    1996-01-01

    In a 7-year period, 70 children aged 5-15 years (mean 9.2 years) were treated for a fracture of the femoral shaft (73 fractures: 71 closed and 2 open) by flexible medullary nailing, either ascending (12 cases) or descending (61 cases). Although the classic treatment is use of the ascending route described by the Nancy team, the subtrochanteric descending route was preferred for its simplicity. Noninvolvement of the knee by the insertion of the nail allows earlier autonomy in children. Results were satisfactory and no complications related to the method were observed. Biomechanical principles are also respected by such treatment.

  11. A STUDY ON SURGICAL MANAGEMENT OF INTERTROCHANTERIC AND SUBTROCHANTERIC FRACTURES OF FEMUR BY PROXIMAL FEMORAL NAIL

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    Kuppa Srinivas

    2015-01-01

    Full Text Available AIMS AND OBJECTIVES: To study the various fracture patte rns, mechanism of injury, operative difficulties encountered, result in terms of radiological union and ultimate functional outcome of intertrochanteric and subtrochanteric fractures of femur treated by proximal femoral nail. RESULTS: In the present study , 22 cases of subtrochanteric and intertrochanteric fractures of proximal femur treated by proximal femoral nail at Govt. General Hospital, Kurnool from August 2010 to July 2012 were included. Out of 22 cases, 18 were subtrochanteric and 4 were intertrochanteric fractures. In subtrochanteric fractures, seinsheimer type III were 44.4%,in intertrochanteric fractures evan’s unstable fractures were 75%. The mean age group was 45years with males 82%, right side femur were involved in 55%, road traffic accidents accounted for 55%, associated injuries found in 36%. Mean duration of hospital stay was 16.83 days, union was achieved in 86.6% with mean time for union was 12.75 weeks. Hip joint stiffness was found 23% and non - union in 4%. CONCLUSI ON: By the analysis of data collected in the present study, proximal femoral nail is an effective device in the management of complex proximal femoral fractures. It offers superior stabilization and good fracture union

  12. Results of titanium elastic nailing in paediatric femoral diaphyseal fractures-report of 30 cases

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    Jalan Divesh

    2013-04-01

    Full Text Available 【Abstract】 Objective: Fractures of the femur are the most incapacitating fractures. For children aged 6-14 years, there is no clear consensus as to the preferred treatment. The conventional treatment of traction and cast-ing is no longer recommended. We report our experience in titanium elastic nailing for treatment of paediatric femoral diaphyseal fractures. Methods: Thirty patients in the age group of 6-16 years with displaced diaphyseal femoral fractures were sta-bilized with titanium elastic nails. Patients were followed up clinically and radiologically for a minimum period of 1 year. The final results were evaluated using Flynn’s criteria. Tech-nical difficulties and complications associated with the pro-cedure were also analysed. Results: Overall results were excellent in 20 cases and satisfactory in 10 cases. No patient had poor result. The average hospital stay was 9 days. All the fractures healed with an average time to union of 6.86 weeks. The most com-mon complication encountered was soft tissue irritation at the nail entry site seen in 6 cases. Clinically, lengthening was noticed in 4 cases, while no patient had shortening. Malalignment was seen in only 6 cases. Perioperative diffi-culties encountered were failure of closed reduction seen in 6 cases and corkscrewing of nails in one case. Conclusion: Titanium elastic nails are a relatively easy to use, minimally invasive, physeal-protective implant sys-tem with high rate of good and excellent outcomes in chil-dren aged 6-16 years. Technical pitfalls can be eliminated by adhering to the basic principles. Key words: Titanium; Nails; Fractures, bone; Femur; Paediatrics

  13. Functional Outcome After Antegrade Femoral Nailing : A Comparison of Trochanteric Fossa Versus Tip of Greater Trochanter Entry Point

    NARCIS (Netherlands)

    Moein, Chloe Ansari; ten Duis, Henk-Jan; Oey, Liam; de Kort, Gerard; van der Meulen, Wout; Vermeulen, Karin; van der Werken, Christiaan

    2011-01-01

    Objectives: This study was performed to explore the relationship between entry point-related soft tissue damage in antegrade femoral nailing and the functional outcome in patients with a proximal third femoral shaft fracture. Design: Retrospective clinical trial. Setting: Level I university trauma c

  14. Nails

    Science.gov (United States)

    ... caused by nail injury or certain drugs and diseases. Bacterial infections, most often due to injury, poor skin hygiene, nail biting, finger sucking or frequent exposure to water. Ingrown toenails, caused by improper nail trimming, poor stance, digestive problems ...

  15. Results of titanium elastic nailing in paediatric femoral diaphyseal fractures— report of 30 cases

    Institute of Scientific and Technical Information of China (English)

    Divesh Jalan; Rajesh Chandra; VK Sharma

    2013-01-01

    Objective:Fractures of the femur are the most incapacitating fractures.For children aged 6-14 years,there is no clear consensus as to the preferred treatment.The conventional treatment of traction and casting is no longer recommended.We report our experience in titanium elastic nailing for treatment of paediatric femoral diaphyseal fractures.Methods:Thirty patients in the age group of 6-16 years with displaced diaphyseal femoral fractures were stabilized with titanium elastic nails.Patients were followed up clinically and radiologically for a minimum period of 1 year.The final results were evaluated using Flynn's criteria.Technical difficulties and complications associated with the procedure were also analysed.Results:Overall results were excellent in 20 cases and satisfactory in 10 cases.No patient had poor result.The average hospital stay was 9 days.All the fractures healed with an average time to union of 6.86 weeks.The most common complication encountered was soft tissue irritation at the nail entry site seen in 6 cases.Clinically,lengthening was noticed in 4 cases,while no patient had shortening.Malalignment was seen in only 6 cases.Perioperative difficulties encountered were failure of closed reduction seen in 6 cases and corkscrewing of nails in one case.Conclusion:Titanium elastic nails are a relatively easy to use,minimally invasive,physeal-protective implant system with high rate of good and excellent outcomes in children aged 6-16 years.Technical pitfalls can be eliminated by adhering to the basic principles.

  16. Role of Russell - Taylor delta reconstruction nail in the management of complex proximal femoral fractures

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    Raj D

    2005-01-01

    Full Text Available Background: Complex proximal femoral fractures are challenging problem. Methods: Forty-one patients had Russell- Taylor Delta reconstruction nailing done during the period from March 1992 to December 1996. 38 patients could be followed both clinically and radiologically either up to the fracture union or death. Clinical outcome was assessed by Kyle′s criteria. Out of 13 patients with high-energy comminuted fractures, 12 were rated excellent or good. There was one death due to poly trauma. Results: Out of six elderly subtrochanteric fractures, 4 had excellent or good results. There was one poor result and one death. Out of 11 elderly interochanteric fractures with subtrochanteric extension, 8 had excellent or good results. There was 1 fair, 1 poor result and 1 death. In the elderly groups, the poor results were due to poor pre- existing medical conditions of the patients. In all the seven cases of pathological lesions, excellent or good results were achieved either till fracture union or death because of their malignant pathology. Conclusion: Russell- Taylor Delta reconstruction nail is a very useful device in high-energy comminuted proximal femoral fractures, in elderly low energy proximal femoral fractures and also in pathological lesions. The implant provides bio-mechanically stable fixation. The relatively high complication rate in elderly patients is because of their poor medical condition. In cases of pathological lesions, it is always preferable to fix the bone at the stage of impending fracture.

  17. Bilateral Distal Femoral Nailing in a Rare Symmetrical Periprosthetic Knee Fracture

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    Marcos Carvalho

    2014-01-01

    Full Text Available The authors report a case of a 78-year-old polytrauma patient, with severe thoracic trauma and bilateral symmetrical periprosthetic femoral fractures after a violent car accident. After the primary survey, with the thoracic trauma stabilized, neurovascular lesions excluded, and provisional immobilization applied, both fractures were classified as OTA: 33-A3, Rorabeck Type II, and closed reduction and internal fixation with distal femoral nails were performed. At 5 months of follow-up, the patient was able to walk with crutches and clear radiologic signs of fracture consolidation could be seen. At 24 months, the patient walked without any walking aid and had recovered her previous functional status. This surgical option allowed the authors to achieve relative stability using an intramedullary technique, preserving fracture hematoma in an osteopenic patient, and was found to be successful in recovering the patient’s previous functional status and satisfaction after major trauma.

  18. EVALUATION OF RESULTS IN INTRAMEDULLARY FIXATION OF SUBTROCHANTERIC FRACTURE OF FEMUR WITH PROXIMAL FEMORAL NAILING (AO TYPE OF DESIGN

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    D. Nitin Reddy

    2016-08-01

    Full Text Available BACKGROUND Among the femoral shaft injuries, upper femoral fractures present a peculiar problem of securing effective neutralization of deforming forces. The mechanical stresses at this level are very high, as they occur at the junction between the trabecular and cortical zone and also because of the deforming forces due to peculiar muscle insertion to the proximal and distal fragments. The present study was conducted to assess the utility and effectiveness of Proximal Femoral Nail evolved by AO-ASIF in 1997, for various types of upper femoral fractures. MATERIAL AND METHOD The present study consists of the patients admitted to Orthopaedic Units of KIMS Hospital, between June 2012 and July 2014; 1267 fracture cases were treated in Department of Orthopaedics, Konaseema Institute of Medical Sciences, Amalapuram, during this period. Of these 264 patients were admitted for femoral fractures. Of the 264 femoral fractures, 18 patients above the age of 20 years with subtrochanteric fractures were included in this study. RESULT Reduction was good in 72.2% (13 of the cases. Acceptable reduction was achieved in 3 (16.6% patients. Poor reduction was noted in 2 (11.1% patients. One of them were of elderly age group and had poor outcome at final follow-up. SUMMARY AND CONCLUSION From this sample study, we conclude that Proximal Femoral Nail is a good implant for the treatment of subtrochanteric fractures of femur provided optimal reduction of the fracture and good positioning of the nail and screws are achieved.

  19. 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

    Directory of Open Access Journals (Sweden)

    Tsiridis Eleftherios

    2011-03-01

    Full Text Available Abstract 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.

  20. SURGICAL MANAGEMENT OF INTERTROCHANTERIC FRACTURES : A STUDY USING DYNAMIC HIP SCREW AND PROXIMAL FEMORAL NAIL

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    Venkateswara Rao

    2015-08-01

    Full Text Available OBJECTIVES: The aim of this study was to compare the outcome of intertrochanteric fractures treated with Dynamic Hip Screw and Proximal Femoral nail. METHODS: This study was conducted on 80 cases of Intertrochanteric fractures of femur treated by a dynamic hip screw and proximal femoral nail. Patients were operated on standard fracture table under image intensifier control. RESULTS: The average age of the patient was 63.2 years. Most common mechanism of fracture was domestic fall. The unstable pattern was more common in old aged patients with higher grade of osteoporosis. The average blood loss was 240 and 320ml in PFN and DHS group respectively. In PFN there were more no. of radiation exposure intraoperatively. The average operating time for the patients treated with PFN was 100min as compared to 80 min in patients treated with DHS. No complications of non - union and infection. In the PFN group the amount of sliding on X - rays was less as compared to DHS. The patients treated with PFN started early ambulation as they had better Harris Hip Score in the early period (at 1 and 3 month. In the long term both the implant had almost similar functional outcomes. CONCLUSION: From the study, we concluded PFN is better alternative to DHS in management of intertrochanteric fractures but is technically difficult procedure and requires more expertise compared to DHS.

  1. OUTCOME ANALYSIS OF PROXIMAL FEMORAL NAIL IN STABLE INTERTROCHANTERIC FEMUR FRACTURES

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    Suneet

    2015-02-01

    Full Text Available BACKGROUND: Proximal femoral nail is commonly recommended as treatment of choice for unstable and reverse oblique intertrochanteric fracture in view of superior biomechanics and prevention of varus collapse associated with Dynamic hip scre w. Although in stable fracture types DHS is still being preferred as the treatment modality of choice. Proximal femoral nail owing to better biomechanics , less complications can still be used as the method of choice in stable fracture pattern as well. The aim of this study is to evaluate the results of PFN nail in stable intertrochanteric fracture and include evaluation of the mean operative time , amount of blood loss , complications and functional status of the patient . MATERIALS AND METHODS : In this study 30 patients presented to Orthopedics Department Hamidia Hospital Bhopal with stable intertrochanteric fracture were treated with p roximal femoral nail. All patients were followed up for a period of 1 year and functional outcome assessment including amount of shortening , neck - shaft angle , Harris hip score was noted. RESULTS : At the time of final follow - up , all 30 patients showed union with average Harris hip score of 86.6 (range 62 - 94 . 14 patients had excellent score , 9 patients had good score , 5 patients ha d fair score and 2 patients had poor outcome . Mean neck shaft angle achieved post - reduction was 131.4 degrees and at final follow - up was 128.4 degrees. Limb length discrepancy was assessed in the final follow - up with average shortening of 5 mm and 4 patien ts had shortening above 1.5 cm. Average blood loss was 80 ml , the mean operative time was 65 minutes. Complications w ere seen in 3 cases with one case of local wound infection, one of screw cut - out and one of screw penetration. CONCLUSION : With proper tech nique PFN gives excellent results with less blood loss and shorter incision with less soft tissue trauma are added advantages which ultimately lead to less morbidity and

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

    Institute of Scientific and Technical Information of China (English)

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

    2016-01-01

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

  3. A biomechanical evaluation of proximal femoral nail antirotation with respect to helical blade position in femoral head: A cadaveric study

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    Jin-Ho Hwang

    2012-01-01

    Full Text Available Objective: Despite new developments in the management of osteoporotic fractures, complications like screw cutout are still found in the fixation of proximal femur fractures even with biomechanically proven better implants like proximal femoral nail antirotation (PFNA. The purpose of this cadaveric study was to investigate the biomechanical stability of this device in relation to two common positions (center-center and inferior-center of the helical blade in the femoral head in unstable trochanteric fractures. Materials and Methods: Eight pairs of human cadaveric femurs were used; in one group [center-center (C-C group], the helical blade of PFNA was fixed randomly in central position both in anteroposterior and lateral view, whereas in the other group it was fixed in inferior one-third position in anteroposterior and in central position in lateral view [inferior-center (I-C group]. Unstable intertrochanteric fracture was created and each specimen was loaded cyclically till load to failure Results: Angular and rotational displacements were significantly higher within the C-C group compared to the I-C group in both unloaded and loaded condition. Loading to failure was higher in the I-C group compared to the C-C group. No statistical significance was found for this parameter. Correlations between tip apex distance, cyclic loading which lead to femoral head displacement, and ultimate load to failure showed a significant positive relationship. Conclusion: The I-C group was superior to the C-C group and provided better biomechanical stability for angular and rotational displacement. This study would be a stimulus for further experimental studies with larger number specimens and complex loading protocols at multicentres.

  4. A novel method of removal of a broken drill bit in the femoral medullary canal during internal fixation of a type C distal femoral fracture: a case report

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    Mounasamy Varatharaj

    2012-11-01

    Full Text Available 【Abstract】 Breakage of surgical instruments and implants during operative procedures is not uncommon in any surgical discipline. The need for removal and the out-come of leaving the broken instruments and implants in the surgical area have not been described in detail. Few studies have suggested removal if they are lying loosely in the tis-sues or joint, close to neurovascular structures. Challenges and the amount of time spent in the retrieval of broken in-struments and implants are well known among surgeons, so most choose to leave them in situ. We reported a novel method of retrieval of a broken drill bit in the femoral medul-lary canal during internal fixation of a type C distal femoral fracture. Key words: Fracture fixation, internal; Femoral fractures; Surgical instruments

  5. "Push-past" reaming as a reduction aid with intramedullary nailing of metadiaphyseal and diaphyseal femoral shaft fractures.

    Science.gov (United States)

    Gary, Joshua L; Munz, John W; Burgess, Andrew R

    2014-06-01

    Eccentric reaming of cortical bone near a fracture site can introduce malalignment when an intramedullary nail is placed. The authors describe a technique of reaming metadiaphyseal and diaphyseal femur fractures in which maintaining reduction at the fracture site is not necessary to obtain an excellent alignment of long bone fractures after intramedullary nailing. They have found that central reaming proximal and distal to, but not at, the fracture site allows for excellent reduction of long bone fractures when the intramedullary nail is passed. The reamer is stopped just before the fracture site and then "pushed" across the fracture prior to resumption of reaming. The authors present "push-past" reaming as a technical trick to facilitate reduction of femoral fractures treated with intramedullary nails and a consecutive series of 18 cases in which excellent postoperative alignment was achieved.

  6. Treatment of distal femoral nonunion and delayed union by using a retrograde intramedullary interlocking nail

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Objective: To analyze the causes of distal femoral nonunion and delayed union and assess the outcome of the corresponding treatment, retrograde intramedullary interlocking nail (RIIN).   Methods: From June 1995 to December 1998, 15 patients (9 males and 6 females) with distal femoral nonunion and delayed union were treated with RIIN. The average age of the patients was 34.5 years (23-46 years). Bone grafting was performed in 10 patients, closed reaming was done in the other 5 patients. Correction osteotomy was performed in 2 patients, and intra-articular release of knee adhesion in 11 patients. X-ray examination and knee society clinical rating system (KSS) were used to evaluate the results.   Results: All fractures were followed up for at least 9 months with average follow-up duration of 14.5 months (9-33 months). Solid union was documented in all patients at 6.4 months on average. There were no infections or malunions in this series. Based on the final follow-up data, acceptable functional range of motion (ROM) of over 90° was achieved in most patients. The average ROM was 93.5° with significant improvement of 28° (42.7%, P<0.05) compared with the preoperative ROM. The average knee score was 96. Excellent ROM emerged in 13 patients. The knee function score was 90.5 on average.   Conclusions: The main causes of distal femoral nonunion and delayed union are improper indications and improper use of the implants. RIIN is an effective alternative for treatment of distal femoral nonunion and delayed union because it can provide a stable and reliable fixation which is beneficial for early functional exercise of knee. Bone grafting, closed reaming and intra-articular release of knee adhesion should be considered in order to enhance the bone healing and improve ROM and the knee function.

  7. A STUDY OF MANAGEMENT OF SUBTROCHANTERIC FRACTURE FEMUR BY PROXIMAL FEMORAL NAILING

    Directory of Open Access Journals (Sweden)

    Venkateswara Rao

    2015-08-01

    Full Text Available Numerous variations of intramedullary nails have been devised to achieve a stable fixation and early mobilisation of pertrochanteric fracture, among which is the proximal femoral nail (PFN. We report here the results of a prospective study carried out at our institute on 60 consecutive patients who had suffered high subtrochanteric fracture between May 2011 and October 2014 and were subsequently treated with a PFN. Close t o anatomical reduction of the fracture fragments was achieved in 54 patients, while limited open reduction was required in 3 patients. In the present series, 3.33(2 of cases had superficial infection and no deep infections were recorded. Cut of the anti - r otational screw was noted in 1 patient. Fracture of the shaft with breakage of the nail was noted 1.66% (1 of patients. In the current series, the mean Harris Hip score was 80.76 and it was ranging from 100 - 29. In this series all the patients between 20 – 3 0 years had excellent result irrespective of the type of fracture. Older age group patients had relatively poor results and 50% (5 of them had poor results and another 50% (5 had good to fair results. In this study excellent outcome was not seen in the o lder age group patients.Our results indicate the necessity of a careful surgical technique and modifications that are specific to the individual fracture pattern in order to reduce complications. Osteosynthesis with the PFN offers the advantages of high ro tational stability of the head - neck fragment, an unreamed implantation technique and the possibility of static or dynamic distal locking.

  8. Preliminary effect of proximal femoral nail antirotation on emergency treatment of senile patients with intertrochanteric fracture

    Institute of Scientific and Technical Information of China (English)

    TANG Xin; LIU Lei; YANG Tian-fu; TU Chong-qi; WANG Guang-lin; FANG Yue; DUAN Hong; ZHANG Hui; PEI Fu-xing

    2010-01-01

    Objective: To retrospectively analyse the clinical outcome of emergency treatment of senile intertrochanteric fractures with proximal femoral nail antirotation (PFNA).Methods: From September 2008 to March 2009, 35 senile patients with intertrochanteric fracture, aged from 65 to 92 years with an average age of 76.5 years, were treated with PFNA within 24 hours after injury. There were 10 type Ⅰ fractures, 19 type Ⅱ and 6 type Ⅲ according to upgraded Evans-Jensen classification system. All patients were complicated with osteoporosis, and 19 patients had preexisting internal medical diseases. According to the rating scale of disease severity by the American Society of Anesthesiologists (ASA), there were 9 grade Ⅰ, 14 grade Ⅱ, 8 grade Ⅲ, and 4 grade Ⅳ.Results: The duration for operation ranged from 45 to 73 minutes with an average of 57.6 minutes. The volume of blood loss during operation ranged from 50 to 120 ml with an average of 77.5 ml. Patients could ambulate 2-4 days after operation (mean 3.5 days). Hospital stay was 4-7 days (mean 5.3 days). Full weight bearing time was 10-14 weeks (mean 12.8 weeks). During hospitalization period, there was no regional or deep infection, hypostatic pneumonia, urinary tract infection and bedsore except for 2 cases of urine retention. All cases were followed up with an average period of 12.3 months, and bone healing achieved within 15-18 weeks (mean 16.6 weeks). No complications such as delayed union, coxa vara or coxa valga, screw breakage or backout occurred and only 2 cases had trochanter bursitis because of thin body and overlong end of the antirotated nail. According to the Harris grading scale, the results were defined as excellent in 21 cases, good in 9 cases and fair in 5 cases, with the excellent and good rates of 85.7%.Conclusion: The emergency treatment of senile intertrochanteric fracture with proximal femoral nail antirotation has the advantages of minimal invasion, easy manipulation,less blood loss

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

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    Koyuncu S

    2015-12-01

    Full Text Available Şemmi Koyuncu,1 Taşkın Altay,2 Cemil Kayalı,2 Fırat Ozan,3 Kamil Yamak2 1Department of Orthopedics and Traumatology, Bayburt State Hospital, Bayburt, 2Department of Orthopedics and Traumatology, İzmir Bozyaka Training and Research Hospital, İzmir, 3Department of Orthopedics and Traumatology, Kayseri Training and Research Hospital, Kayseri, Turkey Background: This study aims at assessing the clinical results, radiographic findings, and associated complications after osteosynthesis of trochanteric hip fractures with proximal femoral nail (PFN.Methods: A total of 152 patients with hip fractures who underwent osteosynthesis with PFN were included. The hip fracture types in the patients included in the study were classified according to the American Orthopedic/Orthopedic Trauma Association (AO/OTA. AO/OTA A1, A2, and A3 type fractures were found in 24 (15.8%, 107 (70.4%, and 21 (13.8% patients, respectively. The Baumgaertner scale was used to assess the degree of postoperative reduction. The Salvati–Wilson hip function (SWS scoring system was used to evaluate functional results. After a follow-up period, clinical and radiographic results were evaluated and complications were assessed. The relationship between the complications and SWS score, age, sex, fracture type, reduction quality, and time from the fracture to surgery was evaluated.Results: Eighty-five (55.9% female patients and 67 (44.1% male patients were enrolled in the study. Seventy-nine (51.9% patients had left hip fractures, and 73 (48.1% had right hip fractures. The mean age was 76 (range 21–93 years, and the mean follow-up duration was 23.6 (range 7–49 months. Postoperatively, one patient (0.6% had a poor reduction, 16 patients (10.5% had an acceptable reduction, and 135 patients (88.9% had a good reduction according to the above criteria. The SWS scores were excellent, good, moderate, and poor in 91 (59.8%, 45 (29.6%, 15 (9.8%, and one (0.6% patients, respectively. Late

  10. A novel method of removal of a broken drill bit in the femoral medullary canal during internal fixation of a type C distal femoral fracture: a case report

    Institute of Scientific and Technical Information of China (English)

    Varatharaj Mounasamy; Pingal Desai; Satya Mallu; Senthil Sambandam

    2012-01-01

    Breakage of surgical instruments and implants during operative procedures is not uncommon in any surgical discipline.The need for removal and the outcome of leaving the broken instruments and implants in the surgical area have not been described in detail.Few studies have suggested removal if they are lying loosely in the tissues or joint,close to neurovascular structures.Challenges and the amount of time spent in the retrieval of broken instruments and implants are well known among surgeons,so most choose to leave them in situ.We reported a novel method of retrieval of a broken drill bit in the femoral medullary canal during internal fixation of a type C distal femoral fracture.

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

    Science.gov (United States)

    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

  12. Comparative endurance testing of the Biomet Matthews Nail and the Dynamic Compression Screw, in simulated condylar and supracondylar femoral fractures

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    Davies Benjamin M

    2008-01-01

    Full Text Available Abstract Background The dynamic compression screw is a plate and screws implant used to treat fractures of the distal femur. The Biomet Matthews Nail is a new retrograde intramedullary nail designed as an alternative surgical option to treat these fractures. The objective of this study was to assess the comparative endurance of both devices. Method The dynamic compression screw (DCS and Biomet Matthews Nail (BMN were implanted into composite femurs, which were subsequently cyclically loaded using a materials testing machine. Simulated fractures were applied to each femur prior to the application of load. Either a Y type fracture or a transverse osteotomy was prepared on each composite femur using a jig to enable consistent positioning of cuts. Results The Biomet Matthews Nail demonstrated a greater endurance limit load over the dynamic compression screw in both fracture configurations. Conclusion The distal locking screws pass through the Biomet Matthews Nail in a unique "cruciate" orientation. This allows for greater purchase in the bone of the femoral condyle and potentially improves the stability of the fracture fixation. As these fractures are usually in weak osteoporotic bone, the Biomet Matthews Nail represents a favourable surgical option in these patients.

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

    Science.gov (United States)

    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.

  14. SURGICAL OUTCOMES OF SUBTROCHANTERIC FRACTURES OF FEMUR TREATED WITH PROXIMAL FEMORAL NAIL (PFN

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    Jenson

    2016-06-01

    Full Text Available BACKGROUND AND OBJECTIVES Subtrochanteric fractures of the femur remain one of the most challenging fractures facing orthopaedic surgeons. Most of the fractures in the elderly results from trivial fall from standing or walking, while in the younger age group it is mainly due to road traffic accidents. Closed management of these subtrochanteric fractures thus poses difficulties in obtaining and maintaining a reduction, making operative management the preferred treatment. Hence, this study is intended to determine the effectiveness of intramedullary fixation of subtrochanteric fractures with the proximal femoral nail and the complications involved in the management of subtrochanteric fractures. METHODOLOGY This is a prospective study of 90 cases of Subtrochanteric fracture admitted to Tagore Medical College and Hospitals between October 2013 and Jan 2016 treated with the proximal femoral nail. Cases were taken according to inclusion and exclusion criteria, i.e. fresh Subtrochanteric fracture in adults. Pathologic fractures, multiple fractures, fractures in children, old neglected fractures were excluded from the study. RESULTS In our study of 90 cases, there were 75 male and 15 female patients with age ranging from 17 years to 75 years with most patients in between 21-40 years; 67% of the cases admitted were road traffic accidents, 23% due to fall from height and 10% due to trivial fall with right side being more common side affected. Russell and Taylor type IA fracture accounted for 40% of cases. Mean duration of hospital stay was 12 days and mean time of full weight bearing was 14 weeks in our patients. Out of 90 cases, 9 cases were lost in follow-up and 3 cases died. Good-to-excellent results were seen in 80% of cases in our study. CONCLUSION From our study, we conclude that PFN is a reliable implant for subtrochanteric fractures leading to high rate of bone union and minimal soft tissue damage. Intramedullary fixation has biological and

  15. Prophylactic bilateral intramedullary femoral nails for bisphosphonate-associated signs of impending subtrochanteric hip fracture.

    Science.gov (United States)

    Yoon, Richard S; Beebe, Kathleen S; Benevenia, Joseph

    2010-04-01

    In the short and midterm, bisphosphonates have proven highly efficacious in the prevention of low-energy fractures, but long-term results and adverse effects have yet to be definitively identified. Of particular concern are emerging reports of long-term bisphosphonate users presenting with unusual low-energy subtrochanteric femur fractures. Perhaps associated with hyperactive bone remodeling leading to an eventually weakened bony architecture, the efficacy of longer-term bisphosphonate use has come into question, especially in those with >5 years of therapy.This article describes a case of a 65-year-old woman with a 10-year history of bisphosphonate use who presented with prodromal thigh pain and characteristic radiographic findings indicative of potential impending subtrochanteric insufficiency fracture. Supported by reports in the literature, unique characteristics of a certain clinical picture warn of potential bisphosphonate-associated subtrochanteric hip fracture; to our knowledge, we present the first reported prophylactic bilateral femoral intramedullary nailing to prevent fragility fracture. A deeper look into the biochemistry behind associated bony weakness caused by long-term incorporation of bisphosphonates is needed, especially if an endpoint to the therapy is to be determined. However, with mounting clinical evidence supporting the risk of bisphosphonate-associated fragility fracture, a characteristic radiographic appearance and clinical presentation cannot be ignored. In the interim, elective surgery may be an efficacious alternative in the treatment of an expected, readily preventable fracture.

  16. Treatment options for unstable trochanteric fractures: Screw or helical proximal femoral nail

    Institute of Scientific and Technical Information of China (English)

    Jeetendra Bajpai; Rajesh Maheshwari; Akansha Bajpai; Sumit Saini

    2015-01-01

    Purpose: To compare treatment outcome of screw proximal femoral nail (PFN) system with that of a helical PFN.Methods: The study included 77 patients with closed unstable intertrochanteric fracture classified as AO 31A2 & 31A3, between June 2008 to August 2011.Inclusion criteria were: all mature skeletons above 50 years of age;closed unstable trochanteric fracture classified as AO 31A2 & A3.Exclusion criteria were: immature skeleton, pathological fracture of any cause other than osteoporosis, inability to walk independently prior to injury.Patients were randomized to 2 treatment groups based on admission sequence.Forty patients were treated with screw PFN and thirty seven were treated with helical PFN.Results: Both groups were similar in respect of time of surgery, blood loss and functional assessment and duration of hospitalization.In screw PFN group 2 patients had superficial wound infection, 1 patient had persistent hip pain and 1 patient had shortening >1 cm but <2 cm, while in helical PFN group 1 patient had superficial wound infection.Conclusion: Both screw and helical PFN are very effective implants in osteoporotic and unstable trochanteric fractures even in Indian patients where the bones are narrow and neck diameter is small.It is an implant of choice for osteoporotic and unstable trochanteric fractures.

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

    Science.gov (United States)

    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.

  18. Augmentation plating in hypertrophic non-union after nail fixation of femoral shaft fracture compared with exchange plating

    Institute of Scientific and Technical Information of China (English)

    Jiang Liangjun; Pan Zhijun; Zheng Qiang

    2014-01-01

    Background Augmentation plating has been used successfully to treat hypertrophic non-union after nail fixation.This study compared the efficacy of augmentation plating and exchange plating for treating hypertrophic non-union of femoral shaft fracture after intramedullary nail fixation.Methods A total of 12 patients received augmentation plating and 15 patients received exchange plating as treatment for femoral shaft hypertrophic non-union.The procedures were conducted at our medical centre between January 2005and January 2012.Clinical follow-up was conducted at 2 weeks,1 month and then monthly until union was achieved to compare union time,operation time,bleeding and complications between the two groups.Results All patients underwent follow-up examinations until fracture union was achieved.The average length of followup time after the second treatment was (18.37±3.28) months.The time needed for union was (4.17±0.94) months in the augmentation plating group and (5.33±1.72) months in the exchange plating group.The operation time was (90.00±17.58) minutes in the augmentation plating group and (160.00±25.35) minutes in the exchange plating group.The amount of blood loss during the operation was (270.00±43.32) ml in the augmentation plating group and (530.00±103.65) ml in the exchange plating group.Both groups showed significant difference (P <0.05) in their results.No complications were reported after the second operation.Conclusions Augmentation plating after nail fixation could remove local rotation instability,facilitate simple operation,create minimal damage and enable exercise for early functional recovery.Therefore,augmentation plating is excellent for treating hypertrophic non-union after nail fixation in femoral shaft fracture.

  19. [Lezius nailing under controversy? Experiences with Lezius-Herzer curved nailing in 1,062 pertrochanteric femoral fractures].

    Science.gov (United States)

    Dehne, A; Bernhard, J; Wolf, R; Kinder, M

    1987-01-01

    Curved nailing according to Lezius and Herzer was applied to 700 of 1,062 cases of pertrochanteric fractures of the femur at the Surgical Department of the "Carl Gustav Carus" Medical Academy, Dresden, between 1964 and 1985. Complications are described, and results are generally compared with other surgical techniques used to handle pertrochanteric fractures of the femur. Lezius nailing, when compared to other methods, has proved to be a simple and reliable approach, primarily under the aspect of geriatric traumatology, and should be used on a much wider scale.

  20. EARLY FUNCTIONAL RESULTS OF UNSTABLE PERTROCHANTERIC FRACTURES TREATED WITH PROXIMAL FEMORAL NAILS IN A PERIPHERAL TERTIARY CARE CENT RE

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    Bharath Kumar

    2015-05-01

    Full Text Available BACKGROUND : Pertrochanteric fractures forms a major share of proximal femoral fractures in young and old . Proper implant selection and surgical planning plays a pivotal role in providing fracture union and early rehabilitation of patients to prevent complications due to recumbency . AIM : The aim of this retrospective study is to assess the results of proximal femoral nails in unstable pertrochanteric f ractures . MATERIALS AND METHODS : This study was performed in the Department of Orthopaedic Surgery , Chettinad hospital and research institute , Kelambakkam between November 2012 and December 2014 . 15 patients with pertrochanteric fractures were retrospectively followed . Among the fifteen 9 were male and 6 were female with an average age of 43 . Eleven patients sustained Intertrochanteric fractures , 8 of A2 type and 3 of A3 type according to AO classification . 4 patients had subtroch anteric fractures of seinseimer Type 5 . RESULTS : Short PFN was used in all the 11 Intertrochanteric fractures and long PFN was used in the 4 subtrochanteric fractures . All fractures healed by around 3 . 5 months . There is one case of varus malunion and one c ase of screw pullout which required implant removal . The limitations of this study are its retrospective nature , small sample size and short follow up . CONCLUSION : Our results show that proximal femoral nails being load sharing implants form an ideal choic e for stabil ising pertrochanteric fractures . Minimally invasive technique of insertion with less blood loss make it an ideal choice in such complex scenarios .

  1. Undetected iatrogenic lesions of the anterior femoral shaft during intramedullary nailing: a cadaveric study

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    Shepherd Lane

    2008-07-01

    Full Text Available Abstract Background The incidence of undetected radiographically iatrogenic longitudinal splitting in the anterior cortex during intramedullary nailing of the femur has not been well documented. Methods Cadaveric study using nine pairs of fresh-frozen femora from adult cadavers. The nine pairs of femora underwent a standardized antegrade intramedullary nailing and the detection of iatrogenic lesions, if any, was performed macroscopically and by radiographic control. Results Longitudinal splitting in the anterior cortex was revealed in 5 of 18 cadaver femora macroscopically. Anterior splitting was not detectable in radiographic control. Conclusion Longitudinal splitting in the anterior cortex during intramedullary nailing of the femur cannot be detected radiographically.

  2. Intramedullary femoral nailing through the trochanteric fossa versus greater trochanter tip : a randomized controlled study with in-depth functional outcome results

    NARCIS (Netherlands)

    Moein, C. M. Ansari; ten Duis, H. J.; Oey, P. L.; de Kort, G. A. P.; van der Meulen, W.; van der Werken, Chr

    2011-01-01

    In a level 1 university trauma center, an explorative randomized controlled study was performed to compare soft tissue damage and functional outcome after antegrade femoral nailing through a trochanteric fossa (also known as piriform fossa) entry point to a greater trochanter entry point in patients

  3. Early intramedullary nailing for femoral fractures in patients with severe thoracic trauma: A systemic review and meta-analysis

    Institute of Scientific and Technical Information of China (English)

    Xiao-Yuan Liu; Meng Jiang; Cheng-La Yi; Xiang-Jun Bai; David J.Hak

    2016-01-01

    Purpose:Early intramedullary nailing (IMN) within the first 24 h for multiply injured patients with femoral fracture and concomitant thoracic trauma is controversial.Previously published studies have been limited in size and their outcomes have been inconclusive.A meta-analysis was conducted to evaluate the available data in order to guide care and help improve the outcomes for these patients.Methods:We searched the literature up to December 2011 in the main medical search engines and identified 6 retrospective cohort studies that explored the safety of early IMN in patients with both femoral fracture and chest injury.Our primary outcome was the rates of pulmonary complication (pneumonia,adult respiratory distress syndrome,fat embolism syndrome),multiple organ failure (MOF) and mortality.Results:We found no statistically significant difference in the rate of pulmonary complications,MOF or mortality in the patients treated with early IMN.Conclusion:Early IMN for femoral fractures does not increase the mortality and morbidity in chestinjured patients in the studies analyzed.

  4. Decreased muscle strength is associated with impaired long-term functional outcome after intramedullary nailing of femoral shaft fracture

    DEFF Research Database (Denmark)

    Larsen, Peter; Elsøe, Rasmus; Graven-Nielsen, Thomas;

    2015-01-01

    -up with clinical examination of 48 patients treated with intramedullary nailing after femoral shaft fracture between 2007 and 2010. The patients underwent a clinical examination and assessment of walking ability, maximal muscle strength during knee flexion and extension and hip abduction. Hip disability...... strength of knee flexion with the injured leg (226.0 N) was significantly lower then knee flexion with the non-injured leg (259.5 N, P abduction (129.2 vs 156.0 N, P ... in the difference in muscle strength were observed as well as between worse HOOS outcome and increasing body mass index. CONCLUSION:This study showed that decreased muscle strength for knee flexion, knee extension and hip abduction was associated with worse long-term functional outcome measured with a disease...

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

    Science.gov (United States)

    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.

  6. Outcome analysis of retrograde nailing and less invasive stabilization system in distal femoral fractures: A retrospective analysis

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    Christian Hierholzer

    2011-01-01

    Full Text Available Background: Two major therapeutic principles can be employed for the treatment of distal femoral fractures: retrograde intramedullary (IM nailing (RN or less invasive stabilization on system (LISS. Both operative stabilizing systems follow the principle of biological osteosynthesis. IM nailing protects the soft-tissue envelope due to its minimally invasive approach and closed reduction techniques better than distal femoral locked plating. The purpose of this study was to evaluate and compare outcome of distal femur fracture stabilization using RN or LISS techniques. Materials and Methods: In a retrospective study from 2003 to 2008, we analyzed 115 patients with distal femur fracture who had been treated by retrograde IM nailing (59 patients or LISS plating (56 patients. In the two cohort groups, mean age was 54 years (17-89 years. Mechanism of injury was high energy impact in 57% (53% RN, 67% LISS and low-energy injury in 43% (47% RN, 33% LISS, respectively. Fractures were classified according to AO classification: there were 52 type A fractures (RN 31, LISS 21 and 63 type C fractures (RN 28, LISS 35; 32% (RN and 56% (LISS were open and 68% (RN and 44% (LISS were closed fractures, respectively. Functional and radiological outcome was assessed. Results: Clinical and radiographic evaluation demonstrated osseous healing within 6 months following RN and following LISS plating in over 90% of patients. However, no statistically significant differences were found for the parameters time to osseous healing, rate of nonunion, and postoperative complications. The following complications were treated: hematoma formation (one patient RN and three patients LISS, superficial infection (one patient RN and three patients LISS, deep infection (2 patients LISS. Additional secondary bone grafting for successful healing 3 months after the primary operation was required in four patients in the RN (7% of patients and six in the LISS group (10% of patients

  7. Comparative biomechanical study of reversed less invasive stabilization system and proximal femoral nail antirotation for unstable intertrochanteric fractures

    Institute of Scientific and Technical Information of China (English)

    Chen Ying; Liu Shouyao; Lin Peng; Wang Yunting; Wang Jinhui; Tao Jianfeng; Cai Rongrong

    2014-01-01

    Objective Unstable intertrochanteric fractures (ITFs) are mostly treated by proximal femoral nail antirotation (PFNA),Inter-Tan,Asian Hip,and other new internal fixation devices.But for complex unstable fractures,such as crushed lateral wall of the greater trochanter,the loss of fixation point on lateral wall slightly reduces the fixing effect.This study aimed to compare the biomechanical strengths between reversed less invasive stabilization system (LISS) and PFNA for treatment of unstable ITFs.Methods Forty synthetic femurs were used to simulate unstable ITFs in vitro and were fixed using the reversed LISS or PFNA.These fractures were divided into two groups depending on whether the lateral wall of the greater trochanter is intact or not (AO classification:31-A2.3 and 31-A3.3,respectively).The load-displacement of femur,stiffness,ultimate load,and cyclic fatigue resistance were detected using an incremental load test and a dynamic fatigue test through an MTS 858 test system.Results For both 31-A2.3 and 31-A3.3,the vertical sinking displacement (VSD) of the femoral head under 500 N load was insignificantly smaller after treatment with reversed LISS than with PFNA,and when the displacement was 5 mm,the femoral head bore insignificantly greater load.The fixation with reversed LISS resulted in greater axial stiffness of the femur but smaller ultimate load.During the same cycle in the dynamic fatigue test,the VSD was insignificantly smaller with the fixation of reversed LISS.Conclusion Reversed LISS and PFNA have similar biomechanical strength for unstable ITFs.This conclusion should be supported by additional large-size research on basic biomechanics and clinical application.This is the first comparative biomechanical study comparing reversed LISS and PFNA for unstable ITFs.

  8. INTRA MEDULLARY FIXATION OF SUB TROCHANTERIC FRACTURERS WITH LONG PROXIMAL FEMORAL NAIL & STAINLESS STEEL WIRE FIXATION: A STUDY

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    Sree Krishna

    2015-01-01

    Full Text Available INTRODUCTION: The objective of this study was to prospectively evaluate the clinical outcome of traumatic subtrochanteric fractures fixed with long proximal femoral nail (PFN & Stainless s te e l wire banding Fixation with particular emphasis on our experience of surgical techniques. Materials and Methods: We reviewed the results of 49 consecutive patients who had undergone intramedullary fixation specifically with a long PFN with S.S wire banding fixation for traumatic subtrochanteric fractures in our hospital during a 2 - year period from January 2013 to December 2014. The average age of the patients was 53 years. Clinical and radiographic analyses were performed when follow - up was made at 6 weeks, 12 weeks, 6 months, 1 year and 2 years. Results: All the 49 traumatic subtro chanteric fractures healed uneventfully except 1 case of delayed union. Walking and squatting ability was completely restored in every case at follow - up examination 6 months postoperatively. Among them, 32 fractures were successfully reduced with traction on a fracture table under fluoroscopy & cerclage wiring or bandage with S.S wire of various diameters (1.6, 1.8 etcthrough a small incision near the fragment to be fixed. The average operative time was 70 minutes (range, 45 to 120. Seventeen Seinsheimer type II fractures were left unlocked distally, and static distal interlocking with 1 bolt was carried out in the other 31 cases. No complications such as cutout or breakage of the implants were encountered. Conclusions: The objective of this study was to evaluate the clinical and radiological outcome of traumatic subtrochanteric fractures with trochanteric exten sion treated with long proximal femoral locking nail (PFNL & S.S wire. This study suggests that long PFN is a reliable implant for subtrochanteric fractures, leading to high rate of bone union and minimal soft tissue damage. Intramedullary fixation has bi ological and biomechanical advantages, but the operation

  9. COMPARATIVE STUDY BETWEEN TITANIUM ELASTIC NAILING (TENS AND DYNAMIC COMPRESSION PLATING (DCP IN THE TREATMENT OF FEMORAL DIAPHYSEAL FRACTURES IN CHILDREN

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    Ramasubba Reddy

    2015-08-01

    Full Text Available BACKGROUND : Orthopaedic surgeons have long maintained that all children who have sustained a diaphyseal fracture of femur recover with c onservative treatment, given the excellent remodeling ability of immature bone in children. Angulations, shortenings and malrotations are not always corrected by conservative treatment. Of many surgical options, titanium elastic nailing has been the newer implant which is being used regularly. Although good results have been reported with elastic intramedullary nails, plate fixation continues to be a viable alternative in surgical treatment of femoral shaft fractures. However there are not many studies comp aring the efficiency of titanium elastic nailing and plating for femoral diaphyseal fractures in pediatric age group. AIM : The present study aims to compare the surgical management of diaphyseal fractures of femur in children with Dynamic Compression Plati ng versus Titanium Elastic Nailing. DESIGN : This is a prospective study . MATERIALS AND METHODS : This prospective study was conducted in a tertiary hospital. Patients who presented to the out - patient department and casualty of the hospital with femoral diap hyseal fractures during April 2012 to June 2014 were considered for the study. Subjects fulfilling the predetermined inclusion and exclusion criteria were included in the study. STATISTICAL METHODS : Fisher Exact test, Chi - Square Test, Student t test (Two t ailed, independent . RESULTS : Patients in the age group of 6 - 14 years were considered for the study, Patients were divided into two groups and treated with DCP/TENS. The duration of surgery, hospital stay, and, amount of blood loss was minimal in TENS grou p. Callus was seen early in TENS group. Radiological union was early in TENS group by 2 - 3 weeks. Outcome was better in patients treated with TENS (Excellent - 70%; Satisfactory – 30%; Poor - 0% in comparison to DCP (Excellent - 70%; Satisfactory - 25%; Poor - 5%. CO NCLUSION : TENS

  10. Structural reorganization of the knee joint cartilage and synovium during diaphyseal femoral fracture management using intramedullary locked nails ^perime^al and morphological study

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    A. A. Emanov

    2015-01-01

    Full Text Available The purpose - to study structural changes in knee articular cartilage and synovial membrane during locking intramedullary osteosynthesis of femoral fractures. Material and methods. The study tested structural changes in the articular cartilage of the femoral condyles and synovium during femoral fracture repair under the conditions of intramedullary locked nailing. Transverse diaphyseal femoral fractures were modeled in 12 adult mongrel dogs. Synovitis severity was assessed with a V. Krenn scale. Wilcoxon Test was used for testing hypothesis. Results. In the first group (n = 6 fractures were fixed with locked intramedullary nails ILoc (Biomedtrix, USA, while the same type of fixation in group 2 (n = 6 was performed on 4th day postoperatively after reduction by skeletal traction. It was revealed that in the first group a unified medullary cavity was seen by day 70 and the cortical layer at the fracture site approximated to the condition of the uninjured bone in intensity of bone formation and thickness. These featured were observed in the second group only by day 100. The histological study showed that the structure of the femoral condyle articular cartilage was regular in the first group but its changes were reduced thickness and reduced volumetric density of chondrocytes that might result due to disturbed trophical condition. In the second group the articular cartilage fibres tended to disintegrate on the surface that was accompanied by disturbed integrity of the basophil line and penetration of the vessels into the cartilage. Moreover, the cartilage destruction progressed as the experiment continued and chondrocyte proliferation sharply decreased. Synovitis was considerably expressed. The data obtained in the second group proved high risk of developing osteoarthrosis.

  11. Treatment of osteoporotic intertrochanteric fractures by zoledronic acid injection combined with proximal femoral nail anti-rotation

    Institute of Scientific and Technical Information of China (English)

    Yong Li; Wen-Bo Zhao; De-Li Wang; Qing He; Qin Li; Fu-Xing Pei; Lei Liu

    2016-01-01

    Objective:To observe the clinical results of proximal femoral nail anti-rotation (PFNA) combined with zoledronic acid injection in the treatment of osteoporotic intertrochanteric fractures in the elderly.Methods:60 elderly patients with osteoporotic intertrochanteric fractures were diagnosed using a dual energy X-ray bone density instrument.Patients were randomly divided into treatment or control groups (30 cases in each group).Patients in both groups were treated by closed/open reduction and internal fixation using PFNA.In the treatment group,patients received one zoledronic phosphonic acid injection of 5 mg/100 ml via intravenous drip,in addition to 600 mg of Caltrate D (qd) and 0.25 μg of alpha ossification alcohol (qd).The control group received 600 mg of Caltrate D (qd) and 0.25 μg of alpha ossification alcohol (qd).The oral drugs were administered for 12 months.Bone pain relief was observed,and changes in the bone mineral density (BMD) of the lumbar and health-side hip were recorded.Clinical results were evaluated using the Visual Analogue Scale (VAS),Harris joint function score,and Osteoporosis Quality of Life Scale (OQOLS).Results:Compared with the control group,bone pain symptoms were significantly alleviated (p < 0.05) in the treatment group.In the treatment and control groups,both between-group and within-group differences in BMD were significantly increased in L1-4,femoral neck and trochanter (p < 0.05).No significant differences were found between the two groups in regard to the involved hip or the total rate of improvement at the end of the follow-up period,although cases in the treatment group had higher OQOLS scores than those of the controls (p =0.04).Cases in the treatment group healed more quickly than those in the control group [(13 ± 3.2) weeks vs (15 ± 4.6) weeks,p =0.02].During the follow-up period,cases in the treatment group had no new fractures,whereas 2 new cases of hip fracture and 2 cases of distal radial fractures were observed

  12. COMPARATIVE STUDY BETWEEN PROXIMAL FEMORAL NAILING AND DYNAMIC HIP SCREW IN THE MANAGEMENT OF INTERTROCHANTERIC FRACTURES OF FEMUR

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    Penugonda Ravi Shankar

    2015-01-01

    Full Text Available AIMS AND OBJECTIVES : To determine the rate of union, complications, operative risks and functional outcomes in intertrochanteric fractures treated with DHS and PFN , To compare the results obtained and To compare the effectiveness of DHS and PFN in treatment of intertrochanteric fractures. RESULTS : In the present series of 24 cases of Intertrochanteric fractures were treated by proximal femoral nailing and dynamic hip screw, 12 cases in each. Out of 24 there were 13 male and 11 female. Minimum age was 36 years, maximum age 76 years with mean age of 59.25 years. Slip and fall accounted for 75% of cases. BOYD and GRIFFIN type II fracture accounted for 58.3% of cases. Mean duration of hospital stay was 26 days in both PFN and DHS groups. Length of incision was small 5 - 6cm in PFN group compared to 10 - 12cm in DHS group. Mean external blood loss 150ml in PFN group and 315 ml in DHS group. Mean time for full weight bearing was 11.5 weeks for PFN group and 14.3 weeks for DHS group. Radiological union was 12.3 weeks in PFN group and 15.5 weeks in DHS group. Good to excellent results were seen in 91.7% of cases in PFN group and 75% in DHS group. CONCLUSION : From the study, we consider PFN as better alternative to DHS in the treatment of intertrochanteric fractures but is technically difficult procedure and requires more expertise compared to DHS.As learning curve of PFN procedure is steep, with experience gained from each case operative time, radiation exposure and intraoperative complications can be reduced in each case of PFN

  13. Stuidy on intramedullary nailing for treatment of femoral shaft fractures%交锁髓内钉治疗股骨干骨折的临床分析

    Institute of Scientific and Technical Information of China (English)

    梁晟伟; 黄恪

    2013-01-01

    目的 探讨交锁髓内钉在股骨干骨折中的应用.方法 自2005年6月至2011年10月采用交锁髓内钉内固定方法治疗各类型股骨干骨折71例,分析探讨临床疗效.结果 71例患者均获随访,术后13~24周骨性愈合,术中出血100~1 200 ml;手术时间50~140 min.所有患者到取内固定时髋、膝关节功能均接近正常,平均愈合时间为12周,无1例发生感染、断钉、骨折畸形愈合等并发症.结论 使用交锁髓内钉治疗股骨干骨折疗效满意.%Objective To explore the application of intramedullary nailing in treatment of femoral shaft fractures. Methods Seventy one patients with various kinds of femoral shaft fractures were treated by intramedullary nail fixation during June 2005 to October 2011 in this hospital. Results These 71 cases got bone healing in 13 to 24 weeks after treatment with an average of 18.2 weeks, their amount of blood loss was 100 ~ 1 200 ml, and operating time was 50 ~ 140 min, with an average of 70.8 min. Internal fixation in all patients could keep the function of hip and knee near to normal, the average healing time was 12 weeks, and there was no one got infection, breakage, nonunion, deformed union and other complications. Conclusion Intramedullary nailing in treatment of femoral shaft fractures is satisfactory.

  14. Comparative endurance testing of the Biomet Matthews Nail and the Dynamic Compression Screw, in simulated condylar and supracondylar femoral fractures

    OpenAIRE

    Davies Benjamin M; Davidson Jerome A; O'Connor-Read Laurence M; Matthews Michael G; Smirthwaite Paul

    2008-01-01

    Abstract Background The dynamic compression screw is a plate and screws implant used to treat fractures of the distal femur. The Biomet Matthews Nail is a new retrograde intramedullary nail designed as an alternative surgical option to treat these fractures. The objective of this study was to assess the comparative endurance of both devices. Method The dynamic compression screw (DCS) and Biomet Matthews Nail (BMN) were implanted into composite femurs, which were subsequently cyclically loaded...

  15. Soft tissue injury related to choice of entry point in antegrade femoral nailing : piriform fossa or greater trochanter tip

    NARCIS (Netherlands)

    Moein, CMA; Verhofstad, MHJ; Bleys, RLAW; van der Werken, C

    2005-01-01

    Intramedullary nailing through the piriform fossa results in some cases in toss of abduction strength and persistent pain. Nail insertion at the tip of the greater trochanter may be favourable. The aim of this study was to assess (possible) iatrogenic injury to the abductor and external rotator musc

  16. Soft tissue injury related to choice of entry point in antegrade femoral nailing: piriform fossa or greater trochanter tip

    NARCIS (Netherlands)

    Moein, C.M.A.; Verhofstad, M.H.J.; Bleys, R.L.A.W.; van der Werken, C.

    2005-01-01

    Intramedullary nailing through the piriform fossa results in some cases in toss of abduction strength and persistent pain. Nail insertion at the tip of the greater trochanter may be favourable. The aim of this study was to assess (possible) iatrogenic injury to the abductor and external rotator musc

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

    Science.gov (United States)

    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 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 axis of the canal is medially to the base of the neck, in a "restricted area". In these cases the entry point should be located at the insertion of the

  18. Three-dimensional finite element analysis on intramedullary controlled dynamic nailing for femoral shaft fracture%髓内持骨动力性髓内钉固定股骨干骨折的三维有限元分析

    Institute of Scientific and Technical Information of China (English)

    王国栋; 姜海波; 张元民; 赵晓伟; 潘滔

    2014-01-01

    背景:交锁髓内钉并发症诸如锁钉弯曲或断裂、退出,钉尾或锁钉孔处再骨折仍然存在,基于此,作者所在课题组设计了一种新型的髓内持骨动力性髓内钉。  目的:检验髓内持骨动力性髓内钉设计和强度的合理性与安全性,并就其临床应用和改进提出合理建议。  方法:分别建立全股骨及髓内持骨动力性髓内钉固定股骨干横形骨折三维有限元模型。对全股骨模型和骨折模型进行垂直加载及步态分析,了解各模型的应力分布和动力加压特点。  结果与结论:在承重载荷下,全股骨模型的股骨颈部及股骨干内外侧缘存在较明显应力集中,骨折模型的应力集中部位位于髓内钉顶端及锁钉周围;步态中,全股骨模型的股骨远端1/2前内侧及股骨颈部存在应力集中,骨折模型的应力集中部位位于髓内钉顶端及锁钉周围;髓内持骨动力性髓内钉有断端动力性加压功能。说明这种髓内持骨动力性髓内钉结构合理,具有良好的生物力学性能。%BACKGROUND:Interlocking intramedul ary nail complications contain nail bent or broken, exit, re-fracture at spiketail or nail hole. Thus, our team designs a novel intramedul ary control ed dynamic nail. OBJECTIVE:To evaluate the rationality and safety of intramedul ary control ed dynamic nail design and strength, and to give rational proposal for its clinical application. METHODThe three-dimensional finite element models of composite femur, transverse fractures of the femoral shaft were constructed with intramedul ary control ed dynamic nailing. The stress and strain were detected under vertical loads and gait cycle. RESULTS AND CONCLUSION:The maximum stress of the intact femur under the compression load was at femoral neck and the medial and lateral aspects of the femoral shaft;while the stresses of fractured femur were at the interface between screw and screw hole. In

  19. Comparison of Outcome of Femoral Shaft Fracture Fixation with Intramedullary Nail in Elderly Patient and Patients Younger than 60 Years Old

    Directory of Open Access Journals (Sweden)

    Asgar Elmi

    2014-06-01

    Full Text Available Background:   Although intramedullary nailing (IMN is an established and accepted operative treatment for femoral shaft fracture in patients younger than 60, there is a lack of data on the results of this treatment on those over 60. The purpose of this study was to determine if the outcome of IMN for femoral shaft fracture in elderly patients is also acceptable. Particular challenges in this group of patients included osteopenia and other associated multiple medical problems frequently observed. Methods: The outcome of 84 patients who had IMN for femoral shaft fracture was reviewed and the results were compared between two groups of patients (younger than 60 and over 60 year old patients. Complications and mortality was analyzed for each group, and then compared between the two groups by testing the null hypothesis that the outcome of treatment in the two groups are similar (P>0.05. Results: The mean duration of follow up was 57.3 months (range: 10-94 months. Incidence of malunion, nonunion, infection, DVT, and dependence on walker/crutch in the groups were similar and differences were not significant (P>0.05. However, incidence of mortality (P

  20. Removal of broken hardware.

    Science.gov (United States)

    Hak, David J; McElvany, Matthew

    2008-02-01

    Despite advances in metallurgy, fatigue failure of hardware is common when a fracture fails to heal. Revision procedures can be difficult, usually requiring removal of intact or broken hardware. Several different methods may need to be attempted to successfully remove intact or broken hardware. Broken intramedullary nail cross-locking screws may be advanced out by impacting with a Steinmann pin. Broken open-section (Küntscher type) intramedullary nails may be removed using a hook. Closed-section cannulated intramedullary nails require additional techniques, such as the use of guidewires or commercially available extraction tools. Removal of broken solid nails requires use of a commercial ratchet grip extractor or a bone window to directly impact the broken segment. Screw extractors, trephines, and extraction bolts are useful for removing stripped or broken screws. Cold-welded screws and plates can complicate removal of locked implants and require the use of carbide drills or high-speed metal cutting tools. Hardware removal can be a time-consuming process, and no single technique is uniformly successful.

  1. Early results of reverse less invasive stabilization system plating in treating elderly intertrochanteric fractures: a prospective study compared to proximal femoral nail

    Institute of Scientific and Technical Information of China (English)

    YAO Chen; ZHANG Chang-qing; JIN Dong-xu; CHEN Yun-feng

    2011-01-01

    Background Intertrochanteric femur fracture is common in elderly population. Though multiple treatment options are available, the choice of implant remains controversial. The reverse less invasive stabilization system (LISS) plating was introduced for treatment of a patient with ipsilateral intertrochanteric and midshaft femoral fractures. The aim of this research was to compare such technique to intramedullary nailing (proximal femoral nail, PFN) for intertrochanteric fractures.Methods Fifty-six patients with an age of at least sixty-five years and an AO/OTA type-A1 or A2 fractures were included and divided into LISS and PFN treatment group. Background parameters, fracture and surgery details were documented. Follow-up time was at least 12 months. Radiology, complication, Harris Hip Score and Rapid Disability Rating Score (RDRS) were recorded to evaluate fixation status and hip function for each patient during follow-up.Results There was no significant difference between the two groups in surgical time ((48.0±8.6) minutes, vs.(51.8±10.8) minutes, P=0.3836) and intraoperative blood loss ((149.1±45.1) ml vs. (176.4±25.4) ml, P=0.0712). The LISS group had less postoperative haemoglobin (Hb) reduction ((10.2±4.5) g/L Hb, vs. (15.1~5.9) g/L Hb, P=0.0475). There was no complication observed in PFN group. All 31A1 type fracture in LISS group showed 100% maintenance of reduction. One nonunion with locking screw breakage and 2 varus union were found in the LISS group. Postoperative hip function was similar between the two groups.Conclusions Though reverse LISS plating may not be recommended as a routine fixation method for elderly unstable intertrochanteric fractures compared to PFN, it may possibly be reserved for rapid fixation and damage control in polytrauma patients and ORIF of subtrochanteric and reverse oblique intertrochanteric fractures.

  2. 股骨近端防旋髓内钉治疗 Russell-TaylorⅡ型股骨转子下骨折%Proximal femoral nail antirotation in Russell-TaylorⅡtype femoral subtrochanteric fracture

    Institute of Scientific and Technical Information of China (English)

    孟位明; 许红生; 付卫杰; 王平

    2014-01-01

    目的:探讨股骨近端防旋髓内钉(PFNA)治疗Russell-TaylorⅡ型股骨转子下骨折的手术方法及疗效。方法对17例Russell-TaylorⅡ型股骨转子下骨折患者牵引复位后均行PFNA内固定治疗。结果手术时间60~90 min,术中出血量150~400 ml。17例均获随访,时间10~24个月。骨折均达骨性愈合。按Harris标准进行髋关节功能评价:优10例,良6例,可1例。结论 PFNA治疗Russell-TaylorⅡ型股骨转子下骨折操作简单,创伤小,疗效满意。%Objective To explore the surgical methods and therapeutic effect of the proximal femoral nail antirotation (PFNA)in treatment Russell-TaylorⅡ type femoral subtrochanteric fractures.Methods The PFNA were used for internal fixation in 17 patients of Russell-Taylor Ⅱ type femoral subtrochanteric fractures.Results The operation time was 60~90 minutes,and intraoperative blood loss was 150~400 ml.All 17 patients were followed up for 10~24 months.The fracture of all patients achieved bony healing.According to the standard of Harris hip joint function assessment,the results were excellent in 10 patients,good in 6 and fair in 1.Conclusions PFNA treatment is sim-ple to be used in Russell-TaylorⅡtype femoral subtrochanteric fractures with minimal trauma,and curative effect is satisfied.

  3. 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

    Directory of Open Access Journals (Sweden)

    Husebye Elisabeth E

    2012-01-01

    Full Text Available Abstract 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

  4. Study on minimally invasive treatment for femoral comminuted fracture of patients with proximal femoral nail anti-rotation%PFNA微创治疗股骨粗隆间粉碎性骨折体会

    Institute of Scientific and Technical Information of China (English)

    周敏; 陈荣庄; 阮紫娟; 潘铭辉; 周佳

    2011-01-01

    Objective To explore the effect application of minimally invasive treatment of proximal femoral nail anti-rotation on comminuted fracture fractures patients. Methods From July 2009 to May 2011,46 patients with femoral comminuted fracture were treated with PFNA. The hospitalized stay time, operation time, perioperative bleeding, fracture healing time, and hip joint function were statistically analyzed. Results The average follow-up duration was 9.3 months. The hospital stay was 15 days (range 14-20 days). The average operation time was 50 minutes (range; 30~90 minutes). The average perioperative bleeding was less than 100 ml. Fracture occurred in all patients with a mean healing time of 9 months. No deformity of hip was found. According to Harris hip score, we found excellent in 19eases, good in 24 cases and poor in 3 cases, with the excellent rate of 93.4%. Conclusion Minimally invasive treatment of proximal femoral nail can obtain good effect for the comminuted fractures patients.%目的 探讨应用股骨近端防旋髓内钉微创治疗股骨粗隆间骨折的疗效.方法 自2009年7月-2011年5月对46例股骨粗隆间粉碎性骨折患者采用PFNA内固定;对患者住院时间、手术时间、术中出血量、骨折愈合时间、髋关节功能进行统计分析.结果 平均随访时间为9.3个月,住院时间为14~20天,平均15天;手术时间30~90min,平均50min;术中出血量小于100ml;骨折均愈合,平均时间为9个月.根据Harris髋关节功能评分,优19例,良24例,差3例,优良率为93.4%.结论 股骨近端防旋髓内钉微创治疗股骨粗隆间粉碎性骨折可以取得良好的疗效.

  5. Treatment of subtrochanteric femoral fractures with proximal femoral nail antirotation%股骨近端防旋髓内钉治疗股骨转子下骨折

    Institute of Scientific and Technical Information of China (English)

    赵海生; 徐耀增; 王贵贤; 李荣群

    2013-01-01

    背景:髓内钉具有优良的力学承载性能,提高了骨与内固定的整体稳定性,减少了骨折畸形愈合和内固定失败的发生率。股骨转子下骨折的内固定治疗对内植物的要求较高,因此在内植物的选择上仍存在很多争议。目的:评价股骨近端防旋髓内钉治疗股骨转子下骨折的临床疗效。  方法:回顾性分析苏州大学附属第一医院2006年6月至2011年11月采用股骨近端防旋髓内钉内固定治疗股骨转子下骨折患者17例的病例资料。其中股骨转子下骨折合并转子间骨折9例(Seinsheimer分型Ⅴ型),股骨转子下骨折(Seinsheimer分型ⅡB 2例,Ⅲ B 1例,Ⅳ4例)累及股骨干骨折7例,Seinsheimer分型Ⅴ型同时累及同侧股骨干骨折1例。受伤原因:高能量损伤16例,低能量损伤1例。记录固定时间、固定时出血量、骨折愈合时间及患肢功能恢复情况。  结果与结论:固定后随访8-24个月,平均16.2个月。固定后X射线片示骨折愈合时间平均5.4个月。固定后X射线片示所有患者骨折复位良好,转子下骨折、转子间及股骨干骨折均愈合,未出现骨折移位、内固定松动及髋内翻畸形,固定时仅有1例患者出现插钉困难。固定后患者Harris髋关节功能评分优良率为88.2%。结果证实,股骨近端防旋髓内钉本身设计合理,其防旋刀片对骨折端具有抗旋转和成角稳定性,疗效较好,安全可靠,是治疗股骨转子下骨折较理想的内固定物。%Postoperative X-ray films showed that the fracture healing time was averagely 5.4 months. Al of the fractures were recovered wel that subtrochanteric fractures, intertrochanteric fractures and femoral shaft fractures were al healed. There was no fracture displacement, internal fixation loosening and varus deformity. Only one case showed difficulties in nail insertion. Excellence rate of Harris hip functional scores was 88

  6. 髓内钉治疗股骨干骨折治疗策略临床回顾%Retrospective strategies for intramedullary nailing in the treatment of femoral shaft fractures

    Institute of Scientific and Technical Information of China (English)

    郝廷; 余斌; 冯卫; 郝增涛; 包国玉

    2011-01-01

    Objective: To retrospective determine current techniques and perioperative complications of intramedullary nailing of diaphyseal femoral fractures. Methods: 120 cases of diaphyseal femoral fractures were collected. Information about fracture classification, time to operation, injury severity score, type of nail, and operative technique, as well as peri -operative complications such as infection, femoral neck fracture were selected. Results: The preferred position for implantation was supine (82.5%). Most surgeons used a traction table (57.1%) and an antegrade implantation technique (84.5%). In 59.2% of the cases, an isolated femur fracture was present, while the rest sustained multiple injuries. In polytrauma pa -tients and patients with severe thorax injuries, most surgeons were chosed a delayed treatment with intramedullary femoral nails. Interestingly, 38.0% of the patients with severe thorax injuries were treated on the first day with intramedullary femoral nails. The total rate of complications for intramedullary femoral nailing was low, but a high rate of intraoperative femoral neck fractures was observed. Conclusion: The vast majority of surgeons prefer the supine position and the ante-grade technique to implant intramedullary femoral nails. The incidence rate of complication is low; A large number of poly -trauma patients and patients with severe thoracic trauma are treated with intramedullary femoral nails on the first day of trauma.%目的:回顾性分析股骨干骨折髓内钉固定术前、术中和术后特点,为临床提供参考.方法:回顾性分析南方医科大学附属南方医院120 例股骨干骨折髓内钉固定术前特点及术后并发症等指标,包括病例特点、骨折类型、手术时间、损伤评分、髓内钉类型、手术方法,术后并发症例如感染、股骨颈骨折等指标.结果:大部分手术采用仰卧位(82.5%)、牵引床牵引(57.1%)和顺行固定技术(84.5%).有59.2%病例为单纯性股骨干骨

  7. Clinical observation of proximal femoral anti-rotation intramedullary nail in treating subtrochanteric fracture%股骨近端防旋髓内钉治疗股骨转子下骨折的临床观察

    Institute of Scientific and Technical Information of China (English)

    晏万述; 袁琛; 韩建建

    2016-01-01

    Objective: To observe the therapeutic effect of proximal femoral anti-rotation intramedullary nail in treating subtrochanteric fracture. Methods: 90 patients with subtrochanteric fracture, who were admitted and treated in our hospital from March 2012 to March 2015, were treated by applying proximal femoral anti-rotation intramedullary nail. Results: The FIM and Fuel-Meyer scores of 90 patients after treatment were significantly higher than that before the treatment (P<0.05). Conclusion: Proximal femoral anti-rotation intramedullary nail had significant therapeutic effect in treating subtrochanteric fracture.%目的:观察股骨近端防旋髓内钉治疗股骨转子下骨折的疗效。方法:采取股骨近端防旋髓内钉治疗我院2012年3月—2015年3月收治的90例股骨转子下骨折患者。结果:90例患者的FIM及Fuel-Meyer评分显著高于治疗前(P<0.05)。结论:股骨近端防旋髓内钉治疗股骨转子下骨折疗效显著。

  8. 小切口股骨近端防旋髓内钉治疗老年股骨粗隆间骨折%Small Incision Proximal Femoral Nail Antirotation for Femoral Intertrochanteric Fractures in Elderly Patients

    Institute of Scientific and Technical Information of China (English)

    周跃江; 包洪卫; 王海红; 程彦骁

    2016-01-01

    目的:探讨股骨近端防旋髓内钉( proximal femoral nail antirotation , PFNA)小切口治疗老年股骨粗隆间骨折的疗效。方法2011年1月~2014年8月使用骨科牵引床,闭合复位165例股骨粗隆间骨折,在大粗隆近端做长约3 cm小切口,于大粗隆内侧壁开孔扩髓后插入PFNA主钉,调整主钉深度及螺旋刀头孔的前倾角,安装螺旋刀头及远端锁钉,固定骨折。结果手术时间为25~45 min,平均38 min;术中出血量50~150 ml,平均80 ml;术后61例接受输血,输红细胞1.5~5 U,平均2.8 U。165例随访8~24个月,平均10个月,骨折愈合时间3~6个月,平均4个月;术后颈干角丢失:Evans分类Ⅰ型1度0例,Ⅰ型2度0例,Ⅰ型3度3例,Ⅰ型4度11例,Ⅱ型2例。1例术后2个月时出现主钉断裂,重新更换PFNA及骨折处植骨后5个月因心脏病死亡;1例术后9个月骨折不愈合,到其他医院治疗。均未发生下肢深静脉血栓,股骨头未发生螺旋刀头切出。165例术后6个月患肢Harris髋关节评分:优107例,良53例,差5例,优良率97.0%(160/165)。结论采用PFNA小切口治疗老年股骨粗隆间骨折,具有固定可靠及恢复快的特点,适合所有类型的股骨粗隆间骨折,但需要注意术后隐性失血的问题。%Objective To evaluate the effect of small incision proximal femoral nail antirotation ( PFNA) for the treatment of femoral intertrochanteric fractures in elderly patients . Methods From January 2011 to August 2014, 165 patients with intertrochanteric fractures were treated with PFNA under closed reduction by using orthopedic traction table .A mini-incision of about 3 cm in length at the level of proximal greater trochanter was made before the nail was inserted into the medullary canal of the proximal femur after reaming , and then the nail depth and the anteversion of the helical blade were adjusted .The fracture was fixed

  9. Elastic stable intramedullary nailing of femoral shaft fractures in children: Particularities and results at Sylvanus Olympio teaching hospital of Lomé, Togo

    Directory of Open Access Journals (Sweden)

    Akakpo-Numado Gamedzi Komlatsè

    2014-01-01

    Full Text Available Introduction: The elastic stable intramedullary nailing (ESIN presently seems the best technique in the surgical treatment of femoral shaft fractures (FSF in >6-year-old children. We hereby report technical difficulties and therapeutic results after our first 8 years of experience. Patients and Methods: It′s a retrospective study over a period of 8 years from January 2005 to December 2012 in the Paediatric Surgery Department of Sylvanus Olympio Teaching Hospital of Lomé. Indications, technical particularities and results were studied. Results: There were 32 patients, 17 were boys and 15 were girls, with a mean age of 11 years old. The mean time to surgery was 21 days (range: 14 and 51 days. A callus was always removed before reduction. The osteosynthesis was stable in 22 cases, but in 10 others, it had been completed with a cast immobilisation. The operation needed a blood transfusion in 18 cases. With a mean follow-up of 3.5 years, the results were excellent in 29 patients (90.63% and good in 3 patients (9.37%. Conclusion: Although undertaking an ESIN can be difficult, due to the lack of adequate equipment the procedure produces satisfactory outcome.

  10. Nail cosmetics

    Directory of Open Access Journals (Sweden)

    Nina A Madnani

    2012-01-01

    Full Text Available 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.

  11. 加长螺旋刀片股骨抗旋髓内钉治疗股骨干合并同侧股骨颈骨折16例%Lengthened proximal femoral nail antirotation for femoral shaft fractures combined with ipsilateral femoral neck fractures

    Institute of Scientific and Technical Information of China (English)

    李山珠; 赵宏谋; 袁锋; 朱辉; 俞光荣

    2012-01-01

    Objective To investigate the methods and results of lengthened proximal femoral nail antirotation (PFNA) in the treatment of femoral shaft fractures combined with ipsilateral femoral neck fractures. Methods Of the 21 patients with femoral shaft combined with ipsilateral femoral neck fractures treated by lengthened PFNA from 2006 to 2009,16 patients with complete follow-up were retrospectively studied.There were 15 males and 1 female,at mean age of 35 years (range,21-51 years).Injury causes were all high-energy trauma including traffic injuries in 11 patients and fall injuries in five.According to Garden classification,there were seven patients with type Ⅰ femoral neck fractures,six with type Ⅱ and three with type Ⅲ.Femoral shift fractures contained six superior part fractures and nine medial part fractures and one inferior part fracture.According to Winquist classification,there were two patients with type Ⅰ femoral shaft fractures,four with type Ⅱ,six with type Ⅲ and four with type Ⅳ.Two patients had open fractures belonging to type Ⅰ Gustilo-Anderson.Harris hip score was used to evaluate functional outcomes at the last follow-up postoperatively. Result The mean follow-up time was 2.4years (range,1-4 years ).The mean period for healing of femoral neck and shaft fractures was 4.2months ( range,3-6 months) and 5.1 months ( range,3-8 months) respectively.Four patients showed delayed diagnoses of femoral neck fractures ; two patients had delayed union of femoral shaft fractures ; one suffered from avascular necrosis of the femoral head ; one patient presented 3 cm of extension of the affected limb and was accompanied by active pain of the knee joint for over four months.According to Harris score,function of hip joints was excellent in seven patients,good in six and fair in three,with excellence rate of 82%. Conclusions It is relatively few that the femoral shaft fracture is combined with ipsilateral femoral neck fracture.The rate of missed diagnosis

  12. Avaliação do emprego da haste femoral curta na fratura trocantérica instável do fêmur Evaluating the use of a proximal femoral nail in unstable trochanteric fracture of the femur

    Directory of Open Access Journals (Sweden)

    João Antonio Matheus Guimarães

    2008-09-01

    , devido a uma redução inadequada em varo, ocorreu um cutout que necessitou de revisão cirúrgica. Outro caso de fratura do tipo 31A2, evoluiu para necrose avascular da cabeça femoral, após consolidação da fratura. Por fim, um caso de fratura do tipo 31A3, devido a redução inadequada no plano sagital, evoluiu para retarde de consolidação, com quebra da haste após 13 meses da cirurgia. CONCLUSÃO: A osteossíntese com haste proximal, como tratamento da fratura trocantérica instável do fêmur realizada em pacientes com idade superior a 60 anos, resultou na consolidação da maioria dos casos. As complicações foram distintas nos dois subgrupos estudados. A redução adequada da fratura antes da introdução da haste intramedular é fundamental para o sucesso do procedimento.OBJECTIVE: Identifying the rate of healing of unstable trochanteric fractures submitted to osteosynthesis with a proximal femoral nail (PFN® - AO/ASIF, in patients operated on between November 1999 and March 2004. METHODS: 45 patients were analyzed, ages ranging from 60 to 93, with unstable trochanteric fractures of the femur submitted to osteosynthesis with short PFN®, with indirect reduction in a traction device guided by radioscopy. The fractures were classified according to the AO/OTA classification. Bone quality was evaluated by the Singh index in the post-operative radiographic routine. The quality of the reduction achieved and the positioning of the implant were evaluated by post-operative anteroposterior and profile X-ray of the proximal femur, with analysis of the cervicodiaphyseal angle and the distance between the tip of the sliding nail and the center of the femoral head, the so-called "tip apex distance" (TAD. RESULTS: The mean age of patients studied was 80.8 years (60-93. Females prevailed, with 37 cases (82.2%. The right side was involved in 22 cases (48.89% and the left side, in 23 (51.1%. All fractures were unstable, 22 of them of the type 31A2 (48.8%, and 23, of the

  13. Your Nails

    Science.gov (United States)

    ... which can be a little challenging. A nail clipper or a pair of nail scissors may be ... other problems, experts recommend taking your own nail clippers and other tools to the manicurist or pedicurist. ...

  14. Treatment of intertrochanteric fractures fractures with the proximal femoral nail antirotation%股骨近端防旋髓内钉治疗股骨转子间骨折

    Institute of Scientific and Technical Information of China (English)

    尚宪平; 王小岗; 银保

    2011-01-01

    Objective To explore the clinical outcome of intertrochanteric fractures with the proximal femoral nail anti-rotation ( PFNA). Methods Twenty-two patients for intertochanteric fractures of the femur were treated with the proximal femoral nail anti-rotation from March 2009 to March 2011. The fractures were reducted with closed reduction technique and fixed with the proximal femoral nail anti-rotation . Results The mean operative time was 65 min (50 ~ 90min). The mean operative blood loss was 270ml (150 ~ 500ml). Reaming in 6 cases andunreaming in 16 cases during operative procedure . With static distal locking nail in 18 cases and without distal locking nail in 4 cases . The median time to partical weight-bearing was 9d(6 - 24d). The mean duration of follow up was 9. 5 months (6 ~ 13months). The wound healing was smoothly in 22 patients. The average time of fracture heaking was5. 2 months (4 ~ 8months). The postoperative function was recovered to premorbid status in all patients. One patient occurred the migration of cut-out of lag screw postoperatively. One patient suffered varus deformity in 13° due to the lateral entrying pointof the main nail . Conclusion The proximal femoral nail anti-rotation can fixed intertrochanteric fractures safely . With a mina-mally invasive,shorter operative time ,less bleeding, anti-rotation capability, can be an early postoperative functional exercise,less complications,is the treatment of intertrochanteric fractures as a good way.%目的 探讨股骨近端防旋髓内钉(PFNA)治疗股骨转子间骨折的临床疗效.2009年3月~2011年3月,采用股骨近端防旋髓内钉治疗股骨转子间骨折患者22例.骨折采用闭合复位,股骨近端防旋髓内钉固定术.结果 平均手术时间65min(50~90min).术中平均失血量270ml( 150~ 500ml).6例患者术中须扩髓即可放入主钉,16例患者术中无须扩髓即可放入主钉,18例患者静力交锁远端螺钉,4例患者未交锁远端螺钉.

  15. 微创股骨近端防旋髓内钉治疗股骨转子间骨折%Minimally invasive fixation with proximal femoral anti-rotation nails for femoral intertrochanteric fractures

    Institute of Scientific and Technical Information of China (English)

    曾展鹏; 苏博源; 黄学员; 周琦石

    2008-01-01

    目的 探讨股骨近端防旋髓内钉内固定术治疗股骨转子间骨折的方法和疗效. 方法 2006年1月至2007年6月,在术中C型臂X线机透视下,采用闭合手法复位、股骨近端防旋髓内钉(PFNA)内固定术治疗股骨转子间骨折52例,其中顺转子间型12例、反转子间型23例、转子下型17例,按AO分型,A1型3例,A2型32例,A3型17例.术后每月进行随访一次,根据随访时髋关节疼痛、功能及关节活动度进行Harris评分,作出疗效评定.结果 术后无感染、脂肪栓塞、深静脉血栓形成、骨折不愈合、髋内翻及旋转畸形等并发症发生,无死亡病例.52例患者全部获得6~12个月(平均10个月)的随访,骨折全部愈合,愈合时间8~11周,平均9周.Harris评分:优44例,良8例,优良率100%. 结论 PFNA内固定术治疗股骨转子间骨折优点多、并发症少,能促进骨折的愈合和患肢功能的恢复.%Objective To investigate the effects of treating femoral intertrochanteric fractures with minimally invasive fixation with proximal femoral anti-rotation nails (PFAN) . Methods From January 2006 to June 2007, 52 patients with intertrochanteric and subtrochanteric fractures were treated with closed manipulative reduction and minimally invasive fixation with PFAN. Surgery was done under the assistance of the C-arm image intensifier. There were 12 cases of syntrochanteric type, 23 cases of countertrochanteric type,and 17 cases of subtrochanteric type. According to AO classification, 3 cases were of A1 type, 32 cases of A2type, and 17 cases of A3 type. The patients were followed up once every month. The treatment effects were accessed according to Harris Score system in terms of severity of pain, range of motion and function of the joint. Results All the 52 patients were followed up for 6 to 12 months. None of them had such com-plications as infection, fat embolism, thrombus of deep vein, nonunion of the fracture, adduction of coxa, or convolute

  16. Biomechanical properties of plum interlocking intramedullary nail in fixed subtrochanteric femoral fracture%改良梅花型交锁髓内钉固定股骨粗隆下骨折的生物力学研究

    Institute of Scientific and Technical Information of China (English)

    王新家; 李晶

    2013-01-01

    Objective To evaluate the biomechanical properties of plum interlocking intramedullary nail in fixed subtrochanteric femoral fracture,compare with the Gamma nail,and analyze the feasibility of plum interlocking intramedullary nail in the treatment of subtrochanteric femoral fracture.Methods Eight male adult femur specimens according to the left and right side were divided into experimental group and control group.Subtrochanteric transverse femoral fracture models were built plum interlocking intramedullary nails(length 350 mm) were used for the experimental group.Gamma nails(length 350 mm) were used for the control group.Then the axially vertical compression,three-point bending and torsion test resistance to axial compression of subtrochanteric fracture model in the different internal fixation methods were compared in experimental group with control group with statistical analysis.Results I n the control group,1 000 N axial load under the pressure of the compressive stiffness,anti-1 000 N pressure bending stiffness and torsional rigidity 3 N/m were (2 359.4±200.8)N/mm,(0.64±0.16)N/m,(614.7±60.2)Nm/°; In the experimental group,three indicators were (2 178.1±129.5)N/mm,(0.48±0.13)N/m,(439.1±48.2)Nm/°.There were no significant differences between the experimental group and the control group (P >0.05).Conclusion The plum interlocking inttrmedullary nail has a good biomechanical properties,and can be used to fix subtrochanteric transverse femoral fracture.%目的 比较自行设计的改良梅花型交锁髓内钉与国产Gamma钉固定股骨粗隆下骨折的即刻生物力学特性,探讨改良梅花型交锁髓内钉固定股骨粗隆下骨折的可行性.方法 8具成年健康男性股骨标本,按左右侧分为实验组和对照组,分别制作股骨粗隆下横形骨折模型.实验组采用长度350 mm的改良梅花型交锁髓内钉固定骨折,对照组采用长度350 mm国产Gamma钉固定骨折.分别检测抗轴向压缩、抗侧弯及抗扭转

  17. Biomechanics study on the femoral neck with side hole hollow nail combined with bone cement%股骨颈带侧孔空心钉添加骨水泥的生物力学实验探究

    Institute of Scientific and Technical Information of China (English)

    闫作

    2014-01-01

    objective To study the healing effects by applying femoral neck with side hole hollow nail combined with bone cement for the promotion of fracture.Methods 58 adult femoral neck specimens were seletced based on the maximum axial pull output (F-Max) in experimental group, 12 femoral neck in bored after the hollow screw directly into the center of the axial, the other 12 femoral neck in the center of the axial drilling will polymethacrylate again after infusion of bone cement into side holes with hollow screw. To pull out the experiment, the hollow nail pulling power of the maximum axial and screw in the process of cycle resistance to bending experiment in loose could withstand the maximum load were determined.Results In PMMA bone cement injection hole hollow nail was signiifcantly higher than that of the maximum axial force ,which was higher than pure hollow nail maximum axial pull output, the difference was statistically signiifcant (P<0.05). Conclusion For hip osteoporosis fracture, the side holes by using methyl methacrylate hollow nail ifxed the fracture end, can signiifcantly reduce the risk of femoral head loose, falling off, and improve the stability of the ifxed the fracture end, accelerate fracture healing.%目的:探讨股骨颈带侧孔空心钉添加骨水泥对骨折愈合的促进效果。方法选取58具成人尸体股骨颈标本,依据最大轴向拔出力(F-max)进行实验分组,12个股骨颈在轴向正中钻孔后将空心钉直接置入,另12个股骨颈在轴向正中钻孔将聚甲基丙烯酸酯骨水泥输注后再置入带侧孔空心钉。进行拔出实验,对空心钉最大轴向的拔出力及周期抗屈实验过程中螺钉在松动时所能承受的最大负荷进行测定。结果注入PMMA骨水泥侧孔空心钉最大轴向力显著高于高于单纯空心钉最大轴向拔出力,对比差异有统计学意义(P<0.05)。结论对于髋部骨质疏松骨折来说,采用加入聚甲基丙烯酸甲酯侧孔

  18. Complications in 16 out of 352 cases following femoral interlocked nail implantation Nail breakage as a main factor%股骨交锁髓内钉置入352例中16例并发症的主要断钉因素分析

    Institute of Scientific and Technical Information of China (English)

    陈刚; 徐凌; 李甲; 梁志民; 徐卫东

    2008-01-01

    BACKGROUND: Interlocking nail implantation exhibits great stability and preventory effect on fracture shortening or rotation.OBJECTIVE: To evaluate the reasons and countermeasures for the complication after interlocking nail implantation in treating femoral fracture.DESIGN, TIME AND SETTING: The case analysis was performed at Department of Orthopedics, Changhai Hospital of Second Military Medical University of Chinese PLA from April 1987 to April 2008.PARTICIPANTS: 352 patients underwent femoral interlocking nail implantation, including 289 male and 63 female with an average age of 35.9 years (range 18-84 years).METHODS: 127 patients were treated with close interlocking nail implantation, of which 30 cases were subjected to minimal incision to assist nail insertion; 24 were treated with dynamic interlocking nail implantation; 321 with static interlocking nail implantation, and 38 with interlocking nail implantation for femoral reconstruction.MIAN OUTCOME MEASURES: Complications post-implantation; limb joint function recovery during long-term follow-up.RESULTS: 331 cases were followed-up for over 60 months, and the longest follow-up lasted for 252 months. Complications were found in 16 cases, including deformity union in 2, femoral neck fracture in 1, exit of the nail in 2, infection in 2, breakage in 8 (nonunion in 3), and perineal nerve injury in 1. Except 2 with deformity union and recovered by secondary surgery, all patients developed bone union. During the followed-up, no pain or knocked pain was found with normal pseudoarthrosis activities and functional activities. The excellent function recovery in joints and limbs was 91.2%.CONCLUSION: Nail breakage is the main complication after interlocking nail implantation. Therefore, we should select longer and thicker interlocking nail as the first choice. In addition, the interlocked screws should be distal to fracture site. For the patients with severe trauma, the interlocking nail implantation in early stage of

  19. The application of locking proximal femoral plate and proximal femoral nail antirotation in femoral subtrochanteric fracture%股骨近端锁定钢板与股骨近端抗旋髓内钉治疗股骨转子下骨折的疗效

    Institute of Scientific and Technical Information of China (English)

    孟位明; 许红生; 付卫杰; 赵志江; 张磊; 李广

    2014-01-01

    目的:探讨股骨近端锁定钢板(LPFP)与股骨近端抗旋髓内钉(PFNA)治疗股骨转子下骨折的临床效果。方法44例股骨转子下骨折患者采用LPFP固定18例、PFNA固定26例。结果 LPFP固定:手术时间60~120 min,术中出血量400~800 ml,骨折愈合时间11~21周。PFNA固定:手术时间60~90 min,术中出血量为150~400 ml,骨折愈合时间11~20周。44例均获得随访,时间10~24个月。髋关节功能按Harris标准进行评价:优31例,良10例,优良率为93.2%。结论两种方式治疗股骨转子下骨折均可获得满意效果,而PFNA具有术中出血量少、手术时间短等优点。%Objective To explore the therapeutic effect of the two internal fixation methods by using locking proximal femoral plate(LPFP)and proximal femoral nail antirotation(PFNA)in femoral subtrochanteric fractures.Methods There were 44 patients who suffered femoral subtrochanteric fracture patients and received operation.The PFNA were used for internal fixation in 26 patients and LPFP in 18 patients.Results By using LPFP fixation,the operation time was 60 ~120 minutes,intraoperative blood loss was 400~800 ml,the bone healing time was 11 ~21 weeks. By using PFNA fixation,the operation time was 60~90 minutes,intraoperative blood loss was 150~400 ml,the bone healing time was 1 1 ~20 weeks.All 44 patients were followed up from 10 months to 24 months.According to Harris rate scale,the results were excellent in 31 patients,good in 10,with excellent and good rate of 93.2%.Con-clusions PFNA and LPFP were both effective devices in femoral subtrochanteric fractures,but by using PFNA fixa-tion,patients suffer less intraoperaive blood loss and shorter operation time.

  20. 股骨近端防旋髓内钉治疗股骨转子下骨折效果分析%Effect Analysis of Proximal Femoral Nail Anti-rotation for the Treatment of Subtrochanteric Fractures of Femur

    Institute of Scientific and Technical Information of China (English)

    庄玉明

    2015-01-01

    目的:分析股骨近端防旋髓内钉治疗股骨转子下骨折效果。方法将在我院就诊的66例股骨转子下骨折患者随机分为观察组(股骨近端防旋髓内钉)和对照组(动力髋螺钉),各33例。结果观察组优良率97.0%高于对照组术后恢复优良率78.8%,手术时间较对照组长,术中出血量、并发症发生率低于对照组,P<0.05。结论股骨近端防旋髓内钉治疗股骨转子下骨折取得显著效果,术后并发症发生率低。%Objective To analyze the effect of treatment of subtrochanteric fractures of femur with proximal femoral nail anti-rotation. Methods 66 cases of patients with subtrochanteric fractures of femur in our hospital were randomly divided into observation group (proximal femoral anti-rotation) and control group (dynamic hip screw), each of 33 cases.Results The excellent and good rate of the observation group was 97% higher than that of the control group, the recovery rate was 78.8%, the operation time was longer than that of the control group, the bleeding volume and the incidence of complications were lower than the control group,P<0.05. Conclusion The proximal femoral nail anti-rotation in the treatment of subtrochanteric fractures of femur has achieved remarkable results, the incidence of postoperative complications is low.

  1. Nail Hygiene

    Science.gov (United States)

    ... Water, Sanitation, & Environmentally-related Hygiene Handwashing and Nail Hygiene Keeping Hands Clean Nail Hygiene Diapering Safe & Healthy Diapering in ... Respiratory Disease Prevention Handwashing in the Developing World Hand Hygiene Saves Lives: Patient Admission Video Division of Oral ...

  2. Nail Fungus

    Science.gov (United States)

    ... problems, a weakened immune system or, in children, Down syndrome A severe case of nail fungus can be ... possibly effective in treating nail fungus, but more study is needed. ... and file down thickened areas. Wear socks that absorb sweat. Fabrics ...

  3. 带锁髓内钉与髓外钢板修复股骨干骨折的Meta分析%Meta-analysis of femoral shaft fractures treated with interlocking intramedullary nail and extramedullary plate

    Institute of Scientific and Technical Information of China (English)

    阿布力米提•阿木提; 张谢卓; 徐超; 丁慧勇

    2016-01-01

    BACKGROUND:With deep understanding of the concept of biological fixation, more and more physicians choose interlocking intramedulary nail in the repair of femoral shaft fracture. Compared with traditional extramedulary plate, the superiority of the interlocking intramedulary nail has not been reported at present. Randomized controled clinical study is less, and lacks of systematic evaluation. OBJECTIVE:The results of meta-analysis were used to compare the therapeutic effects of interlocking intramedulary nail and steel plate for femoral shaft fractures. METHODS: We retrieved the MEDLINE, Embase, PubMed, Cochrane library, CNKI, Wanfang database, and Vip database from 2000 to 2015 by computer to colect randomized controled study on interlocking intramedulary nail and extramedulary plate for treatment of femoral shaft fractures. We screened the literatures that met the inclusion criteria, were strict quality evaluation of the selection. Excelent and good rate, operation time, intraoperative blood loss, hospitalization time, recovery time of knee joint function reaching 135°, knee joint function recovery time of the second operation to remove the internal fixation for reaching 135°, postoperative drainage volume, fracture healing time, nonunion or delayed union, internal fixation loosening, postoperative infection, and osteomyelitis were considered as the evaluation index of meta-analysis. Meta-analysis was performed with RevMan 5.2 software from the Cochrane Colaboration. RESULTS AND CONCLUSION:Finaly 10 Chinese articles were included, including 915 patients with femoral shaft fractures. The results of meta-analysis showed that compared with extramedulary plate, interlocking intramedulary nails for femoral shaft fractures could effectively reduce the amount of blood loss, postoperative drainage, shorten operation time, hospitalization time, fracture healing time, reduce the incidence of postoperative infection, and obtain recovery of knee joint function. These

  4. 股骨颈骨折愈合后钉道植骨应力分布的有限元分析%Finite element analysis of the stress distribution in femoral head and neck of bone grafting in nail path after femoral neck fracture heating

    Institute of Scientific and Technical Information of China (English)

    唐洪涛; 仝允辉; 张美超; 赵卫东

    2011-01-01

    Objective:To investigate the rationality of bone grafting in nail path after femoral neck fracture healing and internal fixator was removed so as to provide theoretical support for clinical therapy. Methods: Two three - dimensional finite element models of the femoral head and neck region were reconstructed after femoral neck fracture healing and internal fixator was removed,one undergone bone grafting.Both of the models were simulated under the load of body weight,and the stress and shift on the femoral head and neck were calculated and compared. Results: Analysis of the three - dimension finite element model showed that the massive stress concentrated on weight loading region of femoral head without bone grafting,while the massive stress concentrated on the region of calcar femorale of grafting- bone model.The max - stress value (0.482 E + 8) in the weight loading region of femoral head without bone grafting was far higher than the max - stress value(0.295 E +8) of ungrafting - bone model. In the nail path shift test,value of shift in the region of femoral head of the ungrafting -bone model (0.391 E - 0.3 ) significantly exceeded that of grafting - bone model (0.352 E - 0.3 ). Conclusion: For the treatment of femoral neck fracture with hollow compression screws, bone grafting in the channel of screw should be used to improve biomechanical integrity of femoral head and neck after fracture healed and hollow compression screws were taken out. This is of benefit to preventing the collapse of femoral head owing to excessive stress concentration on femoral head.%目的:探讨股骨颈骨折经空心加压螺钉固定,骨折愈合后取出螺钉遗留的钉道内是否应予植骨,为临床选择治疗方法提供依据.方法:重建人体股骨头颈部的三维有限元仿真模型,模拟钉道不植骨与钉道植骨的股骨头颈部,对模型进行虚拟加栽和仿真计算.比较2种模型在同一载荷下的应力分布及位移情况.结果:不植骨模型的

  5. 加长防旋股骨近端髓内钉内固定治疗涉及粗隆下股骨多段骨折21例分析%Treatment with proximal femoral nail anti-rotation for multiple femoral fracture of proximal femur:an analysis of 21 cases

    Institute of Scientific and Technical Information of China (English)

    陆海健; 顾小华; 洪潮; 沈智豪; 胡洪奎

    2011-01-01

    Objective: To observe the curative effect of proximal femoral nail-A anti-rotation (PFNA) in treating multisegmental femoral fracture of proximal femur by a new interlocking nail. Methods: Twenty-one cases with multisegmental of femur fractures of proximal femur had been treated with PFNA. The surgery was operated on orthopedic lower limb automatic traction bed, PENA was fulfilled under C-arm fluoroscopy monitoring. Results :The 21 cases were followed up for 6 to 24 months. All eases were well union. The average healing time was 4.8 months, except two patientsˊ recovery was delayed. However, all of them had healed 6 months after PFNA was removed, and the function of hip and knee were well recovered. According to the recovery evaluation criteria of national femoral fracture, 12 cases were excellent,7 were good, and 2 were poor. The acceptance rate was 90.5%. The major nail in one ease was slightly curved, but the function was not affected. Conclusions: PFNA is a reliable fixation method for multisegmental fracture of femur from subtrochanteric to femoral condyle with less trauma and blood loss.%目的:观察加长防旋股骨近端髓内钉(PFNA)内固定治疗涉及粗隆下股骨多段骨折的临床疗效.方法:对21例涉及粗隆下股骨多段骨折患者采用加长PFNA治疗,手术均在骨科下肢牵引床上进行,在C型臂X线机辅助下骨折采用闭合或小切口切开复位加长PFNA内固定术.结果:术后随访6~24个月,平均愈合时间4.8个月,其中2例延迟愈合,拔除远端交锁钉后6个月均愈合.参照全国股骨骨折疗效评定标准,优12例,良7例,差2例;优良率为90.5%.1例出现主钉略弯曲,但患者最终未受影响.结论:加长PFNA操作简单,创伤小,出血少,防旋转,内固定牢靠,是一种治疗涉及粗隆下股骨多段骨折的理想内固定方法.

  6. Radiographic analysis of treatment of inter-trochanteric fractures using proximal femoral nails%股骨近端髓内钉治疗股骨粗隆间骨折的影像学分析

    Institute of Scientific and Technical Information of China (English)

    赵晶鑫; 苏秀云; 赵喆; 张里程; 张立海; 唐佩福

    2015-01-01

    Objective:To establish a reliable approach for measuring proximal femoral 3 dimensional anatomy, and to compare post-operative differences of proximal femoralanatomy in the inter-trochanter fractures with two kinds of antegrade nailings.Methods: Some computer assisted design ( CAD ) soft-wares, e.g.Mimics, were used to establish a reliable approach for measuring proximal femoral 3 dimen-sional (3D) anatomy.Intra-class correlation coefficient ( ICC) was used to test the reliability of intra-and inter-observers.The post-operative pelvic CT data of 19 cases of inter-trochanter fracture patients treated with InterTAN nailing and 21 cases of inter-trochanter fracture patients treated with proximal femo-ral nail anti-rotation ( PFNA) were retrospectively analysed and used to measure bilateral proximal femo-ral anatomical parameters, including 2D and 3D femoral neck-shaft ( NS) angle and femoral neck ante-version (NA) angle, and 2D and 3D anteversion angles of the intramedullary (IM) nailings.ICC was used to test the consistency of the NA angles in the different groups, and the paired student T-test was used to test the differences of the paired quantitative data.Results:The established measurement method hasdexcellent consistency within the intra-and inter-observers, with all the ICCs higher than 0.9.The paired student T-test showed no significant difference between the post-operative bilateral 2D or 3D NA angles.The ICCs results showed that there were no consistency between the post-operative bilateral 2D or 3D NA angles (P values were 0.099 and 0.055, respectively), but the excellent consistency between the 2D injured side NA angle and 2D IM nailing’ s NA angle, or between the 3D injured side NA angle and 3D IM nailing’s NA angle (the ICCs were 0.81 and 0.8, respectively, P values <0.001).In PF-NA group, 57%of the differences between the 2D post-operative injured side’s and intact side’s NA an-gles were higher than 15°, which was more than 15.78%in Inter

  7. 弹性髓内钉治疗儿童股骨干骨折钢板固定失效病例%Elastic intramedullary nail for the treatment of femoral shaft fracture in children with failed plate fixation

    Institute of Scientific and Technical Information of China (English)

    王华明; 陈志龙; 李卫平; 裴生太; 陈世海

    2013-01-01

      BACKGROUND: Elastic intramedul ary nail fixed technology supported by three principle of elastic fixation fracture is suitable for children’s short transverse and oblique shape limbs long tubular bone fracture. This paper wil investigate the advantages of elastic intramedul ary nail in the treatment of femoral shaft fracture with failed plate fixation in children. OBJECTIVE: To observe the clinical effect and prognosis of elastic intramedul ary nail technology in the treatment of femoral shaft fracture with failed plate fixation in children. METHODS: Retrospective analysis was performed in 21 cases of femoral shaft fracture patients with plate fracture and failure after fixation in the Department of Pediatric Orthopedics, Gansu Provincial Hospital of Traditional Chinese Medicine from March 2008 to August 2012. During the surgery, the plates were removed from the primary incision; after cleaned the fracture end, the medial and lateral retrograde percutaneous penetration of elastic nail was performed to fix the fracture on 1.0-2.0 cm from the femoral distal patel ar. At 3-6 months after surgery, the healing of the fracture was evaluated based on the imaging data, and then the screw was removed. The efficacy was analyzed in accordance with the Flynn fracture healing criteria in 2001. RESULTS AND CONCLUSION: Al the 21 patients were fol owed-up for 10 months in average. According to the Flynn fracture healing criteria, there were 19 cases of excel ent, two cases of good, no poor, and the excel ent and good rate was 100%. After fol owed-up for 10 months, two cases had overgrowth of affected limbs with the unequal length 30°, there was no elastic nail breakage or nonunion. Compared with open reduction technology, elastic intramedul ary nail for fracture fixation has fast recovery and healing and has fewer complications, so it is the effective method for the treatment of femoral shaft fracture fixation in children.%  背景:弹性髓内钉固定通过三点

  8. 应用股骨近端防旋髓内钉治疗股骨转子下骨折的临床分析%Use of Proximal Femoral Rotation Intramedullary Nail in the Treatment of Femoral Subtrochanteric Fracture Analysis

    Institute of Scientific and Technical Information of China (English)

    李福厚; 王丽波

    2015-01-01

    Objective To study the femoral proximal anti rotary intramedullary nailing for femoral subtrochanteric fractures of the clinical curative effect. Methods Select our hospital from June 2013 to June 2014 were of the clinical data of 78 patients with femoral subtrochanteric fractures, according to the principle of digital random grouping, divided the patients into two groups, each group of 39 cases. The control group gives the dynamic hip screw fixation, observation group was given proximal femoral in-tramedullary nail fixation, prevention compared two groups of patients with fracture healing time, hip function recovery and com-plications.Results①To observe group hip recovery was 87.18%, the control of hip recovery was 66.67%. Recovery was higher, the observation group contrast there is statistical significance (P<0.05). ②A fracture healing time of observation group was obviously shorter than the control group, compared the two groups was statistically significant (P<0.05).③Group of the femoral neck short-ened, and the incidence of hip varus were lower than the control group, compared with statistical significance (P<0.05). Conclusion By giving the proximal femoral anti rotary intramedullary nail internal fixation of femoral subtrochanteric fractures patients, can promote the healing of fracture, reduce the incidence of complications, worthy of clinical popularization and application.%目的:研究股骨近端防旋髓内钉治疗股骨转子下骨折的临床疗效。方法整群选取该院在2013年6月-2014年6月间收治的78例股骨转子下骨折患者的临床资料,根据数字随机分组法原则,将患者分为两组,每组39例病例。对照组给予动力髋螺钉固定,观察组给予股骨近端防旋髓内钉固定,比较两组患者的骨折愈合时间、髋关节功能恢复情况与并发症发生率。结果①观察组髋关节恢复优良率为87.18%,对照组髋关节恢复优良率为66.67%。观察组恢复优良率

  9. 微创复位术结合加长型抗旋转型股骨近端髓内钉内固定治疗股骨转子下骨折的临床疗效%Clinical Curative Effect of Minimally Invasive Repairs Combined with Long Resistance to Rotation Proximal Femoral Intramedullary Nail Fixation for Treatment of Femoral Subtrochanteric Fracture

    Institute of Scientific and Technical Information of China (English)

    陆驰浩

    2016-01-01

    Objective To study the effect of minimally invasive repairs combining with long resistance to rotation proximal femoral intramedullary nail (PFNA) of internal fixation in treatment of femoral subtrochanteric fractures.Methods40 patients with fracture of femoral subtrochanteric were randomly divided into two groups, 20 cases in the control group and were given PFNA operation treatment, and 20 patients in the experimental group were given minimally invasive joint PFNA reset operation.Results In the clinical treatment, the excellent rate and complication rate of the experimental group were significantly better than that of control group (P<0.05).ConclusionThe combination of minimally invasive repairs and PFNA surgery in the treatment of femoral subtrochanteric fractures has signiifcant clinical curative effect, and it has clinical application value.%目的:分析微创复位术结合加长型抗旋转型股骨近端髓内钉(PFNA)内固定治疗股骨转子下骨折的临床疗效。方法随机将40例股骨转子下骨折患者分成两组,20例对照组患者选择PFNA手术治疗,20例实验组患者选择微创复位联合PFNA手术治疗。结果在临床治疗优良率以及并发症发生率方面,实验组均显著优于对照组(P<0.05)。结论微创复位术结合PFNA手术治疗股骨转子下骨折具有比较显著的临床疗效,具有临床应用价值。

  10. Proximal femoral nail antirotation combined with cable internal fixation for the treatment of Russell-Taylor type Ⅱ femoral subtrochanteric fracture%股骨近端防旋髓内钉结合钢缆治疗 Russell-TaylorⅡ型股骨转子下骨折

    Institute of Scientific and Technical Information of China (English)

    董飞; 李爱国; 王文; 叶伟雄; 陈鸿辉

    2015-01-01

    Objective To investigate curative effect of proximal femoral nail antirotation ( PFNA) combined with ca-ble in treatment of Russell-Taylor typeⅡfemoral subtrochanteric fracture. Methods 21 cases of Russell-Taylor typeⅡ femoral subtrochanteric fractures were treated with PFNA combined with cable. Results The operation time was 62~127 min, the blood loss was 150~420 ml. Good fracture reduction and reliable fixation were obtained. 21 cases were followed up for 7~20 months, and fracture healing time was 5~9 months, with Harris score of 79~93, there were 15 excellent cases, 5 good, and 1 fair. Conclusions PFNA combined with cable for the treatment of Russell-Taylor type Ⅱ femoral subtrochanteric fracture is an effective methrod.%目的 探讨股骨近端防旋髓内钉( PFNA) 结合钢缆治疗Russell-TaylorⅡ型股骨转子下骨折的疗效. 方法 采用PFNA联合钢缆捆扎固定治疗21 例Russell-Taylor Ⅱ型股骨转子下骨折患者. 结果 手术时间62~127 min,术中出血量150~420 ml,患者均骨折复位良好,内固定可靠. 21 例均获得随访,时间7~20 个月. 骨折愈合时间5~9个月. 患髋关节Harris 评分为79~93分,其中优15 例,良5 例,中1 例. 结论 PF-NA 结合钢缆是治疗Russell-Taylor Ⅱ型股骨转子下骨折有效的手段.

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

    Institute of Scientific and Technical Information of China (English)

    HUANG Zhong-lian; YANG Hai-long; XU Jian-kun; XIA Xue; WANG Xin-jia; SONG Jian-xin; HU Jun

    2013-01-01

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

  12. Treatment of children with femoral subtrochanteric fracture with advanced elastic intramedullary nail technology%改良弹性髓内钉技术治疗儿童股骨转子下骨折

    Institute of Scientific and Technical Information of China (English)

    谭家昌; 杨有猛; 徐鸿育; 罗宇; 王辉

    2013-01-01

    Objective:To explore curative effects of advanced elastic intramedullary nail technology in treating children with femoral subtrochanteric fracture.Methods:Form March 2009 to December 2010,16 children with femoral subtrochanteric fracture were treated with advanced elastic intramedullary nail technology.There were 12 males and 4 females ranging in age from 7 to 15 years old with a mean of 9.8 years old.According to fracture classification,9 cases were stable fractures (traverse or short oblique type) and 7 cases were unstable fractures (comminuted or long oblique type).Radiographs and complications were retrospectively reviewed.Fracture healing were evaluated according to Flynn criteria.Results:All children were followed up from 11 to 32 months with an average of 21 months.No incision infecton,bone nonunion and breakage of screw occurred.The fracture healing time was from 8 to 16 weeks with an average of 10.1 weeks.According to Flynn criteria,14 cases got excellent results,1 moderate and 1 poor.Conclusion:Advanced elastic intramedullary nail technology for the treatment of children with femoral subtrochanteric fracture is a safe and effective fixation,which is good for early mobilization,shorter the duration of hospital stays and reduce complications.%目的:探讨改良弹性髓内钉技术治疗儿童股骨转子下骨折的疗效.方法:自2009年3月至2010年12月采用改良弹性髓内钉技术治疗儿童股骨转子下骨折16例,男12例,女4例;年龄7~15岁,平均9.8岁.骨折类型:稳定型骨折(横断或短斜型)9例,非稳定型骨折(粉碎性骨折或长斜型骨折)7例.对患儿的放射学结果和并发症资料进行回顾性研究,采用Flynn评判标准对术后骨折愈合情况进行评价.结果:16例患儿术后均获得随访,时间11~32个月,平均21个月.无切口感染、骨不连及内固定物失效或断裂.骨折愈合时间8~16周,平均10.1周.骨折愈合按照Flynn评判标准进行评估,优14例,良1例,差1

  13. 加长PFNA治疗粗隆下骨折30例疗效分析%Clinical Effective Analysis of 30 Patients with Subtrochanteric Fractures Treated by Extended Proximal Femoral Nail Anti-rotation

    Institute of Scientific and Technical Information of China (English)

    高曦; 黄朱宋; 关勇; 蓝锦福

    2014-01-01

    Objective To analyze the clinical effect of extended proximal femoral nail anti-rotation (extended PFNA) on patients with subtrochanteric fractures. Methods 60 patients with subtrochanteric fractures admitted in the department of orthopedics of our hospital from August 2009 to August 2010 were selected. Of them, 30 patients treated by extended PFNA were set as the extended PFNA group, and 30 patients treated by dynamic hip screw (DHS) were set as the DHS group. And the clinical effects were com-pared between the two groups. Results The operative time and intraoperative blood loss of the extended PFNA group were less than those of the DHS group with statistically significant difference (P0.05). Conclusion Extended proximal femoral nail anti-rotation has satisfied effect in the treatment of subtrochanteric fractures, and is recommended to be used and popularized in clinical practice.%目的:分析加长防旋股骨近端髓内钉(加长PFNA)治疗股骨粗隆下骨折的临床效果。方法选取2009年8月-2010年8月该院骨科收治的股骨粗隆下骨折患者60例,将采用加长PFNA治疗的30例患者作为加长PFNA组,采用动力髋螺钉(DHS)治疗的30例患者作为DHS组,比较两组治疗效果。结果加长PFNA组患者手术时间,术中出血量均少于DHS组,且差异具有统计学意义(P0.05)。结论加长防旋股骨近端髓内钉治疗股骨粗隆下骨折临床效果满意,建议在临床治疗中推广应用。

  14. Proximal femoral nail antirotation for treatment of intertrochanteric fractures: an analysis of 112 patients%股骨近端防旋髓内钉治疗老年股骨转子间骨折112例

    Institute of Scientific and Technical Information of China (English)

    李慧武; 孙月华; 史定伟; 唐坚; 俞超; 龚伟华; 朱振安; 王友; 戴尅戎

    2011-01-01

    目的 探讨股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)治疗老年股骨转子间骨折的手术疗效.方法 自2007年4月至2009年7月应用PFNA治疗股骨转子间骨折112例,其中男34例,女78例;平均年龄76岁.AO分型:31 -A2型80例,31 -A3型32例.Singh指数分类:Ⅰ级4例,Ⅱ级21例,Ⅲ级70例,Ⅳ级15例;骨折前2例跛行.低能量损伤97例,高能量损伤15例.采用Salvati - Wilson评分对髋关节功能进行评估.结果 112例患者中90例接受12 ~24个月随访,平均18.6个月.Salvati - Wilson评分为(29.98±5.18)分:优41例,良40例,可6例,差3例,优良率为90%.术中主要问题为插钉困难22例,其中3例患者在插钉过程中导致股骨近端外侧皮质破裂.敲击螺旋刀片过程中造成骨折断端不同程度的移位或分离34例,远端锁钉困难9例.术后并发症中局部并发症包括髋部疼痛21例,股部疼痛4例,明显髋内翻2例,延迟愈合7例.无论Singh指数为何种类型均未见螺旋刀片切出或穿透股骨头,也未见股骨干骨折发生.全身并发症包括心脑血管疾病1例,肺部感染4例,深静脉栓塞1例,会阴部淤血或肿胀17例.结论 PFNA是治疗股骨转子间骨折特别是骨质疏松性骨折的有效方法,但骨折延迟愈合以及髓内钉与股骨近端形态的不匹配还有待进一步解决.%Objective To investigate the clinical value of proximal femoral nail antirotation ( PFNA) in treatment of intertrochanteric fractures.Methods From April 2007 to July 2009,112 patients with intertrochanteric fractures were treated by using PFNA.There were 34 males and 78 females,at mean age of 76 years.Of all,80 patients were with type 31-A2 fracture and 32 with type 31-A3 fractures according to AO classification.According to Singh index classification,there were 4 patients at grade Ⅰ,21 at grade Ⅱ,70 at grade Ⅲ and 15 at grade Ⅳ.The fracture was caused by low-energy injury in 97 patients and by high

  15. Appication Proximal Femoral Nail in the Treatment of Subtrochanteric Fractures of High Energy Trauma%PFN在高能量股骨粗隆下骨折中的应用

    Institute of Scientific and Technical Information of China (English)

    张立强; 尚文昌

    2016-01-01

    [ABSTRACT]Objective: To summarize the proximal femoral nail(PFN) in high energy subtrochanteric fracture of femur.Methods:23 patients treated with PFN high-energy femoral intertrochanteric fracture patients, according to the seinsheimer type: typeⅢ 8 cases, typeⅣ 10 cases, typeⅤ 5 cases. Results:23 cases were successfully completed surgery and followed up, the average follow-up time 8~12 months, the Harris evaluation standard, 20 cases were excellent, good in 2 cases, commonly in 1 case, the excellent rate was 95.7%. Conclusion:The application of PFN in high energy subtrochanteric fracture, safe and reliable.%目的:总结股骨近端髓内钉(PFN)在高能量股骨粗隆下骨折中的应用。方法:23例应用PFN治疗高能量股骨粗隆下骨折患者,按seinsheimer分型:Ⅲ型8例,Ⅳ型10例,Ⅴ型5例。结果:23例均顺利完成手术和获得随访,随访时间8~12月,平均10月, Harris评定标准,优20例,良2例,可1例,优良率95.7%。结论:PFN应用于高能量股骨粗隆下骨折,安全可靠。

  16. Fungal nail infection

    Science.gov (United States)

    Nails - fungal infection; Onychomycosis; Infection - fungal - nails; Tinea unguium ... hair, nails, and outer skin layers. Common fungal infections include: Athlete's foot Jock itch Ringworm on the ...

  17. The design characteristics of a new femoral compound interlocking intramedullary nail and its clinical outcome%股骨复合型带锁髓内钉的设计及临床应用

    Institute of Scientific and Technical Information of China (English)

    王永清; 夏仁云; 吴家民; 徐占敏; 郝玉彬; 冯雪峰

    2008-01-01

    Objective The design characteristics and clinical outcome of a femoral compound interlocking intramedullary nail(FCIIN)were investigated.Methods According to morphological characteristics of the femoral medullary canal,a radius of radian of intramedullary nail and a oblique interlocking angle were designed to 1250 mm and 135°.Interlocking holes with three 6.5 mm diameter were located in proximal end of FCIIN.Two locking holes and a recess,which was 4.5 mm in diameter,were located at the distal end of FCIIN.At the tip of the proximl interlocking screws whose root diameter rose from 3.5 mm to 6.5 mm gradually,the self-tapping cancellous screw thread was designed.There were two types of distal interlocking screws.One was fine thread screw and the other was bolt screw.Under the biomechanical destructive test,the proximal interlocking screw device had satisfactory strength and reasonable structure.A total of 47 patients with fractures of femur were assessed in this study.There are 31 males and 16 females,with average age of 39.83 years (range 18-74 years).Among them 14 patients were diagnosed as intertrochanteric fracture,7 cases as subtrochanteric fracture,18 cases as femoral shaft fractures,and 8 cases as snpraeondylar fracture.All patients were treated by FCIIN.Results All patients have been followed up for 21-36 months with an average of 25.9 months.The fracture healing time was 6-18 months with an average of 8.4 months.of all 47 patients,anatomic reduction were achieved in 34 cases,good reduction in 11 cases,and force line reduction in 2 cases.The excellent or good rate was in 95.74%.The removal time of FCIIN was 12 to 21 months (average,16.9 months).One patient with intertrochanteric fracture who had a fixation failur combined with non-union had achieved healing by external fixator in 18 months.Failure to insert distal interlocking screws during procedure oecurred in 5 patients which did not influence the fracture healing.Conclusion The FCIIN is a useful device

  18. Proximal Fomaral Nail Antiritation for the Treatment of Seinsheimer IIB-V Femoral Subtrochanteric Fracture in the Olds%PFNA治疗Seinsheimer ⅡB-V型老年股骨转子下骨折

    Institute of Scientific and Technical Information of China (English)

    何啸波; 高玉新

    2016-01-01

    目的:判断防旋型股骨近端髓内钉(Proximal fomaral nail antiritation,PFNA)内固定治疗老年股骨转子下骨折的安全性和有效性。方法回顾性分析采用该方法治疗老年股骨转子下骨折23例。观察内容包括患者年龄、性别、骨折分型、手术时间、出血量、复位质量、骨折愈合时间以及并发症等。结果根据股骨转子下骨折的Seinsheimer分型标准,ⅡB型6例、ⅡC型4例、ⅢA型5例、ⅢB型3例、Ⅳ型3例、Ⅴ型2例。手术时间平均(60.3±19.3)min(43~101 min),术中出血量平均(210.6±88.2) ml(160~410 ml)。23例均获得随访,平均时间(12.4±2.8)个月(8~18个月)。骨折复位良好,内固定可靠。骨折愈合平均时间(4.5±1.7)个月(3~6个月)。术后X线片显示平均髋内翻<(10.2°±2.5°)(5°~16°)。1例患者术后下肢长度偏差超过1 cm。髋关节功能Harris评分:优15例,良6例,可2例,优良率91.3%。结论 PFNA内固定治疗老年股骨转子下骨折,手术方法可行,术后并发症少。%Objective To investigate the curative effect of proximal femoral nail antirotation (PFNA) in the treatment of Seinsheimer IIB-V femoral subtrochanteric fracture in the olds.Methods We reviewed 23 patients with subtrochanteric fractures, which were stabilized with PFNA. The classiifcation,operating time, blood loss and any technical diffculty with the implant were recorded. Patients were followed clinically and radiologically for union at fracture site and implant related complications.Results As per the Seinsheimer classiifcation, there were 6 typeⅡB,4 typeⅡC,5 typeⅢA, 3 typeⅢB,3 typeⅣ and 2 typeⅤ cases. The mean operating time was (60.3±19.3) min(43~101 min)and total blood loss averaged (210.6±88.2) ml (160~410 ml). 23 cases were followed up for (12.4±2.8) months (8~180 months). All patients showed signs of union at an average of (4.5±1.7) months (3

  19. Gamma nail breakage: a report of four cases.

    Science.gov (United States)

    Kasimatis, G B; Lambiris, E; Tyllianakis, M; Giannikas, D; Mouzakis, D; Panagiotopoulos, E

    2007-12-01

    Gamma nails have been used extensively for the treatment of proximal femoral fractures. Nail breakage at the level of the aperture of the lag screw is rare. We report 4 such cases mainly associated with a large posteromedial cortex gap and nonunion. The need for adequate reduction to avoid such a complication is emphasised.

  20. 股骨近端抗旋髓内钉内固定术对股骨转子下骨折的治疗效果观察%Observation on Anti-spin Proximal Femoral Intramedullary Nail Fixation for the Treatment of Intertrochanteric Fracture

    Institute of Scientific and Technical Information of China (English)

    朱延兵; 牛海峰; 赵巍

    2016-01-01

    Objective To observe the anti-spin proximal femoral intramedullary nail fixation for treatment of subtrochanteric fractures. Methods58 cases of subtrochanteric fractures were randomly divided into observation group (anti-spin proximal femoral intramedullary nail ifxation) and control group (proximal femoral locking plate ifxation).Results The operative time, less blood loss in observation group were less than the control group, the difference was signiifcant (P0.05).ConclusionThe proximal femoral nail anti-rotation ifxation in the treatment of intertrochanteric fractures has good effect.%目的:观察股骨近端抗旋髓内钉内固定术对股骨转子下骨折的治疗效果。方法收集股骨转子下骨折患者58例,随机分为观察组(股骨近端抗旋髓内钉内固定术)与对照组(股骨近端锁定钢板固定术)。结果观察组手术时间、术中出血量少于对照组,差异有统计学意义(P<0.05);但两组骨折愈合时间、髋关节功能恢复优良率对比,无统计学差异(P>0.05)。结论股骨近端抗旋髓内钉内固定术在股骨转子下骨折治疗中效果理想。

  1. 股骨近端防旋髓内钉微创内固定治疗股骨转子间骨折%Treatment of intertrochanteric fractures with proximal femoral nail anti-rotation

    Institute of Scientific and Technical Information of China (English)

    徐荣华; 霍维玲; 赵耀; 郭含军

    2015-01-01

    目的:探讨股骨近端防旋髓内钉(PFNA)微创治疗股骨转子间骨折的临床疗效。方法采取闭合复位PFNA 微创内固定治疗48例股骨转子间骨折患者。结果48例均获随访,时间6~24个月。术后6个月所有患者均获得骨性愈合,无髋内翻、螺旋刀片切割股骨头、骨不连、内固定断裂等并发症发生。疗效按 Harris评分标准评定:优37例,良9例,可2例,优良率95.8%。结论PFNA 具有创伤小、固定牢靠、并发症少、防旋、防切割等特点,是治疗股骨转子间骨折的有效方法。%Objective To evaluate the clinical and radiographic results in intertrochanteric fractures treated with prox-imal femoral nail anti-rotation(PFNA).Methods 48 cases of intertrochanteric fractures were reduced with closed reduction technique and fixed with PFNA.Results The patients were followed up for 6 ~24 months and all fractures were healed in 6 months postoperatively.No Coxa vara,cut-out of lag screw,pseudoarthrosis or implant failure was recorded.According to the Harris standard:the results were excellent in 37 cases,good in 9 and fair in 2,the rate of excellent and good was 95.8%.Conclusions PFNA has the advantages of less surgical trauma,less loss of reduc-tion,less complications,more stable fixation,anti-rotation,anti-cutout.So it is a useful device in the treatment of femoral intertrochanteric fracture.

  2. 抗旋型股骨近端髓内钉治疗股骨粗隆下骨折的临床观察%Clinical observations on proximal femoral nail anti-rotation in treatment f subtrochanteric fractures

    Institute of Scientific and Technical Information of China (English)

    姜海涛; 李旭; 徐贤; 刘林; 邵钦; 吴韦

    2012-01-01

    Objective To discuss the clinical outcome of proximal femoral nail anti -rotation (PFNA) in treatment of subtrochanteric fractures. Methods There were 23 patients with traumatic subtrochanteric fractures from Jun. 2008 to Jan. 2011. According to Seinsheiner classification of subtroehanteric fractures ,9 patients were with type II fractures,7 with type III fractures ,5 with type IV fractures and 2 with type V fractures. Close reduction or open reduction was performed through a mini incision before inserting the nail. Results Totally 23 patients (100% ,23/23)were followed up for 9-40 months,with a mean duration of 20 months. Bony union was observed in all patients, with a mean union period of 4.5 months. According to Modified Harris Hip Scale ,the results were excellent in 17 patients,good in 6,with excellent and good rate of 100%. Conclusion PFNA in treatment of subtro?chanteric fractures has advantages of easy operation ,less damage and less bleeding. It's helpful for fracture healing. Stable internal fixation could allow patients with early hip and knee joint functional exercise to reduce the complica -tions. So PFNA is an effective device for treatment of subtrochanteric fracture .%目的 讨论采用抗旋型股骨近端髓内钉((proximal femur nail A,PFNA)内固定治疗股骨粗隆下骨折的临床效果.方法 收集2008年6月~2011年1月我科收治的股骨粗隆下骨折23例病例资料,Seinsheiner 分型Ⅱ型9例,Ⅲ型7 例,Ⅳ型5例,Ⅴ型2例.采用闭合或有限切开,复位满意后,行PFNA 内固定治疗.结果 23例均获随访,随访时间9~ 40个月,平均20个月.全部获得骨性愈合,平均愈合时间为4.5个月.根据改良Harris髋关节评分标准进行功能评价:优17例,良6例; 优良率100%.结论 PFNA治疗股骨粗隆下骨折,具有操作方便、损伤小、术中出血少、有利于骨折愈合、内固定坚强稳定、术后能辅以髋膝关节的早期功能锻炼等优点,对股骨粗隆下骨折有较好的临床治疗效果.

  3. Clinical use of proximal femoral nail in the treatment of subtrochanteric fracture%股骨近端防旋髓内钉治疗股骨转子下骨折临床观察

    Institute of Scientific and Technical Information of China (English)

    郝晓东; 蒋攀峰; 郑云龙; 乔艳琴

    2014-01-01

    目的 观察股骨近端防旋髓内钉(Proximal femoral nail,PFN)治疗股骨转子下骨折(Subtrochanteric fracture,SF)的疗效.方法 选取2010-09-2013-09间接受PFN治疗的88例SF患者为研究对象.以数字法随机分成观察组(46例)和对照组(42例).对照组实施动力髋螺钉(Dynamic hip screw,DHS)术式,观察组实施PFN术式.随访6个月,对比两组疗效及并发症情况.分析PFN术式的优点和临床适用范围.结果 观察组的优良率为95.65%(44/46),显著高于对照组的73.81%(31/42),差异有统计学意义(P<0.05).观察组的切口长度和骨折愈合时间均显著少于对照组,但手术时间和术中出血量显著多于对照组,差异均有统计学意义(P<0.05).观察组的并发症发生率为17.39%(8/46),对照组为16.67%(7/42),差异无统计学意义(P>0.05).结论 PFN治疗SF,疗效好、安全性高.但应注意其适用范围,从而达到最佳治疗效果.

  4. Comparison of clinical efficacy of proximal femoral nail anti-rotatio and locking plate for proximal femoral fractures%髓内钉与近端锁定钢板治疗股骨近端骨折的对比研究

    Institute of Scientific and Technical Information of China (English)

    叶庆林; 邹华章; 罗春强; 梁桂泉; 卢志文

    2016-01-01

    目的探讨股骨近端螺旋刀片抗旋髓内钉( PFNA)和股骨近端锁定钢板( PFLCP)治疗股骨近端骨折患者的临床疗效并进行对比分析。方法笔者回顾性分析2010年3月~2014年3月采用PFNA和PFLCP法治疗股骨近端骨折70例的病例资料,PFNA内固定治疗40例,PFLCP内固定治疗30例。观察比较两组患者手术时间、术中透视时间、术中失血量、术后引流量以及Parker-Palmer评分的差异。结果所有患者随访6~9个月,平均8.9个月。末次随访时两种方法的Parker-Palmer评分差异无统计学意义( P>0.05)。两种方法的手术时间、术中透视时间、术中失血量、术后引流量以及Parker-Palmer评分的差异均无统计学意义(P>0.05),但PFNA组的术中透视时间明显短于PFLCP组。结论 PFNA和PFLCP均是治疗股骨近端骨折较好的内固定材料。%Objective To compare and analyze the clinical efficacy of proximal femoral nail anti-rotation (PFNA) and proximal femoral locking compression plate (PFLCP) in the treatment of proximal femoral fracture . Methods From Mar.2010 to Mar.2014,70 patients with proximal femoral fracture treated with PFNA and PFLCP were collected.All of these patients were randomly divided into PFNA group (40 cases) and PFLCP group (30 ca-ses).The operation time,intraoperative fluoroscopy time,intraoperative blood loss,postoperative drainage volume and Parker-Palmer score between these two groups were compared .Results All patients were followed up for 6-9 months,averaging 8.9 months.There was no significant difference in the intraoperative blood loss ,operative time, postoperative drainage volume and Parker-Palmer score between the two groups .But intraoperative fluoroscopy time of the PFNA group was shorter than that of the PFLCP group .Conclusion PFNA and PFLCP were both good in-ternal fixation materials for the treatment of proximal femoral fractures .

  5. Treatment of comminuted subtrochanteric fracture of the femur with long proximal femoral nail antirotation%加长型PFNA治疗股骨转子下粉碎性骨折的临床研究

    Institute of Scientific and Technical Information of China (English)

    李仁斌; 林焱斌; 庄研; 张怡元

    2012-01-01

    [Objective] To investigate the operative method and evaluate the clinical outcomes of long proximal femoral nail ant-rotation( PFNA-long)in treating comminuted subtrochanteric fracture of femur. [ Method] From June 2006 to June 2011,83 cases of comminuted subtrochanteric fracture of the femoral were treated by closed reduction or limited open reduction and fixation with PFNA-long, including 57 males and 26 females with an average age of 42. 6 years (range, 19 -72). All patients had closed fractures in femur.The average time from injury to operation were4. Ldays(range,3 d tol2 days). All fractures were fixed with the PFNA-long. The patients were followed at 1,2,3,6,9,12 month after surgery,respectively,and next time at least once per year. The clinical outcomes were evaluated according to Harris criteria and radiological examinations. [ Result] The mean operating time of all cases was 65.7 minutes (range, 45 -95 minutes) ,and the mean blood loss during surgery was 86.4 ml (ranged ,50 -150 ml). All patients walked with walking aid 4 - 7 days after surgery. They were followed up for 4-36 months. All fractures healed after 3.3 -5.7 months (mean 3.6 months). No complications such as infection,lower limb vein infarction, cut-out or breakage of the implants occurred. But 3 cases had hip internal reverse-lamb shortening malformation. According to Harris criteria,the clinical results were excellent in 56 cases,good in 24,and moderate in 3. And the excellent and good result rate were 96. 39% (80/83). [ Conclusion] PFNA-long is an effective and minimally invasive method for comminuted subtrochanteric fracture of the femur,with minimally invasive,high fixation,strength and accord with biomechanics characteristics,and with a high rate of bone union,early functional recovery and less complications.%[目的]评价采用加长型股骨近端螺旋刀片抗旋髓内钉(proximal femoral nail anti-rotation,PFNA)治疗股骨转子下粉碎性骨折的临床疗效.[方法]2006年6

  6. 股骨近端抗旋髓内钉在股骨转子下骨折治疗中的应用%Application of new proximal femoral nail antirotation in treatment of subtrochanteric fractures

    Institute of Scientific and Technical Information of China (English)

    俞光荣; 于涛; 饶志涛; 王树青; 周家钤; 袁锋; 王家骐; 梅炯; 张世民

    2010-01-01

    Objective To evaluate the clinical outcome of new proximal femoral nail antirotation (PFNA) in treatment of subtrochanteric fractures. Methods There were 31 patients with traumatic subtrochanteric fractures intramedullarily fixed with PFNA. The patients included 14 males and 17 fe-males at a mean age of 54.6 years (range 34-90 years). According to Seinsheimer classification of sub-trochanteric fractures, 14 patients were with type Ⅱ fractures (including four patients with type ⅡA,seven with type ⅡB and three with type ⅡC), 12 with type Ⅲ fractures (including eight with type ⅢA and four with type ⅢB), two with type Ⅳ fractures and three with type Ⅴ fractures. Close reduction was performed under traction and C-arm fluoroscopy in 26 patients and open reduction through a mini-incision before inserting the nail in five patients due to difficult close reduction. Results The operation lasted for a mean time of 72.5 minutes (range 45-120 minutes), with mean blood loss of 127.5 ml (range 100-350 ml). Of all, 27 patients (87.1%, 27/31) were followed up for a mean duration of 14.3 months (range 8-24 months), which showed fracture union in all patients, with a mean union period of 17.4 weeks (range 10-21 weeks). According to Harris Hip Rate Scale, the results were. excellent in 21 pa-tients, good in two and fair in four, with excellence rate of 85.2% (23/27). Conclusions PFNA is an effective device for treatment of subtrochanteric fracture, with a high union rate and a low complication rate, for it has advantages of easy use and minor trauma, low bleeding and stable fixation in operation.%目的 探讨应用股骨近端抗旋髓内钉(PFNA)内固定治疗股骨转子下骨折的方法及疗效.方法 31例股骨转子下骨折,男14例,女17例;年龄34~90岁,平均54.6岁.骨折按Seinsheimer分型:Ⅱ型14例(ⅡA型4例,ⅡB型7例、ⅡC型3例),Ⅲ型12例(ⅢA型8例、ⅢB型4例),Ⅳ型2例,Ⅴ型3例.26例行闭合复位,5例闭合复位困难置

  7. 髋动力锁定钢板、重建钉与动力髋钢板治疗高龄股骨转子间骨折患者的疗效分析%Effect of anatomical dynamic hip lock plate, proximal femoral nail, and dynamic hip screws in the treatment of subtrochanteric femoral fractures in elderly patients: a comparative study

    Institute of Scientific and Technical Information of China (English)

    许思亮; 朱智奇; 候明

    2012-01-01

    Objective To investigate the effect of anatomical dynamic hip lock plate (ADHLP), proximal femoral nail (PFN), and dynamic hip screws (DHS) in the treatment of subtrochanteric femoral fractures in elderly patients. Methods One hundred and four patients with subtrochanteric femoral fracture in our hospital were divided into three groups: the ADHLP group, the PFN group and the DHS group. The operation time, intraoperative bleeding, Harris score one month and 6, 12 months after surgery, the healing time and the complications were compared between the three groups. Results The operation time, intraoperative bleeding and fracture healing time in PFN group were significantly less than those in DHS and ADHLP group, P<0.05. In the threee groups, Harris scores 12 months after surgery showed statistically significant difference with the scores 1 month and 6 months after surgery, P<0.05. The incidence of complications in PFN group was significantly lower than that in the other two groups, P<0.05. Conclusion PFN is preferred for treating elderly patients with subtrochanteric femoral fracture than DHS and ADHLP, with shorter operation time, less intraoperative bleeding, faster fracture healing and lower complications.%目的 探讨髋动力锁定钢板、重建钉与动力髋钢板在高龄股骨转子间骨折患者中的疗效差别.方法 回顾性研究我院收治的股骨转子间骨折患者共104例,根据治疗方式不同分为髋动力锁定钢板(ADHLP)组、重建钉(PFN)组以及动力髋钢板(DHS)组.对比三组患者手术时间、术中出血术后1个月、6个月、12个月Harris评分、骨折愈合时间以及并发症发生情况.结果 PFN组患者手术时间、术中出血及骨折愈合时间显著低于DHS组及ADHLP组,结果比较差异有统计学意义(P<0.05).三组患者术后12个月Harris评分与术后1个月、6个月评分比较差异有统计学意义(P<0.05).PFN组患者术后并发症发生率显著低于另外两

  8. 观察加长型股骨近端抗旋髓内钉治疗青壮年股骨粗隆下粉碎性骨折的临床效果%Observation Clinical Effect of Lengthened Proximal Femoral Nail Anti-rotation in Treatment of Young Subtrochanteric Comminuted Fracture

    Institute of Scientific and Technical Information of China (English)

    刘永祥

    2015-01-01

    目的:对加长型股骨近端抗旋髓内钉治疗青壮年股骨粗隆下粉碎性骨折的临床效果进行观察与探讨。方法对2012年6月~2015年6月期间在我院接受治疗的43例股骨粗隆下粉碎性骨折患者进行临床的相关研究,对所有患者实施加长型股骨近端抗旋髓内钉治疗,分析43例患者的效果。结果患者的骨折愈合时间为(3.7±0.5)个月,治疗优良率为93.02%。结论对青壮年股骨粗隆下粉碎性骨折患者进行加长型股骨近端抗旋髓内钉治疗的效果较好,可明显改善患者的关节功能。%Objective To lengthened proximal femoral nail anti-rotation clinical effect of comminuted subtrochanteric femur in young adults were observed and discussed.Methods June 2012 to June 2015 in our hospital treated 43 cases of intertrochanteric comminuted fracture patients under clinical studies, for patients of all anti-spin lengthened proximal femoral intramedullary nail treatment analysis of the effect of 43 cases of patients.Results Patients of fracture healing time was (3.7±0.5) months, the treatment rate of 93.02% ifne.Conclusion The young femoral intertrochanteric comminuted fracture patients were under anti-spin lengthened proximal femoral intramedullary nail treatment is better, can signiifcantly improve joint function of patients.

  9. Treatment of long-segment fracture in middle-up part of femoral shaft with long proximal femoral nail antirotation of AO/ASIF%加长型股骨近端螺旋刀片抗旋髓内钉治疗股骨中上段长节段骨折的临床研究

    Institute of Scientific and Technical Information of China (English)

    林焱斌; 李仁斌; 张怡元; 冯尔宥; 熊国胜; 王武练; 林任; 庄研

    2010-01-01

    Objective To investigate the operative method and evaluate the clinical outcomes of long proximal femoral nail ant-rotation(PFNA-long)in treating long-segment fracture in middle-up part of femoral bone.Methods From June 2006 to December 2009,32 cases of long-segment fracture in middleup part of femoral shaft were treated by closed reduction or limited open reduction and fixation with PFNA-long,including 30 males and 2 females with an average age of 3.8.8 years(range,20-69).All patients had closed fractures in shaft of femur.The average time from injury to operation was 4.2 days(range,3 hours to 12 days).All fractures were fixed with the PFNA-long.The patients were followed at 1,2,3,6,9,12 month after surgery,respectively,and next time at least once per year.The clinical outcomes were evaluated according to Harris criteria and radiological examinations.Results The mean operating time of all cases was 55 minutes(range,35-90),and the mean blood loss during surgery was 75.6 ml(ranged,30-150 ml).All patients walked with walking aid 4-7 days after surgery.They were followed up for 9-37 months.All fractures healed after 3.1-5.4 months(mean 3.7 months).No complications such as infection,lower limb vein infarction,cut-out or breakage of the implants occurred.But 2 cases had hip internal reverse-lamb shortening malformation,According to Harris criteria,the clinical results were excellent in 23 cases,good in 7,and moderate in 2,and the excellent and good rate was 93.75%(30/32).Conclusion PFNA-long is an effective and minimally invasive method for long-segment fracture in middle-up part of femoral shaft,with minimally invasive,high fixation-strength and accord with biomechanics characteristics;and with a high rate of bone union,early functional recovery and less complications.%目的 评价采用国际内固定研究学会(association for the study of internal fixation,AO/ASIF)加长型股骨近端螺旋刀片抗旋髓内钉(proximal femoral nail anti-rotation,PFNA)治疗股

  10. [Nail diseases in cosmetology].

    Science.gov (United States)

    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.

  11. Median nail dystrophy involving the thumb nail

    Directory of Open Access Journals (Sweden)

    Rahulkrishna Kota

    2016-01-01

    Full Text Available Median canaliform dystrophy of Heller is a rare entity characterized by a midline or a paramedian ridge or split and canal formation in nail plate of one or both the thumb nails. It is an acquired condition resulting from a temporary defect in the matrix that interferes with nail formation. Habitual picking of the nail base may be responsible for some cases. Histopathology classically shows parakeratosis, accumulation of melanin within and between the nail bed keratinocytes. Treatment of median nail dystrophy includes injectable triamcinalone acetonide, topical 0.1% tacrolimus, and tazarotene 0.05%, which is many a times challenging for a dermatologist. Psychiatric opinion should be taken when associated with the depressive, obsessive-compulsive, or impulse-control disorder. We report a case of 19-year-old male diagnosed as median nail dystrophy.

  12. Digital design and clinical application of intramedullary nailing fixation for femoral shaft fracture based on accurate three-dimensional measurement%基于精确三维测量股骨干骨折髓内钉内固定的数字化设计及临床应用

    Institute of Scientific and Technical Information of China (English)

    陈宣煌; 林海滨; 余正希; 陈旭; 郑锋; 张国栋

    2015-01-01

    背景:传统的髓内钉手术的局限性在于依赖医生的个人经验,而且扩髓会导致髓腔内生物学环境的破坏,影响骨的愈合。目的:观察数字化技术辅助髓内钉内固定治疗股骨干骨折的疗效分析。方法:2010年1月至2014年1月莆田学院附属医院骨科收治股骨干骨折患者80例,均应用数字化技术辅助治疗,术前建立股骨干骨折的三维数字模型,对三维数字骨折端进行虚拟复位,测量髓腔的直径,按测量数据选取合适规格的髓内钉,然后按照数字化技术制定的手术方案进行闭合复位髓内钉内固定治疗。结果与结论:80例患者随访12-24个月,骨折全部获得骨愈合,随访12个月时按骨科临床疗效标准评价,优62例,良15例,可3例,优良率为96%。无感染、内固定物断裂或松动等并发症发生。提示,数字化技术辅助髓内钉内固定治疗股骨干骨折疗效确切,能明显缩短手术时间,减少手术创伤,减少患者和医护人员术中透视的放射量。%BACKGROUND:The limitation of the traditional intramedulary nailing relies on the personal experience of the doctor. Moreover, the enlargement of the bone marrow causes the destruction of the biological environment of the marrow cavity and affects the healing of bone. OBJECTIVE:To observe therapeutic effect of digital technology assisted intramedulary nail fixation for femoral shaft fracture. METHODS:A total of 80 patients with femoral shaft fracture, who were treated in the Department of Orthopedics, Affiliated Hospital of Putian University from January 2010 to January 2014, were enroled. Digital technology was used to assist treatment. Three-dimensional digital model of femoral shaft fracture was established before treatment. Virtual reduction was conducted in the three-dimensional digital fractures. The diameter of medulary cavity was measured. Appropriate specification of intramedulary nailing was

  13. Retrograde nailing for distal femur fractures in the elderly

    Directory of Open Access Journals (Sweden)

    Giddie Jasdeep

    2015-01-01

    Full Text Available Introduction: We report the results of treating a series of 56 fractures in 54 elderly patients with a distal femur fracture with a retrograde femoral nail. Methods: Fifty-four of the nails were inserted percutaneously with a closed reduction. After surgery all patients were allowed to weight bear as tolerated. Four fractures were supported in a temporary external splint. Results: The mean age of patients was 80.6 years (range 51–103 years, 52/54 (96% were females. There were no cases of nail related complications and no re-operations were required. One patient was lost to follow up. The 30-day mortality was 5/54 (9.3% and the one year mortality was 17/54 (31.5%. Conclusions: Distal femoral nail fixation provides a good method of fixation allowing immediate mobilisation for this group of patients.

  14. Nutrition and nail disease.

    Science.gov (United States)

    Cashman, Michael W; Sloan, Steven Brett

    2010-01-01

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

  15. [Subtrochanteric femoral fractures].

    Science.gov (United States)

    Ulmar, B; Simon, S; Eschler, A; Mittlmeier, T

    2013-12-01

    Subtrochanteric femoral fractures are proximal femoral fractures which are located between the trochanter minor and an area of 3 cm below the minor trochanter on the femoral shaft. About 10-15% of all proximal femoral fractures correspond to this fracture site. Elderly or geriatric patients are generally affected and the injury is often the result of a fall in the home, while high-energy trauma is the cause in a small group of generally younger patients. Clinical evaluation of the affected extremity shows disability of axial weight-bearing and pain during compression and rotation of the hip joint. Basic diagnostics include conventional x-rays of the injured femur in the anterior-posterior and lateral planes. These subtrochanteric femoral fractures are almost always treated surgically due to the inherent high degree of instability. The main goals of surgical intervention are to achieve anatomic fracture reduction and primary full weight-bearing stability of the corresponding leg. Intramedullary interlocking nails are used for primary treatment, while extramedullary implants are often used in revision surgery. Early mobilization and intensive respiratory exercises are necessary to prevent early postoperative complications.

  16. Nailing Pompeii

    Science.gov (United States)

    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.”

  17. Proximal femoral nail versus hemiarthroplasty for senile intertrochanteric fractures%PFN钉置入内固定与人工股骨头置换治疗高龄股骨转子间骨折的比较

    Institute of Scientific and Technical Information of China (English)

    邓海源

    2011-01-01

    背景:PFN钉置入内固定用于治疗高龄股骨转子间骨折已被广泛应用于临床.但人工关节置换是否可以运用于高龄股骨转子骨折患者仍存在争议.目的:比较PFN钉置入内固定与人工股骨头置换治疗高龄股骨转子间骨折疗效的差异方法:选择青海省藏医院骨科高龄股骨转子间骨折患者62例,年龄75~87岁,按治疗方式随机分为PFN钉内固定组、人工股骨头置换组,二组均采用常规手术入路.观察2组患者的手术时间、出血量及髋关节功能、内科并发症等指标.结果与结论:62例高龄股骨转子间骨折患者经切开复位内固定均获得成功.①两组手术时间差异无显著性意义(P > 0.05).②人工股骨头置换组术中出血量多于PFN组、术后卧床时间、内科并发症及髋部畸形率均少于PFN组(P < 0.05).人工股骨头置换组术后髋关节Harris评分优于PFN钉内固定组.人工股骨头置换因手术手术创伤较大出血量多,但在术后恢复时间、预防术后内科并发症及髋部畸形方面优于PFN钉内固定组,近期髋关节活动度要优于PFN钉内固定组.%BACKGROUND: Proximal femoral nail (PFN) internal fixation has been widely used for the treatment of intertrochanteric fractures in senile patients and has a good therapeutic effect. However, it is still controversial that whether artificial joint replacement can be used in intertrochanteric fractures in senile patients.OBJECTIVE: To investigate the clinical effect of PFN internal fixation versus hemiarthroplasty in intertrochanteric fractures of senile patients.METHODS: Sixty-two senile patients with intertrochanteric fractures were selected from Department of Orthopedics at Tibetan Medicine Hospital, the age of patients was from 75 years old to 87 years old. All patients were randomly divided into PFN groups (PFNG) and hemiarthroplasty groups (HEMG), and received operative treatment with common operative route. Operative time

  18. 股骨近端防旋髓内钉治疗老年人髋部骨折疗效的多因素分析%Multivariate analysis of geriatric intertrochanteric fractures treated with proximal femoral nail antirotation (PFNA)

    Institute of Scientific and Technical Information of China (English)

    纪泉; 高凡; 文良元; 薛庆云; 黄公怡

    2012-01-01

    Objective To investigate the clinical and functional outcome of the proximal femoral nail antirotation (PFNA) in the treatment of geriatric intertrochanteric fractures and analylze various factors affecting the prognosis. Methods All of 76' patients with intertrochanteric fractures treated with PFNA were included. Patients' general health, injury mechanism, fracture pattern, operation time, intraoperative blood loss, perioperative complications, bone healing and evaluation of the operated hip joint were reviewed. Results The incidence of superficial infection occurred 2.6% (n=2),cerebrocardiovascular accidents 3.9%(n=3),postoperative pneumonia was 6.6%(n=5), geriatric delirium 15.8%(n=12),postoperative deep venous thrombosis 5.3%(n=4), upper peptic tract hemorrhage 2.6%(n=2).Multivariate analysis indicated that age, fracture stability, ASA score was the predictors of postoperative hip function (P =0.032,P =0.032,P =0.038) while gender, early operation and operation time was not statistically correlated with hip joint function (P >0.05).Conclusion PFNA is a suitable and less invasive procedure for geriatric intertrochanteric fractures via stable fixation and early rehabilitation but the complication incidence is relatively high. Age, fracture stability and ASA score may be related to the postoperative hip joint function.%目的 研究股骨近端防旋髓内钉(PFNA)治疗老年股骨粗隆间骨折的疗效,并分析影响预后的因素.方法 76例股骨粗隆间骨折患者接受PFNA内固定治疗,记录患者一般情况、骨折类型、手术时间、术中出血量、围手术期并发症,患侧髋关节Harris评分.结果 术后并发症发生率:表浅软组织感染2.6%(2例),心脑血管意外3.9%(3例),肺炎6.6%(5例),老年谵妄15.8%(12例),术后DVT5.3%(4例),应激性溃疡2.6%(2例).多因素回归分析显示年龄、骨折稳定性(股骨内后侧皮质)、ASA评分是骨折愈合后髋关节功能的预测因子(P =0.032,P =0.032,P

  19. Fixed treatment for femoral neck fracture of young adults by bone flap M. sartorious transplanting and hollow pulling nails%缝匠肌骨瓣移植空心拉力钉固定治疗青壮年股骨颈骨折

    Institute of Scientific and Technical Information of China (English)

    蔡明; 白金广

    2000-01-01

    目的:通过采用缝匠髂骨瓣移植、空心拉力钉固定治疗青壮年股骨颈骨折,获得更好的疗效。方法:自1992年1月~1999年12月,采用缝匠肌骨瓣移植桥接与空心拉力钉固定治疗青壮年股骨颈骨折,随访时间1~5年,平均4年。结果:73例新鲜骨折中1例骨折不愈合,股骨头坏死,1例骨折愈合股骨头坏死;27例移位型陈旧骨折中3例骨折不愈合,股骨头坏死,2例骨折愈合后股骨头坏死。骨折愈合率96%,股骨头坏死率7%。结论:缝匠肌骨瓣移植可改善股骨头血供并使植骨以"活骨骨折愈合"的方式完成,陈旧性骨折股骨颈吸收的可重建股骨颈,并有一定的强度支撑防止股骨头坏死应力塌陷,与空心拉力钉有协同支撑固定作用。三根空心拉力钉固定创伤小而连接控制面积大是理想的内固定物。%Objective: To achieve better effects through the application of bone flap M. Sartorious transplanting and hollowpulling nails for the treatment of the femoral neck fracture of young adults. Methods: From 1,1992 to 12, 1999, We treatedfemoral neck fracture of young adults by bone flap M. Sartorious transplanting and hollow pulling nails with one to five yearsfollow-up,averaging 4 years. Results: Among 73 fresh (new) fracture 1 not healed up,femoral head necrosis, 1 healed up, withtemoral head necrosis;27 transferred old fractures, 3 not healed up, femoral head necrosis, 2 healed up, femoral head necrosis.Fracture healing rate was 96 percent, femoral head necrosis rate was 7 percent. Conclusion: That the bone flap M. Sartorioustransplanting can improve femoral blood supply, finish bone transplanting in a way of"live bone fracture healing up", rebuildfemoral neck for old fracture and together with hollow pulling nails prevent femora from necrosis. Three hollow pulling forcenails make little wound and large joined controlling area. They are the ideal inner fixed objects.

  20. Internal fixations of proximal femoral nail antirotation versus that of dynamic hip screw for femoral intertrochanteric fracture%抗旋转型股骨近端髓内钉内固定与动力髋螺钉内固定治疗股骨转子间骨折的临床疗效对比观察

    Institute of Scientific and Technical Information of China (English)

    梁荣班; 赵佳; 卢珂恩; 谭宏昌

    2014-01-01

    Objective To explore and study the clinical effects of the internal fixations of proximal femoral nail antirotation(PFNA) and dynamic hip screw(DHS) for femoral intertrochanteric fracture.Methods 100 patients with femoral intertrochanteric fracture admitted into our hospital from April,2009 to April,2013 were selected as study objects and randomly and equally divided into two groups.50 patients (PFNA group) were treated by the internal fixation of PFNA,and the other 50 patients (DHS group) by the internal fixation of DHS.They were followed up for 9-18 months.The curative effects of both groups were observed and compared.Results The volumes of intraoperative bleeding and of the postoperative drainage were smaller and the postoperative weight-loading walking time and healing time were shorter in the PFNA group than in the DHS group.The Harris hip function scores were increased in both groups after the treatment; the hip function scores,motion ranges,and synthetic scores were increased more but the hip joint score of deformity less in the PFNA group than in the DHS group.The incidence of postoperative complications of the PFNA group was 6.0%,which was significantly lower than that of the DHS group (26.0%),with a statistical difference (P<0.05).Conclusions PFNA has better curative effects than DHS in the treatment of femoral intertrochanteric fracture and has greater comparative advantages in intraoperative bleeding volume,postoperative healing time,and weight-bearing walking time.Comparing with DHS treatment,PENA treatment causes fewer postoperative complications and recovers hip joint function better,so it can be the first treatment choice for patients with femoral intertrochanteric fracture.%目的 探究抗旋转型股骨近端髓内钉(PFNA)内固定与动力髋螺钉(DHS)内固定在股骨转子间骨折中的临床疗效.方法 选取自2009年4月至2013年4月我院收治的股骨转子间骨折患者100例,将其作为研究对

  1. Distal nail embbeding

    Directory of Open Access Journals (Sweden)

    Patricia Chang

    2014-01-01

    Full Text Available Male patient, 35 years old who came to dermatological consultation due to contact dermatitis on back, during his clinical examination alterations of his digits was seen. Dermatological examination reveals a rim of tissue at the distal edge of the nail of both big toenails and thickened nails (Fig.1a – c, 2a, b. Both big toenails were removed due to ingrown nails two times. Diagnosis of distal nail embedding was done. Distal nail embedding is a rim of tissue at the distal edge of the nail. Causes can de acquired or congenital.

  2. Broken Bones (For Parents)

    Science.gov (United States)

    ... Feeding Your 1- to 2-Year-Old Broken Bones KidsHealth > For Parents > Broken Bones Print A A ... bone fragments in place. When Will a Broken Bone Heal? Fractures heal at different rates, depending upon ...

  3. 缝线锚钉修复肾功能衰竭伴自发性股四头肌腱断裂的临床研究%Clinical Research of Suture Anchor Nail Repair Renal Failure Associated with Spontaneous Femoral Quadriceps Tendon Rupture

    Institute of Scientific and Technical Information of China (English)

    杨瑞; 陈祥云; 颉朝阳; 韩晓军; 刘志鹏; 宋矿朋

    2015-01-01

    目的:评估缝线锚钉修复肾功能衰竭伴自发性股四头肌腱髌骨止点断裂的临床疗效。方法:2007年1月-2012年1月,对本院收治的21例肾功能衰竭伴自发性股四头肌腱断裂患者采用缝线锚钉行股四头肌腱髌骨止点修补缝合。术前常规实验室检查,拍摄患侧膝关节X线片及MRI;术后6周内支具保护,6周后行屈膝练习,术后2年测量患者屈膝角度。结果:21例患者均获得随访。随访结束,均未发生锚钉松动及脱出。术前术后均采用Lysholm和Kujala膝关节评分标准,评分差异有统计学意义(P<0.05)。结论:选择适当的病例,应用缝线锚钉是修复肾功能衰竭伴自发性股四头肌腱髌骨止点断裂的有效方法。%Objective: To assess the clinical efficacy of suture anchor nail repair renal failure associated with spontaneous femoral quadriceps tendon patellar check point of fracture.Method: From January 2007 to January 2012, 21 renal failure patients with spontaneous femoral quadriceps tendon rupture were given the nail line of patella femoral quadriceps tendon suture anchor check point repair suture. Preoperative routine laboratory examination was taken by lateral knee X-ray films and MRI. With a protection within 6 weeks, after 6 weeks bend knees practice was taken, and knees angle was measured 2 years later.Result: 21 patients were all followed up and in the end they were not loose bolts and emergence. The effect was evaluated by Kujala and Lysholm knee scoring standards and showed significant difference before and after operation (P<0.05).Conclusion: Selecting appropriate cases and using suture anchors is renal failure associated with spontaneous femoral quadriceps tendon patellar fracture effective method of check point.

  4. The efficacy comparison between hollow screw fixation and head and tail nail fixation treatment for the elderly femoral neck fractures%空心拉力螺钉内固定与首尾钉内固定治疗老年人不同类型股骨颈骨折疗效比较

    Institute of Scientific and Technical Information of China (English)

    郝应文; 唐军伟

    2014-01-01

    Objective To analyze and compare the efficacies of internal fixation by the cancellous bone screw and by the head and tail nail in the treatment of femoral neck fracture of the elderly. Methods 103 cases of elderly femoral neck fractures who were followed up for more than one year accepted the retrospective analysis. They were divided into group A(n=55)and group B(n=48)according to the treatment they received. Group A was treated by cancellous bone screw,and group B was treated by head and tail nail. The efficacy was evaluated by Harris score. Results There was no statistical difference in the efficacy of the treatment between two groups( P >0. 05)and Harris score was improved in each type of femoral neck fracture. However,the excellent rate was higher in group A than in group B(91. 2% vs. 62. 5%)for subcapital type ( P 0. 05),and lower in group A than in group B(66. 7% vs. 95. 0%) ( P 0.05)。两组患者不同类型术后髋关节Harris评分均有不同程度的改善。头下型骨折:A组优良率为91.2%,B组优良率为62.5%,A组优良率高于B组( P 0.05);基底型骨折:A组优良率为66.7%,B组优良率为95.0%,B组优良率高于A组( P <0.05)。结论空心拉力螺钉内固定与首尾钉内固定治疗老年人股骨颈骨折,都可以达到良好的骨折复位效果,头下型骨折空心拉力螺钉内固定效果更优,基底型骨折首尾钉内固定效果更优。

  5. 关节镜下逆行交锁髓内钉治疗股骨髁上骨折48例临床治疗观察%Therapeutic effects of retrograde interlocking intramedullary nailing underarthroscopy for supracondylar femoral fractures

    Institute of Scientific and Technical Information of China (English)

    王彦明; 李玉民; 刘牛庆; 李红新; 夏勇; 任慧勇; 田明

    2012-01-01

    Objective To evaluate the clinical therapeutic effects of retrograde interlocking intramedullary nailing under arthroscopy on the treatment of supracondylar femoral fractures . Methods From Jan. 2007 to Jan. 2011,there were 48 supracondylar femoral fractures including 31 closed fractures and 17 open fractures. There were 29 males and 19 femals,and the average age was 57 years ranging from 21 to 77 years. According to the AO/ASIF classification system ,27 fractures were evaluated as type A1,12 type A2 and 9 type A3. All the patients were treated by arthroscopically assisted retrograde intramedullary interlocking nails ,and were directed to take function exercise after operation. Results Totally 48 cases were followed up for 6-48 months,24. 6 months on average. All the fractures were healed on an average of 14.9 weeks postoperatively ranging from 10 to 18 weeks. The functional results of knee joint were assessed according to the Kolmert criteria as excellent in 27,good in 18,fair in 2 and poor in 1. The rate of excellent and good was 93. 7%. Conclusion The arthroscopically-assisted retrograde intramedullary interlocking nailing for treating supracondylar femoral fractures has advantages of micro -trauma, firm fixation, high fracture healing rate , good recovery of joint function , few complications. It is an optimal measure for treating su ?pracondylar femoral fractures.%目的 观察膝关节镜辅助下逆行交锁髓内钉(GSH)内固定术治疗股骨髁上骨折的临床疗效.方法 自2007年1月~2011年1月采用膝关节镜辅助下GSH治疗48例股骨髁上骨折病例.其中男性29例,女性19例; 年龄21~77岁,平均57岁.闭合性骨折31例,开放性骨折17例; 按AO/ASIF分类系统分类:A1型27例,A2型12例,A3型9例.结果 48例随访6~48个月,平均24.6个月.骨折在术后10~18个月内愈合,平均愈合时间14.9个月.术后膝关节功能评价参照Kolmert评分标准,优良率达93.7%.结论 膝关节镜辅助下GSH治疗股骨

  6. Facts about Broken Bones

    Science.gov (United States)

    ... Room? What Happens in the Operating Room? Broken Bones KidsHealth > For Kids > Broken Bones Print A A ... sticking through the skin . What Happens When a Bone Breaks? It hurts to break a bone! It's ...

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

    Science.gov (United States)

    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.

  8. Intramedullary fixation of a femoral shaft fracture with preservation of an existing hip resurfacing prosthesis.

    Science.gov (United States)

    Bilkhu, A; Sisodia, G; Chakrabarty, G; Muralikuttan, K P

    2015-04-01

    Femoral neck fractures have been reported as a cause for failure in patients with a hip resurfacing arthroplasty. However, the incidence and management of fractures of the femoral shaft with an ipsilateral hip resurfacing arthroplasty is relatively absent in current literature. Although, the gold standard for the fixation of a closed femoral shaft fracture is with the use of an intramedullary nail, this can be a challenge in the presence of a hip resurfacing arthroplasty. We describe the case of anterograde intramedullary nail fixation for a femoral shaft fracture in a patient with an ipsilateral hip resurfacing arthroplasty in situ.

  9. Biomechanical properties of retrograde interlocking intramedullary nail versus less invasive stabilization system plate in the repair of distal femoral fractures%逆行交锁髓内钉与微创内固定钢板修复股骨远端骨折的生物力学性能比较

    Institute of Scientific and Technical Information of China (English)

    张慧东; 王井伟; 白净

    2016-01-01

    背景:目前股骨远端骨折多采用微创内固定系统(LISS)钢板或逆行交锁髓内钉内固定治疗,但两种方法的选择尚有争议,且对其生物力学性能研究尚少。目的:比较逆行交锁髓内钉与LISS钢板置入内固定修复股骨远端骨折的生物力学稳定性。方法:取12根尸体股骨标本,均为男性,X射线摄片排除损伤、骨密度异常及骨病标本。随机分成2组,制成相同标准AO分型A3型髁上骨折模型,分别用LISS钢板和逆行交锁髓内钉内固定。观察股骨标本承受轴向压缩时的抗压刚度和载荷100,300,500 N下的位移值,以及标本承受弯曲载荷时的抗弯强度。结果与结论:①在抵抗轴向变形能力(抗压刚度)方面,LISS钢板大于逆行交锁髓内钉(P0.05);②在100,300,500 N轴向压缩载荷作用下,LISS钢板组的位移均小于逆行交锁髓内钉组(P0.05). (2) Under axial compressive loading of 100, 300 and 500 N, the displacement values of LISS plate were significantly less than those of the retrograde interlocking intramedul ary nail (P<0.05). (3) In conclusion, in the distal femoral fracture fixation, the stiffness of the retrograde interlocking intramedul ary nail is low. While the LISS plate not only has certain deformation, but also has strong rigidity with firm internal fixation, which provides excel ent biological environment for fracture healing;thus it is a reliable treatment for distal femoral fractures.

  10. Femoral reconstruction nail for the treatment of intertrochanteric and ipsilateral subtrochanteric fractures in patients with multiple exostoses%股骨重建钉治疗多发性骨软骨瘤患者粗隆间骨折合并同侧粗隆下骨折

    Institute of Scientific and Technical Information of China (English)

    赵世昌; 张春林; 曾炳芳

    2012-01-01

    Objective To investigate; the clinical effects of femoral reconstruction nail for the treatment of subtrochanteric and ipsilateral subtrochanteric fractures in patients with multiple exostoses. Methods From January 2009 to June 2010, a total of 18 patients with multiple exostoses were treated with femoral reconstruction nail for intertroehanteric and ipsilateral subtrochanteric fractures in our department. Among them there were 13 males and 5 females, whose average age was 48.512.7 years old (range; 23-69 years). There were 10 cases on the right side and 8 cases on the left side. In the intertroehanteric fractures group, according to Evans classification, there were 1 case of type I. 2 of type 33. 6 of type 133 A. 4 of type 133 B. 3 of type 3 V and 2 of type V. In the ipsilateral subtrochanteric fractures group, according to the Russell-Taylor classification, there were 6 cases of type I A, 8 of type I B and 4 of type II B. Imaging material of all patients indicated as general multiple exostoses. The occurrence of complications after fracture operation, clinical healing time and functional evaluation of all patients were followed up. Results All the 18 patients were followed up over an average period of 24.2±0.8 months (range; 12-30 months). The mean operation time wras 10516.5 minutes (range; 75-135 minutes), and the mean postoperative hospital stay was 9.3.1.1.2 days (range; 7-12 days). The average Harris score in the final follow-up was 86.6±3.4 scores (range; 65-95 scores). Among the 18 patients, 7 patients were excellent, 8 good, 2 fair and 1 poor. The excellence rate was 83.33%. The mean healing time of the fractures was 16.2±1.8 wreeks ('range; 12-20 weeks). In the final fo!lowr-up, except for 1 patient with nail cutting the femoral head and 1 patient with coxa vara, there was no complication such as fracture redisplacement, failure of internal fixation, a vascular necrosis of femoral head, infection and so on. Conclusions Femoral reconstruction nail for

  11. Hair and nail relationship.

    NARCIS (Netherlands)

    Baran, R.; Dawber, R.P.; Haneke, E.

    2005-01-01

    Hair and nails are often stated to have much in common in relation to their origin, anatomical structures, and common involvement in many diseases. Hair and nails are predominantly epithelial structures derived from primitive epidermis and made up of keratinous fibrils embedded in a sulfur-rich matr

  12. [Cosmetology and brittle nails].

    Science.gov (United States)

    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.

  13. Nail patela elbow syndrome

    Directory of Open Access Journals (Sweden)

    Jain V

    1990-01-01

    Full Text Available A 15 year old male having nail-patella elbow syndrome presented with deficient nail with pterygium formation rudimentry patellae, iliac horn, increased carrying angle of elbow joints and thickened ribs. Family history was suggestive of autosomal dominant inheritance.

  14. Nail changes after carbamazepine

    Directory of Open Access Journals (Sweden)

    Chopra Adarsh

    2000-01-01

    Full Text Available Antiepileptics are known to produce different types of side effects including nail changes. A 20-year-old epileptic man had yellowish discolouration followed by dystrophy and onycholysis of his 15 nails after taking carbamazepine for 3 months which cleared within six months after discontinuation of the drug. This type of change has not been reported earlier with carbamazepine

  15. Yellow nail syndrome

    Directory of Open Access Journals (Sweden)

    Dixit Ramakant

    2007-01-01

    Full Text Available A case of yellow nail syndrome is described in a forty year old male patient who presented with classical triad of this syndrome i.e. deformed yellow nails, lymph-edema and chronic recurrent pleural effusion. The practical problems in the di-agnosis are also briefly discussed with emphasis on awareness of this rare clinical entity.

  16. Use of minimally invasive operation therapy with extended intramedullary nail on children with femoral fracture and deformity due to osteogenesis imperfecta%可延长髓内钉微创治疗成骨不全术后股骨再发畸形或骨折

    Institute of Scientific and Technical Information of China (English)

    房凤岭; 任秀智; 冯世庆; 李志良; 王风君; 袁桐强

    2013-01-01

    目的 探讨可延长髓内钉治疗成骨不全术后股骨再发畸形或骨折的疗效.方法 回顾性分析2009年6月至2012年6月采用可延长髓内钉治疗21例成骨不全术后股骨再发畸形或骨折患儿资料,男13例,女8例;年龄9岁6个月至15岁7个月,平均12岁3个月.所有患儿均已行股骨干截骨矫形不可延长髓内钉手术,此次手术距初次手术时间为2~4年,平均3年.所有患儿成长肢体于髓内钉远端部位再次出现畸形或骨折,其中9例为股骨干弯曲畸形,畸形成角度数为10°~30°,平均15°;12例为再发骨折.依据修订后的Sillence分型:Ⅲ型6例,Ⅳ型14例,Ⅴ型1例.21例患儿均在大转子及远端截骨处切开手术,切口长度为2~3 cm,采用可延长髓内钉再次固定骨折及矫正畸形.结果 21例患儿均获得随访,随访时间6~30个月,平均18个月.骨折愈合时间为7~12周,平均8.5周.待X线片示截骨愈合后患儿开始负重行走.所有患儿及其父母均对手术结果及畸形矫正效果表示满意,末次随访时患儿Barthel指数评分由术前平均72.85分(范围,50~90分)提高到术后平均91.42分(范围,80~100分).WeeFIM评分由术前平均55.42分(范围,40~70分)提高到术后平均79.00分(范围,70~86分).10例术前需拐杖辅助行走患儿,随访时可独立行走;6例术前因骨折而卧床患儿中,4例可独立行走,2例需拄拐活动.末次随访时,无一例出现感染、骨髓炎等并发症,无神经、血管损伤病例.结论 应用可延长髓内钉小切口手术,对肢体损伤小、出血少、骨折愈合时间短、患儿痛苦小,是治疗成骨不全术后股骨再发畸形或骨折的良好方法.%Objective To evaluate the therapeutic effect of extendable intramedullary nail on children with femoral deformity due to osteogenesis imperfecta.Methods From June 2009 to June 2012,21 patients with femoral deformity due to osteogenesis imperfecta were treated with extendable

  17. Interventions for nail psoriasis (Review)

    NARCIS (Netherlands)

    Vries, A.C. de; Bogaards, N.A.; Hooft, L.; Velema, M.; Pasch, M.C.; Lebwohl, M.; Spuls, P.I.

    2013-01-01

    BACKGROUND: Psoriasis is a common skin disease that can also involve the nails. All parts of the nail and surrounding structures can become affected. The incidence of nail involvement increases with duration of psoriasis. Although it is difficult to treat psoriatic nails, the condition may respond t

  18. Carbon fiber intramedullary nails reduce artifact in postoperative advanced imaging

    Energy Technology Data Exchange (ETDEWEB)

    Zimel, Melissa N. [Memorial Sloan Kettering Cancer Center, Orthopaedic Surgery Service, Department of Surgery, New York, NY (United States); Hwang, Sinchun [Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, NY (United States); Riedel, Elyn R. [Memorial Sloan Kettering Cancer Center, Department of Epidemiology and Biostatistics, New York, NY (United States); Healey, John H. [Memorial Sloan Kettering Cancer Center, Orthopaedic Surgery Service, Department of Surgery, New York, NY (United States); Weill Medical College of Cornell University, Department of Orthopaedic Surgery, New York, NY (United States)

    2015-09-15

    This study assessed whether radiolucent carbon fiber reinforced-polyetheretherketone (CFR-PEEK) intramedullary nails decreased hardware artifact on magnetic resonance imaging (MRI) and computed tomography (CT) in vitro and in an oncologic patient population. In vitro and clinical evaluations were done. A qualitative assessment of metal artifact was performed using CFR-PEEK and titanium nail MRI phantoms. Eight patients with a femoral or tibial prophylactic CFR-PEEK nail were retrospectively identified. All patients had postoperative surveillance imaging by MRI, CT, and were followed for a median 20 months (range, 12-28 months). CFR-PEEK images were compared to images from a comparative group of patients with titanium femoral intramedullary nails who had a postoperative MRI or CT. A musculoskeletal-trained radiologist graded visualization of the cortex, corticomedullary junction, and bone-muscle interface, on T1-weighted (T1W), STIR, and contrast-enhanced T1-weighted fat-saturated (T1W FS) sequences of both groups with a five-point scale, performing independent reviews 4 months apart. Statistical analysis used the Wilcoxon rank-sum test and a weighted kappa. Substantially less MRI signal loss occurred in the CFR-PEEK phantom than in the titanium phantom simulation, particularly as the angle increased with respect to direction of the static magnetic field. CFR-PEEK nails had less MRI artifact than titanium nails on scored T1W, STIR, and contrast-enhanced T1W FS MRI sequences (p ≤ 0.03). The mean weighted kappa was 0.64, showing excellent intraobserver reliability between readings. CFR-PEEK intramedullary nail fixation is a superior alternative to minimize implant artifact on MRI or CT imaging for patients requiring long bone fixation. (orig.)

  19. Observaiton on clinical effetc applicatoin of anit -osteopo rosis treatment with intramedullary nail in treatment of femoral intertrochanteric fractures in elderly patient's%高龄股骨粗隆间骨折应用髓内钉结合抗骨质疏松治疗的效果观察

    Institute of Scientific and Technical Information of China (English)

    晏万述; 于德洋; 谢东方

    2015-01-01

    Objective:To investigate the application of anti osteoporosis treatmentwith intramedullary nail in treatment of femoral inter-trochanteric fractures in the elderly patient's clinical effect.Methods:Our hospital 70 cases of elderly patients with femoral intertrochan-teric fracture were divided into observation group and control group.Given to the control group of patients with intramedullary nails in the treatment, the patients in observation group were given intramedullary nailinternal fixation combined with anti osteoporosis treatment, pa-tients were followed up for 1 years.Results:preoperative hip joint function were compared between the two groups ( Harris score) there was no significant difference (P>0.05), after 1 years observation of hip function score was significantly higher than that of the control group patients (P<0.05), the observation group of patients with postoperative complication rate was 11.4%, significantly lower than the control 28.6%groups of patients (P<0.05).Conclusion :The application of anti osteoporosis therapy combined with intramedul-lary nail in treatment offemoral intertrochanteric fractures in the elderly patients,might have a significant clinical effect, high safety.%目的:探讨应用抗骨质疏松治疗结合髓内钉内固定治疗高龄股骨粗隆间骨折患者的临床效果。方法:将我院收治的70例高龄股骨粗隆间骨折患者平均分为观察组和对照组。给予对照组患者髓内钉内固定治疗,给予观察组患者髓内钉内固定结合抗骨质疏松治疗,术后随访1年。结果:术前比较2组患者的髋关节功能评分( Harris)不存在明显差异( P>0.05),术后1年观察组患者的髋关节功能评分明显高于对照组患者(P<0.05),术后观察组患者的并发症发生率为11.4%,明显低于对照组患者的28.6%( P<0.05)。结论:应用抗骨质疏松治疗结合髓内钉内固定治疗高龄股骨粗隆间骨折患者

  20. 弹性髓内钉与钢板固定儿童转子下骨折的疗效比较%Comparison of Clinical Effects with Methods of the Titanium Elastic Nails(TENs)and Compression Plate in Treating Femoral Subtrochanteric Fractures in Children

    Institute of Scientific and Technical Information of China (English)

    楚宇鹏; 牟遐平; 水小龙; 孔建中

    2011-01-01

    目的 比较弹性髓内钉与加压钢板治疗儿童股骨转子下骨折的临床疗效.方法 收集2004年3月至2007年10月我院收治的儿童股骨转子下骨折42 例,其中采用弹性髓内钉治疗23 例,加压钢板治疗19 例,比较两组患者手术时间、术中出血量、住院时间、术后引流量、术后并发症及髋关节功能Sanders评分.结果 所有患儿骨折均临床愈合,两种方法在手术时间、出血量、住院时间及术后引流量方面差别有统计学意义(P<0.05),术后并发症和髋关节功能Sanders评分差异无统计学意义(P>0.05).结论 弹性髓内钉治疗儿童股骨转子下骨折的疗效优于加压钢板,是一种安全、微创、疗效良好的手术方法.%Objective To compare the clinical outcomes of Titanium Elastic Nails (TENs) and compression plate methods in treating femoral subtrochanteric fracture in Children.Methods Forty-two children with femoral subtrochanteric fracture from March 2004 to October 2007 were treated by TENs (23 cases) and compression plates (19 cases) respectively,then we compared the operation time,inhospital time,blood loss,drainage,postoperarive complications and Sanders scores.Results All children showed clinical cure.Two groups had statistical differences in operation,in-hospital time,blood loss and drainage(P<0.05),but had no statistical differences in postoperarive complications or Sanders scores (P>0.05).Conclusion TENs method is secure,minimally invasive and effective in treating femoral subtrochanteric fracture in Children,and TEN methods provided better clinical outcomes than compression plate methods.

  1. Femoral Locking Compression Plate (LCP)for the Subtrochanteric Fractures in Children%股骨锁定加压钢板(LCP)在儿童股骨转子下骨折中的应用

    Institute of Scientific and Technical Information of China (English)

    蔡文全; 覃佳强; 南国新; 王忠良; 宿玉玺; 张德文

    2014-01-01

    Objetive To study the clinical effect of the femoral locking compression plate (LCP)in children femoral subtrochanteric fracture. Methods 22 cases of femoral subtrochanteric fracture in children diagnosed in our hospital from February 201 0 to December 201 2 were analyzed retrospectively,including 1 6 ca-ses of male,6 cases of female,with an average age of 8.5.Results All of the 22 cases received follow-ups ranging from 6 to 48 months (27 months in average);osseous healing was found in all these 22 cases of frac-ture,without broken nails,nail,loose steel plate,broken board or coax vara,articular dyskinesia,etc. Con-clusion Application of femoral locking compression plate (LCP)for children femoral subtrochanteric fractures can effectively improve the deficiencies of the traditional conservative treatments including traction,k-wire,ti-tanium elastic nail fixation and other therapies,and can achieve a better effect through early functional exercise to reduce joint rigidity.%目的:探讨股骨锁定加压钢板(LCP)对儿童股骨转子下骨折的临床疗效。方法回顾性分析本院2010年2月至2012年12月收治的22例股骨转子下骨折患儿临床资料,其中男16例,女6例,平均年龄8.5岁。结果22例均获得随访,随访时间6~48个月,平均27个月,22例均骨性愈合,无断钉、脱钉、钢板松动、断板及髋内翻、关节活动障碍等并发症发生。结论股骨锁定加压钢板(LCP)对于儿童股骨转子下骨折可以有效改善传统保守牵引、克式针、弹性髓内钉固定及其他治疗方法的不足,可早期进行功能锻炼,减少关节僵直,效果良好。

  2. Lateral cortex blowout during PFNA blade insertion in a subtrochanteric fracture -Should bone quality determine the type of nail used?

    Institute of Scientific and Technical Information of China (English)

    Sunil Gurpur Kini; Lai Choon Hin; Jikku Haniball

    2015-01-01

    Subtrochanteric fractures pose a therapeutic challenge to the surgeons.With the advent of proximal femoral nails, most of the cases are treated with nailing.Newer nails like proximal femoral nail ant-rotation (PFNA) require the blade to be directly hammered into the bone compared to older nails where the screws are drilled and tapped before insertion.We report one such case in a middle aged female that had intraoperative lateral cortex blowout during PFNA blade insertion in a sclerotic bone.This occurrence to the best of our knowledge is unreported in literature.It is therefore imperative to consider the quality of bone before a decision is made on the implant chosen.

  3. A STUDY OF CLOSED INTERLOCKING NAILING FOR FRACTURES OF SHAFT OF FEMUR IN ADULTS

    Directory of Open Access Journals (Sweden)

    Ashwin

    2013-06-01

    Full Text Available ABSTRACT: BACKGROUND:-This study is to determine the clinical course and results after interlocking nailing for femoral shaft fractures , merits and demerits of interlocking nailing, achieving the final goals of femoral shaft fracture management with special references to time for radiological union, knee stiffness, limb length discrepancy, ambulation and return to work. Femur is the strongest and heaviest bone in the human skeleton. It is also the longest bone contributing 26% to height of an individual. Fractures of the shaft of the femur are among the most common fractures encountered in orthopaedic practice, can cause prolong morbidity and extensive disability unless treatment is appropriate. Many treatment modalities were described; with many surgeons advocating different methods of treatment .At present Interlocking nailing of the femur seems to be the ideal method of treatment for complex femoral fractures.

  4. Pseudoarthrosis in atypical femoral fracture: case report.

    Science.gov (United States)

    Giannotti, S; Bottai, V; Dell'Osso, G; De Paola, G; Ghilardi, M; Guido, G

    2013-11-01

    Atypical femoral fractures can be subsequent to a long-term biphosphonates treatment; they have a high frequency of delayed healing. The authors describe a femoral pseudoarthrosis of an atypical fracture treated with intramedullary nailing in a female after prolonged alendronate therapy. Atypical femoral fractures can be subsequent to a long-term biphosphonates treatment even if, in the literature, there is no clarity on the exact pathogenetic mechanism. The Task Force of the American Society for Bone and Mineral Research described the major and minor features to define atypical fractures and recommends that all the five major features must be present while minor features are not necessary. Another controversial aspect regarding the atypical femoral fractures is the higher frequency of the delayed healing that can be probably related to a suppressed bone turnover caused by a prolonged period of bisphosphonates treatment. This concept could be corroborated by the Spet Tc exam. In the case of a pseudoarthrosis, there is not a standardization of the treatment. In this report, the authors describe a femoral pseudoarthrosis of an atypical fracture treated with intramedullary nailing in a female after prolonged alendronate therapy; the patient was studied with clinical, bioumoral end SPECT-Tc exam of both femurs. Many studies show the relationship between bisphosphonates and the presence of atypical fractures. These fractures should be monitored more closely due to the risk of nonunion and they require considering an initial treatment with pharmacological augmentation to reduce the complications for the patient and the health care costs.

  5. Skin or nail culture

    Science.gov (United States)

    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, ...

  6. Nail abnormalities in rheumatoid arthritis.

    Science.gov (United States)

    Michel, C; Cribier, B; Sibilia, J; Kuntz, J L; Grosshans, E

    1997-12-01

    Many nail abnormalities have traditionally been described in association with rheumatoid arthritis (RA), but their specificity has never been assessed in a controlled study. Our purpose was to evaluate the frequency and the specificity of nail changes associated with RA in a case-controlled study including 50 patients suffering from RA and 50 controls. For each patient, a general skin examination was performed and the 20 nails were examined. The nail features were noted and classified. A chi 2 test or a Fisher test was used to compare the two groups. The only nail abnormalities significantly associated with RA were longitudinal ridging on nine or 10 finger nails (29 patients in the RA group vs. three in the controls, chi 2: P nail (24 patients vs. 10, chi 2: P nail changes were noticed but were not frequent enough to be significant. The presence of longitudinal ridging on the finger nails was significantly associated with RA.

  7. [Nail involvement in leprosy].

    Science.gov (United States)

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

    2012-05-01

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

  8. Bisphosphonate-induced atypical subtrochanteric femoral fracture

    OpenAIRE

    2013-01-01

    The use of bisphosphonates (BPs) is universally accepted in the management of osteoporosis. However, a small percentage of patients have been recognised to develop atypical subtrochanteric fractures of the femur with the prolonged use of BPs. We report a rare case of bilateral insufficiency lesions in the proximal femora, where a major subtrochanteric fracture developed with a minor fall. This was successfully treated with internal fixation using proximal femoral nail.

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

    LENUS (Irish Health Repository)

    Shah, M H

    2012-02-03

    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. 克氏针操纵复位与有限切开复位在弹性髓内钉固定治疗儿童股骨干骨折中的疗效比较%Special operative techniques for flexible intramedullary nail fixation of pediatric femoral shaft fractures:comparison between percutaneous joystick reduction and limited open reduction

    Institute of Scientific and Technical Information of China (English)

    刘飞; 楼跃; 唐凯; 张志群; 林刚; 孙祥水; 倪磊; 董展; 郑朋飞

    2014-01-01

    Objective To evaluate the effectiveness and clinical outcomes in pediatric femoral shaft fractures treated with flexible intramedullary nailing,with percutaneous joystick reduction versus limited open reduction.Methods This retrospective comparative study was analyzed in a total of 47 pediatric femoral shaft fractures treated with flexible intramedullary nailing from Jan.2006 to Oct.2011.Twenty-five cases were percutaneous reduction using the K-wire pin as joystick,and 22 cases were treated with limited open reduction.The clinical and radiographic data including the age,sex,time from injury to surgery,follow-up time,fracture types,operation time,volume of bleeding,X-ray exposure times,hospitalization,postoperative weight-bearing time,healing time,complications,Harris score and Hospital for Special Surgery knee score(HSS score) at the final follow-up were collected and compared in both surgical groups.Results All patients were postoperatively followed up for 18-23 months with an average of 21 months.The age,sex,time from injury to surgery,follow-up time,fracture types,X-ray exposure times,postoperative weight-bearing time,healing time,Harris score and HSS score at the last follow-up were not statistically different(all P > 0.05).The blood loss [(5.0 ± 1.3) mL vs (17.4 ±4.1) mL],operative time[(40.0 ±4.8) min vs (51.4 ±9.4) min],hospital stay[(6.5 ± 1.7) days vs (12.5 ±2.4) days] and postoperative incision pain(2 cases vs 8 cases) were all significantly less in the percutaneous joystick reduction than limited open reduction group (t =-13.600,-4.936,-9.052,x2 =6.112,all P < 0.05).Conclusions Compared with limíted open reduction,the percutaneous joystick reduction significantly reduced bleeding,operation time,hospitalization and complications and can be considered as a useful reduction technique in the treatment of pediatric femoral shaft fractures with flexible intramedullary nailing.%目的 比较应用克氏针操纵复位与有限切开复位技术在

  11. Nail manifestations in pemphigus vulgaris

    Directory of Open Access Journals (Sweden)

    Cahali Juliana Burihan

    2002-01-01

    Full Text Available Nail involvement in pemphigus vulgaris is rare. We describe 5 patients with pemphigus vulgaris presenting nail involvement. In this disease, nail manifestations present, by order of frequency, as chronic paronychia, onychomadesis, onycholysis, Beau's lines and trachyonychia. All our 5 cases presented with paronychia, and 1 of them also had Beau's lines. Treatment with prednisone and/or cyclophosphamide controlled mucocutaneous and nail manifestations in all cases.

  12. OPTIMAL DISTAL SCREW ALIGNMENT IN THE GAMMA NAIL

    Institute of Scientific and Technical Information of China (English)

    Ching-KongChao; Chun-ChingHsiao; Po-QuangChen

    2002-01-01

    The effect of stress distribution due to the changes of the distal screw alignment in relation to the Gamma nail and the femoral shaft is thoroughly studied in this paper. Failure of the Gamma nail composite occurs through the cranial aperture of the distal screws and the insertion hole for the lag screw due to nonunion, delayed-union and continued weight-bearing. A three-dimensional finite element model was used to study the fractured femur, the Gamma nail, the lag screw and the distal locking screws. The first and the second distal screws were inserted into the Gamma nail in four different configurations. We found that the stress of the Gamma nail composite was substantially reduced with the two screws configured in the anterior to posterior direction. This alignment can bear greater loading in the more demanding fracture types. In the subtrochanteric fracture or the comminuted fractures at the proximal femur, the optimal alignment of the two distal screws was in the anterior to posterior direction.

  13. 弹性髓内钉治疗大龄儿童股骨粗隆下骨折的临床疗效分析%The efficacy of elastic intramedullary nailing for femoral subtrochanteric fractures in older children

    Institute of Scientific and Technical Information of China (English)

    潘骏; 武垚森; 易先宏; 张敬东

    2010-01-01

    目的 比较弹性髓内钉(TEN)和石膏外同定治疗儿童股骨粗隆下骨折的临床疗效.方法 回顾分析30例儿童股骨粗隆下骨折的病例资料,其中14例行弹性髓内钉固定治疗(弹件髓内钉组),16例采用手法复位髋石膏固定(石膏固定组)治疗,记录骨折愈合时间及并发症,术后对两组患儿的影像学结果、髋关节功能进行比较分析.结果 所有患儿术后随访20~43个月,平均31个月.骨折均获愈合,愈合时间8~17周,平均10.5N.TEN组未发生切口感染、内同定物失效或断裂,有1例患儿术后复查有轻度矢状面成角,无髋内翻、肢体短缩等畸形.所有患儿随访中均未发现有骨骺损伤早闭,股骨头缺血性坏死.石膏固定组术后复查有5例患儿出现轻度矢状面成角畸形,髋内翻畸形3例,肢体缩短6例.早期结果按Beaty标准:TEN组满意率为92.9%,明显优于石膏固定组62.5%(P<0.01);晚期结果按Theologis标准:TEN组满意率为100%,石膏同定组81.3%,两组亦存在显著性差异(P<0.01).髋关节功能按Sanders标准:TEN组优12例,良1例,优良率:92.9%;石膏固定组优9例,良4例,优良率:81.4%,组间差异有统计学意义(P<0.05).结论 TEN固定治疗儿童股骨粗隆下骨折的临床疗效优于石膏固定法,它具有创伤小、操作简便、固定更为牢同、并发症少等优点,值得临床推广应用.%Objective To compare the result of treatment with titanic elastic nail (TEN) and plaster fixation for subtrochanteric fractures in skeletally immature adolescents.Methods A retrospective review of 30 subtrochanteric fractures was carried out.In this series,14 patients were treated with TEN fixation and 16 had plaster immobilization.Early and late radiographic evaluation,joint function assessment were carried out.Results On average,the patients were followed up for 31 months(20-43 months).Bone union was accomplished in all patients.The mean time to union was 10.5 weeks,ranging from 8

  14. Ender nailing for supracondylar fracture of the femur after total knee arthroplasty: five case reports.

    Science.gov (United States)

    Hayakawa, Kazue; Nakagawa, Kenji; Ando, Kenichi; Ohashi, Hiroshi

    2003-10-01

    We studied 5 women with supracondylar fractures after total knee arthroplasty (TKA). The mean age at fracture was 67.4 years. Four patients had chronic rheumatoid arthritis, and 1 had osteoarthritis. The range of motion, knee score, femorotibial angle, and component alignment were investigated. Flexion was slightly decreased after Ender nailing, but extension only changed in 1 patient. The knee score decreased, but all patients were ambulatory. The femorotibial angle changed in all patients. Measurement of femoral component alignment showed a postoperative change of angle alpha (1 degrees to 11 degrees ) and angle gamma (0 degrees to 9 degrees ). Union was achieved in all patients. Ender nailing is an acceptable method of treatment for supracondylar fractures of the femur after TKA if the nails can be inserted deeply into the femoral condyles.

  15. Titanium exposure and yellow nail syndrome

    Directory of Open Access Journals (Sweden)

    Ali Ataya

    2015-01-01

    Full Text Available Yellow nail syndrome is a rare disease of unclear etiology. We describe a patient who develops yellow nail syndrome, with primary nail and sinus manifestations, shortly after amalgam dental implants. A study of the patient's nail shedding showed elevated nail titanium levels. The patient had her dental implants removed and had complete resolution of her sinus symptoms with no change in her nail findings. Since the patient's nail findings did not resolve we do not believe titanium exposure is a cause of her yellow nail syndrome but perhaps a possible relationship exists between titanium exposure and yellow nail syndrome that requires further studies.

  16. Surgical anatomy of the nail apparatus.

    NARCIS (Netherlands)

    Haneke, E.

    2006-01-01

    Nail surgery is an integral part of dermatologic surgery. An in-depth knowledge of the anatomy, biology, physiology, and gross pathology of the entire nail unit is essential. In particular, knowledge of nail histopathology is necessary to perform diagnostic nail biopsies and other nail procedures co

  17. 髋关节动力螺钉和股骨近端髓内钉-螺旋刀片固定股骨转子间骨折的效果比较%Therapeutic effect of dynamic hip screw versus proximal femoral nail anti-rotation blade for intertrochanteric fractures

    Institute of Scientific and Technical Information of China (English)

    陈生文

    2012-01-01

    BACKGROUND: Dynamic hip screw (DHS) is the gold standard for clinical fixation of intertrochanteric fractures, and achieves certain effect. But proximal femoral nail anti-rotation (PFNA) blade is a new modified proximal femoral fixation system, which is used to solve the deficiencies of previous fixation. OBJECTIVE: To compare the clinical effect of DHS and PFNA blade for intertrochanteric fractures. METHODS: Totally 76 patients with intertrochanteric fractures were selected including 36 cases treated with DHS and 40 cases with PFNA. All the patients received operative treatment with common operative route. RESULTS AND CONCLUSION: Incidence rate of medical complication and deformity rate of hip joint in the PFNA group were lower than those in the DSH group (P< 0.05). The excellent and good rate of the hip function recovery was 78% (28/36) in the DSH group, and which in the PFNA group was 82% (33/40). The results showed that both the two method of DHS and PFNA have good clinic curative effect for the treatment of intertrochanteric fractures, but the PFNA has the advantages of simple operation, less bleeding, and reliable fixation.%背景:髋关节动力螺钉是临床固定股骨转子间骨折的金标准,取得了一定的疗效,而股骨近端髓内钉-螺旋刀片是经过改进的新型股骨近端髓内固定系统,它的运用解决了以往内固定的不足.目的:比较髋关节动力螺钉和股骨近端髓内钉-螺旋刀片治疗股骨转子间骨折的疗效.方法:76例股骨转子间骨折患者,其中36例用髋关节动力螺钉固定,40例用股骨近端髓内钉-螺旋刀片固定,均采用常规手术入路.结果与结论:股骨近端髓内钉-螺旋刀片组的髋部畸形率及并发症发生率均低于髋关节动力螺钉组(P < 0.05),髋关节动力螺钉组髋关节功能恢复优良率达78%(28/36),股骨近端髓内钉-螺旋刀片组为82%(33/40).结果可见两组治疗股骨转子间骨折均有满意的临床疗效,但是股骨近

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

    Directory of Open Access Journals (Sweden)

    Sampat S Dumbre Patil

    2016-01-01

    Full Text Available 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.

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

    Science.gov (United States)

    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

  20. Analysis of Clinical Effect of Lateral Position and Supine Position Under the Proximal Femoral Intramedullary Nail in Treatment of Femoral Intertrochanteric Fracture%侧卧位与平卧位下股骨近端防旋髓内钉治疗股骨转子间骨折的临床效果分析

    Institute of Scientific and Technical Information of China (English)

    孙秀钦

    2015-01-01

    目的:探讨侧卧位与平卧位下股骨近端防旋髓内钉(PFNA)治疗肥胖患者股骨转子间骨折的疗效。方法回顾性分析59例应用PFNA内固定治疗股骨转子间骨折患者的临床资料,随机分为侧卧位组和平卧位组,比较两组患者的手术时间、术中出血量、转子顶端切口长度、骨折愈合时间及髋关节Harris评分等。结果侧卧位组患者手术时间、转子顶端切口长度短于平卧位组,差异有统计学意义(P<0.05),侧卧位组患者术中出血量少于平卧位组,差异有统计学意义(P<0.05),两组患者骨折愈合时间、髋关节Harris评分等比较差异均无统计学意义(P>0.05)。结论侧卧位行PFNA治疗肥胖患者股骨转子间骨折,降低了手术难度,缩短了手术时间和手术切口长度,减少了术中出血量,较平卧位行PFNA治疗肥胖患者股骨转子间骨折有明显优势。%Objective The paper explores the curative effects of proximal femur nail anti-rotation (PFNA) on obese patients’ intertrochanteric fracture in lateral position and horizontal position.MethodsThe paper makes a retrospective analysis on the clinical data of 59 cases applying PFNA internal ifxation for the treatment of intertrochanteric facture, and divides the cases into the lateral position group and the horizontal position group randomly to compare the two groups in terms of duration of operation,blood loss during operation, incision length on trochanter top, facture healing time and Harris hip score.Results Lateral position group’s duration of operation and incision length on trochanter top are signiifcantly shorter than those of horizontal position group, of which the difference shows the statistical significance (P0.05). Conclusion The horizontal-position PFNA for obese patients’ intertrochanteric fracture decreases operation dififculty, shortens operation time and length of surgical incision and reduces blood loss

  1. Weakly broken galileon symmetry

    Energy Technology Data Exchange (ETDEWEB)

    Pirtskhalava, David [Scuola Normale Superiore, Piazza dei Cavalieri 7, 56126 Pisa (Italy); Santoni, Luca; Trincherini, Enrico [Scuola Normale Superiore, Piazza dei Cavalieri 7, 56126 Pisa (Italy); INFN, Sezione di Pisa, Piazza dei Cavalieri 7, 56126 Pisa (Italy); Vernizzi, Filippo [Institut de Physique Théorique, Université Paris Saclay, CEA, CNRS, Gif-sur-Yvette cédex, F-91191 (France)

    2015-09-01

    Effective theories of a scalar ϕ invariant under the internal galileon symmetryϕ→ϕ+b{sub μ}x{sup μ} have been extensively studied due to their special theoretical and phenomenological properties. In this paper, we introduce the notion of weakly broken galileon invariance, which characterizes the unique class of couplings of such theories to gravity that maximally retain their defining symmetry. The curved-space remnant of the galileon’s quantum properties allows to construct (quasi) de Sitter backgrounds largely insensitive to loop corrections. We exploit this fact to build novel cosmological models with interesting phenomenology, relevant for both inflation and late-time acceleration of the universe.

  2. [Nail-patella-elbow syndrome].

    Science.gov (United States)

    Uruñuela, J; Ybarra, J; Escudero, R

    1976-01-01

    The authors describe a typical, non familiar case of nail-patela-elbow syndrome, in which was found malformation of the nails and bones involving mainly the Knees and elbows, together with spondylolisthesis of the spine at the level L5-S1. There were no renal, ocular or psychic alterations.

  3. Nail clipping in onychomycosis*

    Science.gov (United States)

    Bertanha, Laura; Chiacchio, Nilton Di

    2016-01-01

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

  4. Subtrochanteric fractures: treatment with cerclage wire and long intramedullary nail.

    Science.gov (United States)

    Tomás, Jordi; Teixidor, Jordi; Batalla, Lledó; Pacha, Daniel; Cortina, Josep

    2013-07-01

    Fracture malalignment and nonunion are not infrequent after treating subtrochanteric fractures with intramedullary nails. The use of a cerclage wire with a minimally invasive approach to aid and maintain reduction in certain subtrochanteric fracture patterns can be an effective surgical strategy to improve outcome. It allows the surgeon to obtain and maintain an anatomic reduction with more bone contact, which will aid in fracture consolidation. This has the added advantage of optimizing the greater trochanteric starting point. It minimizes malreductions of the proximal femoral fragment, and, we believe, that its rational use with a minimally invasive technique is a key factor in achieving good results.

  5. 亚洲型股骨近端防旋髓内钉治疗老年股骨转子间骨折体会%Initial experience of using proximal femoral nail antirotationⅡ to treat intertrochanteric femoral fractures in elderly patients

    Institute of Scientific and Technical Information of China (English)

    王华; 樊仕才; 叶书熙; 杨成亮; 曾参军; 李涛; 金大地

    2012-01-01

    目的 评价亚洲型股骨近端防旋髓内钉(PFNA-Ⅱ)治疗老年股骨转子间骨折手术策略及临床疗效,总结相关的经验体会.方法 2009年5月~2010年4月,我院共收治并行PFNA-Ⅱ固定的老年股骨转子间骨折21例,所有患者均于入院后72h内在全麻下完成手术;手术在骨科牵引床上进行,患者取平卧位,C型臂X线机透视下,患髋内收内旋屈曲30°牵引,骨折解剖复位后,自转子尖打入合适规格的PFNA-Ⅱ固定.统计手术时间和出血量,术后常规预防感染及预防深静脉血栓(DVT)治疗,并对内科疾病进行对症治疗,合并骨质疏松患者行抗骨质疏松治疗.结果 本组21例均顺利完成手术,术中透视及术后髋关节正侧位X线片显示骨折复位固定好.手术时间28~51min,平均35min;出血量30~110ml,平均50ml;愈合时间平均9周.根据Harris功能评分:优18例,良2例,可1例;优良率95.2%.结论 PFNA-Ⅱ是PFNA的亚洲型,更适合国人股骨近端的解剖特点,在手术操作、固定的稳定性方面优于PFNA-Ⅰ型.Ⅱ固定.统计手术时间和出血量,术后常规预防感染及预防深静脉血栓(DVT)治疗,并对内科疾病进行对症治疗,合并骨质疏松患者行抗骨%O b jective To evaluate tie surgical strategy and clinical effect of proxinal fanoral nail antirota-tion II ( PFNA-II ) to treat elderly patients with intertrochanteric fenoral fractures and sun up the relevant experience M ethods Fran May 2009 to Apr 2010,21 elderly patients with intertrochanteric fanoral fractures were fixed with PFNA under general anesthesia within72 h after admission Surgery was perfomed in the orthopedic traction bed in supine position Hip was placed in30c of flexion, and then the adduction and internal rotation of hips was applied underG-am fluoroscopy Then patients were fixed with the suitable FFNA II following achieving anatomical reduction The operative tine and blood loss were assessed Conventional treatnentwas perfomed

  6. Yellow Nail Syndrome - a Case Report

    Directory of Open Access Journals (Sweden)

    Paravina Mirjana

    2015-06-01

    Full Text Available Yellow nail syndrome is a rare disease of unknown etiology. It is clinically characterized by a triad of yellow nails, lymphedema at one or more sites, and chronic respiratory disease (bronchitis, bronchiectasis and rhinosinusitis. All nails may be affected, but some may be spared. The nail plates are yellowish green, thickened, occasionally with transverse ridging and onycholysis, with increased longitudinal and transversal over-curvature, with partial or complete separation of the nail plate from the nail bed, without lunula and cuticle and slow nail growth rate. The lymphedema is usually peripheral, affecting the lower limbs, or in the form of pleural effusion.

  7. Comparison of of Proximal Femoral Nail and Dynamic Hip Screw in Treatment of Subtrochanteric Unstable Fractures of Femur in Elder Patients%PFN与DHS治疗老年不稳定型股骨粗隆下骨折的疗效分析

    Institute of Scientific and Technical Information of China (English)

    沈翔; 倪江东; 张淑云; 易文辉; 贺建军; 唐长友; 熊湘彦; 刘小华; 宋德业

    2011-01-01

    比较PFN与DHS内固定治疗老年不稳定型股骨粗隆下骨折的预后及评其疗效.方法:2002年1月至2008年1月我科共收治老年不稳定型股骨粗隆下骨折患者129例,男59例,女70例,年龄51~86岁,平均61.7岁.随机选择PFN或DHS内固定,PFN组62例,DHS组67例.比较两组的手术时间、术中出血量、术后第二天CRp值、张力侧出现骨痂时间、骨折愈合时间、Harris评分等6项指标.结果:116例获得13~48个月的随访,平均18.7月,除手术时间及Harris评分无差异外,PFN组在术中出血量、术后第二天CRP值、张力侧出现骨痂时间、骨折平均愈合时间等方面与DHS组比较有显著优势(P<0.05).结论:PFN内固定创伤小、术后并发症率较低,可以成为治疗老年不稳定型股骨粗隆下骨折的主要方法.%Objective: To compare the prognosis of the proximal femoral nail (PFN) and the dynamic hip screw (DHS) in the treatment of subtrochanteric unstable fractures of femur in elder patients. Methods.- From January 2002 to January 2008, 129 patients were treated with unstable fractures of femur (59 males and 70 females) with an average age of 61.7 years ranging from 51 to 86 years. The patients were randomly divided into PFN group (n=62) and DHS group (n=67). The operative duration, volume of blood loss, CRP value of postoperative day, callus growth time, fracture healing time and Harris Hip Score were statistically analyzed and compared between the two groups. Results: A total of 116 cases were followed up for 13 to 48 months (average 18.7 months). There was no difference between the two groups in operative duration and Harris Hip Score. But compared with the DHS group, PFN group showed significant advantages in indicators of volume of blood loss, CRP value of postoperative day, callus growth time and fracture healing time (P<0.05). Conclusion: With the excellence of fewer trauma and complications, PFN treatment could be primarily used in treating the

  8. Comparison Between Proximal Femoral Interlocking Nail and Dynamic Condylar Screw for the Treatment of Unstable Intertrochanteric Fracture in Elderly Patients%股骨近端交锁髓内钉与动力髁螺钉治疗老年不稳定型股骨粗隆间骨折的比较

    Institute of Scientific and Technical Information of China (English)

    刘张冰; 廖乐乐

    2012-01-01

    [目的]对比股骨近端交锁髓内钉(PFN)与动力髁螺钉(DCS)治疗老年不稳定型股骨粗隆间骨折的临床疗效.[方法]选取本院收治的老年不稳定型股骨粗隆间骨折患者43例,其中 22例采用股骨近端交锁髓内钉手术内固定治疗(PFN组),21例采用动力髁螺钉手术内固定治疗(DCS组).术后随访12~26个月,对两组患者的手术情况、术后髋关节功能及并发症情况进行统计分析.[结果]两组患者手术时间比较,差异无统计学意义(P>0.05).PFN组术中出血量和引流量均明显少于DCS组(P0.05).术后1年PFN组Harris髋关节功能评分为(89.23±5.93)分,明显高于DCS组(84.09±9.38)分(P0.05).[结论]股骨近端交锁髓内钉在术中出血量、术后引流量及术后功能恢复方面均优于动力髁螺钉,是治疗老年不稳定型股骨粗隆间骨折较理想的手术方式.%[Objective] To compare the clinical efficacy of proximal femoral interlocking nail(PFN) vs dynamic condylar screw(DCS) for the treatment of unstable intertrochantcrie fracture in elderly patients. [Methods] Forty-three patients with unstable intcrtrochantcric fracture admitted to our hospital were chosen. Among them, 22 paticnts (PFN group) underwent PFN internal fixation, and 21 paticnts (DCS group) underwent DCS internal fixation. All patients were followed up for 12~26 months. The operation state, hip joint function after operation and complications in two groups were analyzed statistically. [Results] There was no significant difference in the operation time between two groups (P >0.05). The intraopcrative blood loss and drainage volume in PFN group were obviously less than those in DCS group( P0.05). Harris hip joint function score in PFN group at a year after operation was 89. 23±5. 93, which was obviously higher than that in DCS group(84. 09±9. 38) ( P0.05). [Conclusion] The intraopcrativc blood loss, postoperative drainage volume and functional recovery in PFN arc better than

  9. How Cryptosystems Get Broken

    Institute of Scientific and Technical Information of China (English)

    Adi Shamir

    2009-01-01

    @@ It's all us pleasure to come to China.a great deal of cheerful times already.I hope that we have additional opportunity to meet,talk about cryptography and other components.Today I am going to give a general talk which is not designed for special lists,about how could the systems get broken like this.I think I don't assume you know much about cryptography and some of the basics.Cryptography deals with issue how to send secret information from a sender which is usually called Alice.to a receiver which is usually called Bob.The usual way how to encrypt data is to use an encryption box that accepts the plaintext,the plaintext is the message that you would like to send encrypted.It could be just"Good morning".By using a secret cryptographic key K,you put ciphertext which looks very very strange."zqvkj…".

  10. One-Stage Femoral Osteotomy and Computer-Assisted Navigation Total Knee Arthroplasty for Osteoarthritis in a Patient with Femoral Subtrochanteric Fracture Malunion

    Directory of Open Access Journals (Sweden)

    C. H. Jason Fan

    2014-01-01

    Full Text Available Extra-articular femoral deformity in total knee arthroplasty (TKA is realigned by either intra-articular correction or extra-articular osteotomy. The more distant the deformity is away from knee joint, the more likely it is corrected by the former method. No report described the use of antegrade cephalomedullary femoral nail to fix the osteotomy followed by computer-assisted navigation TKA. This report described the unusual use of this method to manage a 64-year-old man with femoral subtrochanteric fracture malunion and osteoarthritis of knee. He demonstrated a satisfactory functional outcome and good lower limb alignment.

  11. Injuries Associated with Femoral Shaft Fractures with Special Emphasis on Occult Injuries

    Directory of Open Access Journals (Sweden)

    E Carlos Rodriguez-Merchan

    2013-12-01

    Full Text Available Background: Fractures of the femoral shaft are mostly the result of high-energy accidents that also cause multiple trauma injuries, in particular ipsilateral knee and hip injuries. The purpose of this study was to investigate the incidence of injuries associated with femoral shaft fractures and how many of them were undetected. Methods: We studied 148 patients (150 femoral shaft fractures with an average age of 52 (range: 18-97. Femoral shaft fractures were treated with antegrade intramedullary nailing in 118 cases (78.7%, and with open reduction and internal fixation in 32 cases (21.3%. Unlocked reamed intramedullary nailing was performed in Winquist type I and type II fractures, while statically locked unreamed intramedullary nailing was carried out in Winquist type III and type IV fractures. Results: There were 70 patients with associated injuries (46.4%. The associated injuries went undetected in 18 out of 70 patients (25.5%. Six femoral nonunions (4% occurred in patients under 70 years of age (high-energy accidents treated by open reduction and internal fixation. Conclusion: Injuries associated with femoral shaft fractures were very frequent (46.4% in our series, with 25.5% undetected. Open reduction and internal fixation was a poor prognostic factor of nonunion in these fractures.

  12. Partial wedge resection of nail, nail bed and nail matrix in ingrown toenail treatment

    Directory of Open Access Journals (Sweden)

    Mustafa Dönmez

    2010-05-01

    Full Text Available Objectives: Ingrown toenail is a frequent problem which can be seen in all ages. There are many treatment methods both surgical and nonsurgical. In this study we evaluated the results of wedge resection of ingrown toe nail.Patients and Methods: A total of 80 toenails of 74 patients (55 female, 19 male who complaint with discharge and deformity of their toenail underwent partial wedge resection of the nail and nail matrix. According to the Heifetz’s staging system, 34 toenails were grade II, 46 toenails were grade III. There was active drainage due to an infectious process in all effected toe nails. All patients were operated after 10 day of oral antibiotic treatment. We evaluated the recurrence, postoperative infection, patient satisfaction and time to return to work.Results: The mean follow up period was 8 months (4-12 months. There was no recurrence in any patient. Two patients came with wound drainage in postoperative 14th day. Intravenous antibiotic treatment, debridement and wound dressing with rifampicine every other day were accomplished. All patients expressed their satisfaction with surgery.Conclusion: In treatment of ingrown toenail; wedge resection of nail, nail matrix and nail bed is a very effective treatment. Recurrence rate following this technique is negligible if it is done properly and it has high patient satisfaction.

  13. Yellow nail syndrome, pincer nails, colon cancer and polyps in a 76 year-old-woman

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    Vitorino Modesto dos Santos

    2015-11-01

    Full Text Available The yellow nail syndrome is a scarcely described condition characterized by dystrophic yellowish nails, respiratory disturbances and lymphedema; while the pincer nail deformity is characterized by thickening and excessive transverse curvature of the nail plate. The objective of this case study is to report a 76-year-old Japanese descent woman with yellow nail syndrome and pincer nails, intestinal polyps, and sigmoid colon adenocarcinoma. Both the yellow nail syndrome and pincer nails may develop in association with malignancies, either by chance or by some etiopathogenic mechanism not well-known.

  14. The affordances of broken affordances

    DEFF Research Database (Denmark)

    Grünbaum, Martin Gielsgaard; Simonsen, Jakob Grue

    2015-01-01

    important: how users may (i) achieve their goals in the presence of such broken affordances, and may (ii) repurpose or otherwise interact with artefacts with broken affordances. We argue that (A) thorough analyses of breakdowns of affordances and their associated signifiers and feedbacks have implication...

  15. A study on the surgical treatment of ingrowing toe nail with nail excision with chemical matricectomy versus nail excision alone

    Directory of Open Access Journals (Sweden)

    Ashutosh Talwar

    2013-01-01

    Full Text Available An in growing toenail develops when the proper fit of the nail plate in the lateral nail groove is altered. We selected 30 patients of ingrowing toe nail for the study. The patients were divided into two groups of 15 patients each. In group I patients, nail avulsion with chemical matrictectomy with 88%phenol was done. In group II only nail avulsion was done. In group I patients the surgical success rate was 98% and in group II, the surgical success rate was 86.6%. No patient complained about the cosmetic appearance of toe nail after the operation.

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

    Science.gov (United States)

    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.

  17. Revisiting Pneumatic Nail Gun Trigger Recommendations.

    Science.gov (United States)

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

    2015-03-01

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

  18. Impact of nutritional status on perioperative hidden blood loss in elderly patients with intertrochanteric fracture treated with proximal femoral nail antirotation%老年人营养状况对股骨近端防旋髓内钉治疗围术期隐性失血的影响

    Institute of Scientific and Technical Information of China (English)

    刘国印; 张勇; 王进; 朱冬梅; 鲍磊; 徐院生; 贾小宝; 吴宇; 骆虎

    2016-01-01

    femoral nail antirotation (PFNA).Methods Ninety-six elderly patients with femoral intertrochanteric fracture aged 72-94 years [mean,(78.7 ± 9.5) years] were submitted to closed reduction and PFNA internal fixation.According to the mini nutritional assessment (MNA) score,the patients were randomized into normal-nourishment group (n =26),potentially malnourishment group (n =32) and malnourishment group (n =38).Correlation between MNA score and serological examination was analyzed.Total blood loss and hidden blood loss were calculated depending on height,weight,intra-operative blood loss,post-operative blood loss,preand post-operative Hct,and blood transfused.According to the mean hidden blood loss,patients were divided into low (n =51) and high (n =45) hidden blood loss groups.Relationship among high hidden blood loss,MNA score,and serological examination was evaluated.Results Preoperative MNA score showed strong correlation with nutritional evaluation results assessed by serological examination,and the detection effectiveness of malnutrition by albumin (ALB),prealbumin (PA),transferrin (TRA),and T lymphocyte percentage (TLP) was better than that by total protein (TP),total lymphocyte count (TLC) and hemoglobin (Hb).Nutritional status was further deteriorated after PFNA in patients with malnutrition.Forty-five patients were found to have high hidden blood loss.Incidence of high hidden blood loss revealed significant difference among groups (P < 0.05).Preoperative incidence of hidden blood loss assessed by ALB,PA,TRA,TLP and Hb in high hidden blood loss group was obviously higher than that in low hidden blood loss group.Postoperative incidence of hidden blood loss assessed by the serological examination in high hidden blood loss group was evidently higher than that in low hidden blood loss group as well as higher than the preoperative results.Preoperative MNA score,ALB,PA,TRA,TLP and Hb showed strong correlations with high hidden blood loss (r =0.4-95,0

  19. Six nails in the head: multiple pneumatic nail gun head injury.

    Science.gov (United States)

    Lee, Chang Sub; Park, Kyung Hye

    2010-08-01

    A 62-year-old man was admitted to our hospital after attempting to commit suicide with a pneumatic nail gun. Six nails were launched. Because the nail head acted as a brake, the launched nail could make a hole in the skull but could not entirely pass it.

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

    Science.gov (United States)

    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.

  1. Broken Bones, Sprains, and Strains (For Parents)

    Science.gov (United States)

    ... Feeding Your 1- to 2-Year-Old Broken Bones, Sprains, and Strains KidsHealth > For Parents > Broken Bones, ... home. What to Do: For a Suspected Broken Bone: Do not move a child whose injury involves ...

  2. Distal Radius Fracture (Broken Wrist)

    Science.gov (United States)

    .org Distal Radius Fracture (Broken Wrist) Page ( 1 ) The radius is the larger of the two bones of the forearm. The ... the distal end. A fracture of the distal radius occurs when the area of the radius near ...

  3. Broken toe - self-care

    Science.gov (United States)

    Fractured toe - self-care; Broken bone - toe - self-care; Fracture - toe - self-care; Fracture phalanx - toe ... often treated without surgery and can be taken care of at home. Severe injuries include: Breaks that ...

  4. Job loss and broken partnerships

    DEFF Research Database (Denmark)

    Kriegbaum, Margit; Christensen, Ulla; Lund, Rikke;

    2008-01-01

    The aim of this study was to investigate the effects of the accumulated number of job losses and broken partnerships (defined as the end of cohabitation) on the risk of fatal and nonfatal events of ischemic heart disease (IHD).......The aim of this study was to investigate the effects of the accumulated number of job losses and broken partnerships (defined as the end of cohabitation) on the risk of fatal and nonfatal events of ischemic heart disease (IHD)....

  5. Study Of Nail Changes In Psoriasis

    OpenAIRE

    Ghosal Astikmoni; Gangopadhyay D N; Chanda M; Das Nilay Kanti

    2004-01-01

    Background: In psoriasis, nail involvement is quite a common phenomenon and the manifestation may range from pitting, Beauâ€s line, leuconychia, onychorrhexis, onycholysis, subungual hyperkeratosis, thinning of nail plate to less commonly splinter hemorrhage, oil drop sign and salmon patch. Objective: To study overall pattern of nail involvement in psoriatic patients along with making a comparison between the patterns of nail changes on finger and toenails and to analyze the ass...

  6. Congenital malalignment of the big toe nail.

    Science.gov (United States)

    Wagner, Gunnar; Sachse, Michael Max

    2012-05-01

    Congenital malalignment of the big toe nail is based on a lateral deviation of the nail plate. This longitudinal axis shift is due to a deviation of the nail matrix, possibly caused by increased traction of the hypertrophic extensor tendon of the hallux. Congenital malalignment of the big toe nail is typically present at birth. Ingrown toenails and onychogryphosis are among the most common complications. Depending on the degree of deviation, conservative or surgical treatment may be recommended.

  7. Yellow Nail Syndrome: Dystrophic Nails, Peripheral Lymphedema and Chronic Cough

    Directory of Open Access Journals (Sweden)

    Christian Dornia

    2011-01-01

    Full Text Available A case involving a 41-year-old man with yellow nail syndrome (YNS is reported. YNS is a rare disorder characterized by yellow, dystrophic nails, peripheral lymphedema and bronchiectasis with recurrent lower respiratory tract infections. YNS is often misdiagnosed because the syndrome is not well known. An interdisciplinary approach is required to recognize and collate the components of the syndrome accurately. Correct diagnosis is of utmost clinical importance because YNS can occur secondary to malignancies and autoimmune disorders. Hence, the diagnosis of YNS must prompt further investigation.

  8. Nail abnormalities in patients with vitiligo*

    Science.gov (United States)

    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

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

    Directory of Open Access Journals (Sweden)

    Kapoor Sudhir

    2009-01-01

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

  10. Femoral bowing plane adaptation to femoral anteversion

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    Alp Akman

    2017-01-01

    Full Text Available 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 (P0 < 0.001; r = 0.680 and r = −0.682, respectively. Combined correlation is perfect (R[2] = 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

  11. Femoral bowing plane adaptation to femoral anteversion

    Science.gov (United States)

    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

  12. A comparative study of fracture shaft of femur in adults treated with broad dynamic compression plate versus intramedullary interlocking nail

    Directory of Open Access Journals (Sweden)

    Sushil Thapa

    2016-08-01

    Full Text Available Background and Objectives: Diaphyseal femur fracture is one of the commonest fractures to present in an emergency room. The objective of the study was to compare femoral shaft fractures treated using nail with those using plate and screws. Patients and Methods: We studied a total of 62 patients of fracture shaft of femur admitted in the Bharatpur Hospital, Bharatpur, Chitwan and National Academy of Medical Sciences, BirHospital,Kathmandu. Two cases were lost to follow up. Thirty cases were treated with plating and 30 cases with nailing. The age group was from 16-30 years. Fifty-three were male and seven were females. Fifty-eight patients had closed fracture and two had Gustillo Anderson grade I openfracture. Result: Time from injury to surgery was 19 days on an average. Mean time for union was more in patients treated by plating, 19.46 weeks as compared to nailing 14.78 weeks. We found one case of infection with plating and breakage of plate in four patients. One patient with nailing did not show any signs of healing and two had failure in case of nailing. Our series revealed 23(38.3% excellent, five (8.3% good and two (3.3% poor results in patients who had nailing while 15 (25.5% excellent, nine (15% good, one (1.7% fair and five (8.3% poor in patients who had plating out of 30 patients in each group. Conclusion:In our study we found that there was no significant difference in outcomes between plating and intramedullary nailing of femoral diaphysis fracture in terms of union, infection and implant failure.JCMS Nepal. 2016;12(2:66-9.

  13. Consensus on melanonychia nail plate dermoscopy*

    Science.gov (United States)

    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

  14. Clinical study of nail changes in vitiligo.

    Science.gov (United States)

    Anbar, Tag; Hay, Rania Abdel; Abdel-Rahman, Amal T; Moftah, Noha H; Al-Khayyat, Mohamed A

    2013-03-01

    Both vitiligo and alopecia areata (AA) are associated together, associated with other autoimmune diseases, and autoimmunity is one of the important theories in their etiology. Nail changes are a known association with AA, thus we hypothesized that nail changes can be found in vitiligo patients. On revising the literature, only two types of nail changes were described in association with vitiligo. Our aim was to study the frequency and types of nail changes among vitiligo patients in comparison with normal healthy volunteers. This multi-centric study was carried on 91 patients with vitiligo, as well as 91 normal healthy control subjects who were age- and sex-matched. Nails were examined for changes in nail plates as regards striations, texture, curvature, dystrophy, and pigmentation. The presence or absence of the thumb lunula was also reported. Nail changes were observed in 62 patients (68.1%) and 46 (50.5%) control subjects with a statistically significant difference (P = 0.016). Longitudinal ridging and absent lunula were significantly higher in patients than in the controls (P = 0.001 and 0.037, respectively). Other reported nail abnormalities in the current study included punctate leukonychia, pitting, flag sign, and Terry's nails. Awareness of this association will widen the clinician's perspective to carefully examine the nail changes in vitiligo patients and conversely examine patients with nail changes for vitiligo.

  15. Nail psoriasis: The journey so far

    Directory of Open Access Journals (Sweden)

    Alka Dogra

    2014-01-01

    Full Text Available 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.

  16. Study Of Nail Changes In Psoriasis

    Directory of Open Access Journals (Sweden)

    Ghosal Astikmoni

    2004-01-01

    Full Text Available Background: In psoriasis, nail involvement is quite a common phenomenon and the manifestation may range from pitting, Beau’s line, leuconychia, onychorrhexis, onycholysis, subungual hyperkeratosis, thinning of nail plate to less commonly splinter hemorrhage, oil drop sign and salmon patch. Objective: To study overall pattern of nail involvement in psoriatic patients along with making a comparison between the patterns of nail changes on finger and toenails and to analyze the association of nail changes with arthropathy and Koebner’s phenomenon. Subjects and settings: One hundred consecutive cases of psoriasis of all age and both sexes were selected for studying the nail changes, in whom diagnosis of psoriasis was made on clinical parameters. KOH preparation was also performed in all cases where onychomycosis was considered a possibility. Results: Thirty six Percent of patients of psoriasis had nail change and fingernails (32% were more commonly affected than toe nails (24%. Pitting was found to be the most common manifestation in fingernails (65.63% with significant difference between fingernails and toenails (p<0.001. The frequency of nail changes in psoriasis with joint pain was 73.33% whereas 29.41% in those without joint pain. Chi-square test with Yates correction for the association of nail changes with joint pain gave p value < 0.005 and for the association of nail changes with koebner’s phenomenon p value <0.05. The frequency of nail changes with Koebner’s phenomenon was 56% whereas in those without koebner’s phenomenon it was 29.33%. Conclustion : Pitting was the most common manifestation in fingernails although in toenails subungual hyperkeratosis was the commonest finding. A very strong association was seen between nail changes and joint pain. Association was also strong between nail changes and Koebner’s phenomenon in psoriasis.

  17. Femoral hernia causing pneumoperitoneum.

    OpenAIRE

    King, H. A.; Boulter, P. S.

    1986-01-01

    Richter's hernia, in which only a portion of the circumference of the intestine lies within the sac, is a common complication of femoral hernia. This case report is of 39 year old female who presented with a pneumoperitoneum and was found at laparotomy to have a right femoral Richter's hernia containing a knuckle of perforated small bowel. This is a previously unreported presentation of femoral hernia.

  18. Femoral hernia repair

    Science.gov (United States)

    Femorocele repair; Herniorrhaphy; Hernioplasty - femoral ... During surgery to repair the hernia, the bulging tissue is pushed back in. The weakened area is sewn closed or strengthened. This repair ...

  19. Thoracic surgical implications of the yellow nail syndrome.

    Science.gov (United States)

    David, I; Crawford, F A; Hendrix, G H; Harley, R A; Tucker, T

    1986-05-01

    Idiopathic lymphedema associated with yellow discoloration of the nail beds constitutes the yellow nail syndrome. Pleural effusions and chronic sinusitis are also frequently present. This report describes a case of yellow nail syndrome in a 65-year-old woman.

  20. Nail abnormalities in patients with vitiligo

    OpenAIRE

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

    2016-01-01

    Abstract: 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 corre...

  1. Safety aspects in surgical treatment of pathological fractures of the proximal femur – modular endoprosthetic replacement vs. intramedullary nailing

    OpenAIRE

    Fakler, Johannes KM; Hase, Franziska; Böhme, Jörg; Josten, Christoph

    2013-01-01

    Background Pathologic fractures of the femoral intertrochanteric and subtrochanteric region require special consideration in terms of biomechanically stable fixation and durability of the implant. In addition, the type of surgery might also influence patient survival. We conducted this retrospective study to evaluate the safety of modular proximal femur replacement compared to intramedullary nailing with patient survival being the primary and complications the secondary endpoint. Methods We r...

  2. Radiographic femoral varus measurement is affected unpredictably by femoral rotation

    DEFF Research Database (Denmark)

    Miles, James Edward

    Radiographic measurements of femoral varus are used to determine if intervention to correct femoral deformity is required, and to calculate the required correction. The varus angle is defined as the angle between the proximal femoral long axis (PFLA) and an axis tangential to the distal femoral c...

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

    Directory of Open Access Journals (Sweden)

    Yu Ozaki

    2016-01-01

    Full Text Available 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.

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

    Science.gov (United States)

    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

  5. Investigation of Human Nail Microstructure with Ultrasound

    Science.gov (United States)

    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.

  6. Invariants of broken discrete symmetries

    OpenAIRE

    Kalozoumis, P.; Morfonios, C.; Diakonos, F. K.; Schmelcher, P.

    2014-01-01

    The parity and Bloch theorems are generalized to the case of broken global symmetry. Local inversion or translation symmetries are shown to yield invariant currents that characterize wave propagation. These currents map the wave function from an arbitrary spatial domain to any symmetry-related domain. Our approach addresses any combination of local symmetries, thus applying in particular to acoustic, optical and matter waves. Nonvanishing values of the invariant currents provide a systematic ...

  7. Invariants of broken discrete symmetries

    CERN Document Server

    Kalozoumis, P; Diakonos, F K; Schmelcher, P

    2014-01-01

    The parity and Bloch theorems are generalized to the case of broken global symmetry. Local inversion or translation symmetries are shown to yield invariant currents that characterize wave propagation. These currents map the wave function from an arbitrary spatial domain to any symmetry-related domain. Our approach addresses any combination of local symmetries, thus applying in particular to acoustic, optical and matter waves. Nonvanishing values of the invariant currents provide a systematic pathway to the breaking of discrete global symmetries.

  8. Comparison of nail-plate fixation and Ender's nailing for intertrochanteric fractures.

    Science.gov (United States)

    Hall, G; Ainscow, D A

    1981-02-01

    Two comparable groups of patients with fractures of the trochanteric region of the femur were studied. One hundred and sixty-five fractures had been fixed with conventional nail-plates and 132 with Ender's nails. Ender's nails gave superior results in the treatment of trochanteric fractures. The operation was quicker and less traumatic than that using conventional nail-plates and both the mortality rate and the time in hospital were reduced. More patients in the group with Ender's nails who were initially independent returned to an independent existence.

  9. Nail alterations during pregnancy: a clinical study.

    Science.gov (United States)

    Erpolat, Seval; Eser, Ayla; Kaygusuz, Ikbal; Balci, Hatice; Kosus, Aydin; Kosus, Nermin

    2016-10-01

    During pregnancy, cutaneous and appendageal alterations manifest and may cause concern in the subject. The nails may be affected by pregnancy. This study investigated the frequency and nature of nail changes occurring during pregnancy in 312 healthy, 18-40-year-old pregnant women in gestation weeks 16-40. After a routine obstetric examination at the obstetrics and gynecology clinic at the study institution, all subjects submitted to an examination of all fingernails and toenails. Only nail alterations that had developed during pregnancy were recorded. Any nail changes that had occurred before the start of gestation were not considered. Data were presented as percentages. The Shapiro-Wilk and chi-squared tests were used to make categorical comparisons. A P-value of nail pathologies were detected in 116 (37.2%) of the 312 subjects. The most commonly found nail change was leukonychia (24.4%). Ingrown toenail (9.0%) and onychoschizia (9.0%) represented the second most common nail changes. Rapid nail growth and subungual hyperkeratosis were observed in 6.7% and 4.2%, respectively, of subjects. When the alterations were evaluated according to gestational age, the most common nail pathology was leukonychia at both 14-28 weeks (16.3%) and 29-42 weeks (27.4%) of pregnancy. Leukonychia, onychoschizia, onycholysis, and brittle nail pathologies were frequently observed at 29-42 weeks of pregnancy (P = 0.047). A large proportion of nail changes that occur during pregnancy are benign and do not require treatment. However, these changes may cause significant cosmetic stress in women.

  10. Nail tic disorders: Manifestations, pathogenesis and management

    Directory of Open Access Journals (Sweden)

    Archana Singal

    2017-01-01

    Full Text Available 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.

  11. Opto-thermal radiometry for in-vivo nail measurements

    Energy Technology Data Exchange (ETDEWEB)

    Xiao, P; Ciortea, L I; Berg, E P [Biox Systems Ltd, 103 Borough Road, London SE1 0AA (United Kingdom); Singh, H [Faculty of ESBE, London South Bank University, 103 Borough Road, London SE1 0AA (United Kingdom); Imhof, R E, E-mail: xiaop@lsbu.ac.u

    2010-03-01

    We have developed a new method for in-vivo human nail characterization by using opto-thermal transient emission radiometry (OTTER) and condenser-chamber TEWL (trans-dermal water loss) method - AquaFlux. With OTTER, we can measure nail water content, nail water concentration depth profiles, as well as topically applied solvent penetration through nail. With AquaFlux, we can measure nail transonychial water loss (TOWL). Combining the water content results with TOWL results, we can get the water diffusion coefficient of nail. Measuring the water diffusion coefficients of nail at different nail water concentration levels can also yield information on how nail diffusion coefficients change with water content. We will present the theoretical background, and experimental results on water concentration depth profile in nail, as well as topically applied solvent penetration through nail.

  12. Mycobacteria in nail salon whirlpool footbaths, California.

    Science.gov (United States)

    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.

  13. Nail psoriasis: a questionnaire-based survey

    NARCIS (Netherlands)

    Klaassen, K.M.G.; Kerkhof, P.C.M. van de; Pasch, M.C.

    2013-01-01

    BACKGROUND: Skin manifestations are the most characteristic finding of psoriasis. However, nail involvement is also a clinical feature of disease although it is often overlooked. The documented prevalence of nail psoriasis varies between 10.0% and 81.1%. OBJECTIVES: The aim of this investigation is

  14. How to Stop Biting Your Nails

    Medline Plus

    Full Text Available ... Replace the nail-biting habit with a good habit: When you feel like biting your nails, try playing with a stress ball or silly putty instead. This will help keep your hands busy and away from your mouth. Identify your triggers: These could be physical triggers, ...

  15. Functional Analysis and Treatment of Nail Biting

    Science.gov (United States)

    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…

  16. Nail changes and disorders among the elderly

    Directory of Open Access Journals (Sweden)

    Singh Gurcharan

    2005-01-01

    Full Text Available Nail disorders are frequent among the geriatric population. This is due in part to the impaired circulation and in particular, susceptibility of the senile nail to fungal infections, faulty biomechanics, neoplasms, concurrent dermatological or systemic diseases, and related treatments. With aging, the rate of growth, color, contour, surface, thickness, chemical composition and histology of the nail unit change. Age associated disorders include brittle nails, trachyonychia, onychauxis, pachyonychia, onychogryphosis, onychophosis, onychoclavus, onychocryptosis, onycholysis, infections, infestations, splinter hemorrhages, subungual hematoma, subungual exostosis and malignancies. Awareness of the symptoms, signs and treatment options for these changes and disorders will enable us to assess and manage the conditions involving the nails of this large and growing segment of the population in a better way.

  17. [Nail bed changes in the neonatal period].

    Science.gov (United States)

    Engels, M

    1985-01-01

    In the years from 1973-1983, 36 children, ranging in ages from 14 days to 4 years, with ingrown toenails, which they had had since birth, were admitted for stationary treatment. For 26 of the children, the nails of both large toes were ingrown. In eight cases the smear from the nail wall revealed pathological germs of differing types. Conservative therapy was attempted in each case without success. The operative treatment consisted of completely removing the nail in 50%, an incomplete removal in 30%, and in all cases resection of the nail wall. None of the children showed a relapse. The treatment was completed within 14 days following the operation and conservative treatment. The cause is assumed to be a congenital hyperplasia of the nail bed.

  18. Sistemas osso-implante ex vivo utilizando haste intramedular polimérica para imobilização de fraturas femorais em bovinos jovens Ex vivo bone-implant systems using polymeric intramedullary nails for fixation of femoral fractures in young calves

    Directory of Open Access Journals (Sweden)

    Odael Spadeto Junior

    2011-02-01

    Full Text Available O desenvolvimento de novos aparatos usando materiais disponíveis e de baixo custo pode ser uma alternativa viável para o tratamento cirúrgico de fraturas em ossos longos de bovinos. O objetivo deste estudo foi avaliar a resistência mecânica de fêmures de bovinos jovens com fratura diafiseal, imobilizados com hastes intramedulares bloqueadas, compostas por diferentes polímeros. Para tanto, testes físicos de compressão e flexão, por meio de uma máquina universal de ensaios foram realizados em quatro grupos distintos de seis fêmures obtidos de bovinos jovens. Em um dos grupos, os ossos foram mantidos íntegros (grupo controle, enquanto que os outros os ossos, foram fraturados e imobilizados com uma haste intramedular bloqueada, composta por polipropileno, poliacetal ou poliamida (uma para cada grupo. Independente do polímero utilizado, nenhuma das hastes estudadas ofereceu aos fêmures fraturados resistência comparável ao osso íntegro, quando consideradas em conjunto as forças de flexão e compressão. A concordância desses achados com resultados in vivo previamente publicados, demonstra que a metodologia utilizada para testes ex vivo pode ser útil na seleção de materiais mais resistentes para confecção de novos modelos.The development of new devices using available and low cost materials may be an useful alternative for the treatment of long bone fractures in large animals. The aim of this study was to evaluate the mechanical strength of young bovine femur with diaphyseal fracture fixed with different polymeric intramedullary nails. Bending and compression tests using a universal machine were carried out in 4 distinct groups of 6 femurs from young calves. In one of the groups bones were intact while in the other three fractured bones were fixed using an intramedullary nail made of polypropylene, polyacetal or polyamide (one for each group. Considering bending and compression tests together, none of the used polymers offered

  19. Invariants of Broken Discrete Symmetries

    Science.gov (United States)

    Kalozoumis, P. A.; Morfonios, C.; Diakonos, F. K.; Schmelcher, P.

    2014-08-01

    The parity and Bloch theorems are generalized to the case of broken global symmetry. Local inversion or translation symmetries in one dimension are shown to yield invariant currents that characterize wave propagation. These currents map the wave function from an arbitrary spatial domain to any symmetry-related domain. Our approach addresses any combination of local symmetries, thus applying, in particular, to acoustic, optical, and matter waves. Nonvanishing values of the invariant currents provide a systematic pathway to the breaking of discrete global symmetries.

  20. Ritual of the Broken Stone

    OpenAIRE

    Bel, Bernard

    2011-01-01

    This “ritual of the broken stone” was performed in July 1996 to celebrate an auspicious event in a private house of Choglamsar, a settlement of Tibetan migrates in a suburb of Leh (Ladakh, India). According to local informants, its performers were ermits living in caves of Spiti. Most astonishing is the mixture of a religious ritual with comical scenes and demonstrations of 'magical' powers. Este “ritual de la piedra rota“ se llevó a cabo en julio de 1996 para celebrar un acontecimiento au...

  1. Broken Windows and Collective Efficacy

    Directory of Open Access Journals (Sweden)

    Aldrin Abdullah

    2015-01-01

    Full Text Available The broken windows thesis posits that signs of disorder increase crime and fear, both directly and indirectly. Although considerable theoretical evidence exists to support the idea that disorder is positively related to fear of crime, the empirical literature on examining the indirect effect of the individual’s perception of incivilities on fear of crime is limited, especially in developing countries. This research was conducted to assess the indirect relationship between perceived disorder and fear of crime through collective efficacy. A total of 235 households from Penang, Malaysia, participated in this study. Results reveal that high perception of disorder is negatively associated with collective efficacy. High collective efficacy is associated with low fear of crime. Moreover, a significant and indirect effect of disorder on fear of crime exists through collective efficacy. The results provide empirical support for the broken windows theory in the Malaysian context and suggest that both environmental conditions and interactions of residents play a role in the perceived fear of crime.

  2. Nail involvement in leprosy: a study of 300 patients.

    Science.gov (United States)

    Kaur, Inderjeet; Chakrabarti, Aditi; Dogra, Sunil; Rai, Ranju; Kumar, Bhushan

    2003-12-01

    Three hundred leprosy patients were recruited to study the pattern and frequency of nail changes. Nail changes, like longitudinal ridging in finger nails, transverse striations involving both finger and toe nails etc. which occurred with similar frequency in the PB and MB patients in comparison with the control group, were excluded from the analysis. Out of a total number of 150 PB patients, 84 (56%) showed nail changes. Fifty-eight (38.6%) patients showed changes in the finger nails, with an average of 3.2 involved nails per patient. Fifty-three (35.3%) patients showed changes in the toe nails, with an average of 3.0 nails per patient. The most common change observed was longitudinal melanonychia (32.4%) in the finger nails and longitudinal ridging (46.3%) in the toe nails.In comparison, 131/150 (87.3%) MB patients showed nail changes. Finger nail changes were seen in 102 (68%) patients with an average of 5.5 nails affected per patient. Changes in toe nails were seen in 116 (77.3%) patients, with an average of 6.0 nails involved per patient. The most common nail change observed was longitudinal melanonychia in 89/523, (17%) of the total involved finger nails and subungual hyperkeratosis in 164/702, (23.4%) of the total toe nails involvement. Out of a total of 32 colony patients, 31 (96.9%) showed nail changes both in finger and toe nails with an average of 7.9 and 8.4 affected nails per patient, respectively. The most common nail change observed was rudimentary nail(s) on fingers (29%) and toes (21.1%). Among MB patients, a significantly higher number had finger nail involvement in LL group. The frequency of nail involvement for both fingers and toes was significantly greater in LL as compared to BL group of patients. The frequency of nail involvement was significantly more in patients having disease for more than 5 years and in those having trophic changes secondary to loss of sensations and impaired circulation.

  3. Early Stage Disease Diagnosis System Using Human Nail Image Processing

    Directory of Open Access Journals (Sweden)

    Trupti S. Indi

    2016-07-01

    Full Text Available Human’s hand nail is analyzed to identify many diseases at early stage of diagnosis. Study of person hand nail color helps in identification of particular disease in healthcare domain. The proposed system guides in such scenario to take decision in disease diagnosis. The input to the proposed system is person nail image. The system will process an image of nail and extract features of nail which is used for disease diagnosis. Human nail consist of various features, out of which proposed system uses nail color changes for disease diagnosis. Here, first training set data is prepared using Weka tool from nail images of patients of specific diseases. A feature extracted from input nail image is compared with the training data set to get result. In this experiment we found that using color feature of nail image average 65% results are correctly matched with training set data during three tests conducted.

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

    Science.gov (United States)

    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.

  5. Ultrasound-mediated nail drug delivery system.

    Science.gov (United States)

    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 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.

  6. Open intramedullary nailing for segmental long bone fractures: An effective alternative in a resource-restricted environment

    Directory of Open Access Journals (Sweden)

    Olasunkanmi M Babalola

    2016-01-01

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

  7. NAIL AS A PROMISING DRUG DELIVERY SYSTEM FOR CONTROLLED RELEASE

    OpenAIRE

    G. Sai Krishna*, P. Prem Kumar, K. Bala Murugan

    2013-01-01

    ABSTRACT: The effectiveness of topical therapies is limited by minimal drug permeability through the nail plate. Nail permeability is however quite low and limits topical therapy to early/mild disease states such as onychomycosis (fungal infections of the nail). Current research on nail permeation that focuses on altering the nail plate barrier by means of chemical treatments, penetration enhancers as well as physical and mechanical methods is reviewed also the recent research into ungual dru...

  8. Physicochemical characterization of the human nail: I. Pressure sealed apparatus for measuring nail plate permeabilities.

    Science.gov (United States)

    Walters, K A; Flynn, G L; Marvel, J R

    1981-02-01

    Diffusion characteristics of the nail plate are necessary in providing the baselines for rational topical management of nail infections. In order to develop such baselines a unique stainless steel diffusion cell has been designed. The cell permits the exposure of 0.38 cm2 of nail plate to a bathing medium which is stirred by small motors mounted above the cell. The diffusion of water, methanol and ethanol at constant temperature (37 degrees C), has been examined over periods up to 4 h. Average permeability coefficients of water, methanol and ethanol were determined as 16.5 +/- 5.9 X 10(-3) cm hr-1, 5.6 X 10(-3) cm hr-1 and 5.8 +/- 3.1 X 10(-3) cm hr-1 respectively. Moreover rates of diffusion across the nail were inversely proportional to nail thickness. Based on methanol data, nail plate barrier property appears stable for long periods of aqueous immersion.

  9. Surgical outcome of proximal femoral fractures using proximal femoral - locking compression plate

    Directory of Open Access Journals (Sweden)

    Prakash A. Sasnur

    2015-07-01

    Full Text Available Introduction: Proximal femoral fractures are complex fractures following devastating injuries in young and elderly population. Despite marked improvement in implant design, surgical technique and patient care these fractures are associated with high incidence of implant failure, refracture and varus collapse. Intramedullary nails are technically demanding and associated with high re-operation rates. The study was done to evaluate the outcome of proximal femoral fractures treated with proximal femur locking compression plate (PF-LCP. Methods: This study is conducted at Al Ameen Medical College and Hospital, Bijapur during the period Jan 2012 to March 2014.Pertrochanteric fractures especially unstable intertrochanteric & subtrochanteric fractures were included. Technical difficulties with the implant and operating time were quantified. Union of fracture site and implant related complications were followed up clinically and radiological. The Harris Hip Score was used to evaluate the functional outcome. Results: Thirty-two patients were available for final evaluation with average age of 55.4 years. The average operation time was 1 hour and 35 minutes with mean blood loss of 180ml. Union was achieved in all the cases with an average time of 17 weeks. Complications included one case of delayed union and three cases of varus collapse. Conclusion: PF-LCP achieves anatomical reduction and stable fixation with higher union rate and fewer complications.

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

    Science.gov (United States)

    Snorrason, Ivar; Woods, Douglas W

    2014-03-01

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

  11. MRI of broken bioabsorbable crosspin fixation in hamstring graft reconstruction of the anterior cruciate ligament

    Energy Technology Data Exchange (ETDEWEB)

    Bakhru, Prashant [Department of Radiology Jacobi Medical Center, Bronx, NY (United States); Park, Brian [Albert Einstein College of Medicine, Bronx, NY (United States); Umans, Hilary [Department of Radiology Jacobi Medical Center, Bronx, NY (United States); Lenox Hill Radiology and Imaging Associates, P.C., New York, NY (United States); DiFelice, Gregory S. [Hospital for Special Surgery, New York, NY (United States); Tobin, Keith [Lenox Hill Radiology and Imaging Associates, P.C., New York, NY (United States)

    2011-06-15

    To report seven cases of broken bioabsorbable femoral crosspins identified by MRI in evaluation of hamstring grafts of the anterior cruciate ligament. Seven cases of broken bioabsorbable crosspins utilized in femoral fixation of ACL hamstring grafts were identified prospectively and retrospectively from our PACs database during a period from 9/1/08 to 8/31/09. All imaging was performed using 1.5 or 3.0 Tesla MRI and were evaluated for T2 signal within and surrounding the crosspin, osteolysis surrounding the fragments, displacement of fragments, and graft integrity. Time from surgery was also recorded. Seven cases of hamstring grafts with broken bioabsorbable crosspins were imaged 4 months to 3 years following grafting. There was osteolysis surrounding the crosspin in all but one case in which the graft was intact but a pin fragment was displaced into the joint. One graft failed due to aseptic foreign-body reaction to the fixation with aggressive osteolysis at 9 months post surgery. In the remaining five, the ACL graft was either completely torn, partially torn, lax, or degenerative and frayed. Of these, the crosspins were broken and angulated with osteolysis surrounding the apex of the angulated fragment or demonstrated lateral extrusion of the peripheral fragment. Bioabsorbable crosspins utilized in femoral fixation of hamstring graft reconstruction of the ACL may become fractured. While the natural history of osteo-integration of these devices as demonstrated by MRI has not been defined, osteolysis surrounding the fragments, extrusion or displacement of the fragments, and graft laxity or failure would suggest that these are abnormal findings that should be reported. (orig.)

  12. Treatments for nail psoriasis: a systematic review by the GRAPPA Nail Psoriasis Work Group.

    Science.gov (United States)

    Armstrong, April W; Tuong, William; Love, Thorvardur J; Carneiro, Sueli; Grynszpan, Rachel; Lee, Steve S; Kavanaugh, Arthur

    2014-11-01

    Nail involvement in psoriatic diseases causes significant physical and functional disabilities. Evaluating, measuring, and treating nail involvement is important in improving the health outcomes and quality of life among patients with psoriasis and psoriatic arthritis (PsA). We performed a systematic analysis of the literature on nail psoriasis to help inform an update of treatment recommendations by the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA).

  13. Femoral varus: what's the angle

    DEFF Research Database (Denmark)

    Miles, James Edward; Svalastoga, Eiliv Lars; Eriksen, Thomas

    Agreement and reliability of femoral varus measurements: a comparison of four techniques Three different techniques have been described for measuring femoral varus radiographically in the dog, but how the measurements from these techniques compare is unknown. Further, measurement reliability has ...

  14. New technique for withdrawing broken sheath

    Directory of Open Access Journals (Sweden)

    Süleyman Cagan Efe

    2016-03-01

    Full Text Available A sheath that is broken inside vessel is a rare complication, and intravascular fragments from broken sheaths are retrieving transcutaneously by techniques including the loop snare catheter, basket catheter, and grasping/biopsy forceps. We reported a less common type of broken central venous sheath in location and a successful unique technique for retrieving it from subclavian vein by using noncompliant balloon from 40 year old female patient.

  15. Laparoscopic repair of femoral hernia

    OpenAIRE

    Yang, Xue-Fei; Liu, Jia-Lin

    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, ...

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

    Science.gov (United States)

    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 (ppolish 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.

  17. [Pleuritis in yellow nail syndrome].

    Science.gov (United States)

    Kossakowski, C A; Schmiegelow, P; Müller, K-M

    2012-03-01

    A 76-year-old man presented clinically with coughing and shortness of breath and was diagnosed radiologically to have massive pleural effusion as a combined feature of yellow nail syndrome. A lung biopsy was taken and revealed histologically: chronic non-specific inflammation in the pleuropulmonary border, intrapleural edema with eightfold pleural thickening in comparison to normal, angiogenesis in both the nutritive and functional intrapleural blood vessels, no abnormalities of lymphatic vessels with normal topographical distribution as detected by immunohistochemistry for antibody D2-40, granulomatous chronic foreign body reaction as a consequence of pleural effusion therapy by talcum pleurodesis.The histopathological findings of chronic non-specific pleuritis with angiogenesis and increased permeability of blood vessels led to massive intrapleural edema with pleural effusion. Abnormalities of lymphatic vessels could not be confirmed. Considering the features of this disease, they are probably secondary to chronic r infectious or immunological inflammation or paraneoplastic complications with angiogenesis (in about 19%).

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

    Science.gov (United States)

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

    2005-04-01

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

  19. Nail involvement in mycosis fungoides: brief report

    Directory of Open Access Journals (Sweden)

    Amir Houshang Ehsani

    2014-11-01

    Conclusion: We found about 30% prevalence that is a little higher than previously shown. It seems that nail changes in CTCL have no relationship to CTCL staging or other specifications including demographic specifications.

  20. Retrograde Ender nailing for humerus shaft fractures.

    Science.gov (United States)

    Khurana, Ashish; Pendse, Anirudha; Modi, Hitesh; Diwanji, Sanket; Mathur, Hemant; Daveshwar, Rajiv

    2009-10-01

    Humerus fractures are common; their management remains controversial. Infection, neurovascular injury, joint problems and non-union are recognised complications of surgical treatment. These complications can be decreased by opting for a surgical treatment that is less invasive and safe. We present a series of 59 patients treated with retrograde Ender nailing; 56 healed in an average of 9.1 weeks, 2 had delayed union (> 15 weeks) and one went on to non-union, which healed after secondary plate fixation. Nail back out occurred in 8 cases, of which only 3 required nails repositioning. The mean Constant score at final follow-up (mean 19 months) was 91; it was significantly lower in patients over 50 years of age and in those with segmental fractures. In this series, Ender retrograde nailing gave overall satisfactory results and appeared as a safe and efficient technique.

  1. How to Stop Biting Your Nails

    Medline Plus

    Full Text Available ... payer Medicare physician payment MACRA implementation Alternative payment models Fee schedule State policy State policy and action ... Diseases: A-Z index Skin, hair, and nail care Skin care Hair care / hair loss Injured skin ...

  2. Teaching Your Child Healthy Nail Care

    Science.gov (United States)

    ... for public Dermatology World Dialogues in Dermatology JAAD Mohs AUC MyDermPath+ Psoriasis Patient education resources Practice Management ... is especially hard on the nails. 5. Eat foods that contain plenty of protein and vitamin B7 ( ...

  3. Nail disorders in children, a clinical study

    Directory of Open Access Journals (Sweden)

    Ayşe Akbaş

    2016-04-01

    Full Text Available Introduction: Aims of the study to investigate the frequency and the nature ofnail disorders in children significant clinical data is available. Nail disorders although common in children in some parts of our country. This study was carried out to document the clinical and demographic pattern of nail disorders in a dermatology outpatient clinic of a pediatric hospital in Ankara, Turkey. Material and Methods: All consecutive patients a total of 3000 children from age 0-16 were admitted to dermatology outpatient clinic of Ankara Pediatric Hematology and Oncology Education and Research Hospital during January 2011 to December 2011 were studied and retrospectively evaluated for age, gender, drug use, diseases, systemic or genetic disorders and demographic features. Diagnostic evaluation results were noted and patients were categorized for demographic features and diagnosis. Results: These 133 patients (M: F 58:75, %44 vs 56, respectively were under 16 years of age and have 17 different dermatological disorders related with nail symptoms. Fifty three of (39,8% these patient were under 2 years of age, 31 (23.3% were between 3-5 years, 30 (22.5% were between 6-11 years old, 19 of 133 (14%, 2 were between 11-16 years of age. Through all of ages and independent of gender the most etiologies of nail disorders were, onychomadesis, paronychia, onycholysis, onychomycosis and systemic nail presentation of systemic dermatosis. Conclusion: Nail disorders are different in children than in adults. In our study, the first 5 years of age was found in 53% of nail disorders. Nail disorders are uncommon but may be seen as a part of a systemic disease and may be associated with cosmetic and psychologic problem.

  4. Proximal femoral fractures

    DEFF Research Database (Denmark)

    Palm, Henrik; Teixidor, Jordi

    2015-01-01

    searched the homepages of the national heath authorities and national orthopedic societies in West Europe and found 11 national or regional (in case of no national) guidelines including any type of proximal femoral fracture surgery. RESULTS: Pathway consensus is outspread (internal fixation for un...

  5. PREVALENCE OF NAIL ABNORMALITIES IN PATIENTS WITH PSORIASIS

    Directory of Open Access Journals (Sweden)

    Nermina Ovcina-Kurtovic

    2013-07-01

    Full Text Available Introduction: Psoriasis is a chronic inflammatory skin disease that affects about 2% of general population. Cllinicaly, disease can present with cutaneous and nails lesions. Nail abnormalities can be seen in up to two-thirds of patients with psoriasis and both fingernails and toenails may be affected.Objective: The objectives of our study were to evaluate the frequency and clinical presentations of nail abnormalities in patients with psoriasis. Also, we aimed to find correlation between nail changes and some clinical parameters.Methods: One hundred and ten patients with psoriasis were included in this study. A detailed history and examination was recorded for all study subjects, including the age and gender of the patients, type of psoriasis, duration, and extent of disease. Finger and toe nails were clinically examined and nail changes were noted. In the case of clinicaly suspected of fungal infection, further mycological investigations were performed.Results: Nail abnormalities were present in 67 patients (60.9% with psoriasis. Nail pitting was the most common lesion observed on fingernails, followed by discoloration of nail plate. Subungual hyperkeratosis of nail plates were significantly more frequent on the toenails. Positive mycological culture was in 14 (20.8% psoriatic patients with nail involvement. Also, positive correlation between nail abnormalities and duration of psoriasis was found.Conclusions: Nail involvement is common in patients with psoriasis and accompanies skin lesions on the body surface. Pitting and subungual hyperkeratosis are the most frequent nail abnormality in psoriatic patients.

  6. Heat profiles of laser-irradiated nails.

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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.

  8. 49 CFR 230.39 - Broken staybolts.

    Science.gov (United States)

    2010-10-01

    ..., DEPARTMENT OF TRANSPORTATION STEAM LOCOMOTIVE INSPECTION AND MAINTENANCE STANDARDS Boilers and Appurtenances Staybolts § 230.39 Broken staybolts. (a) Maximum allowable number of broken staybolts. No boiler shall be... inside the firebox or combustion chamber on a straight line. No boiler shall be allowed to remain...

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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.

  12. Estimation of pretraumatic femoral antetorsion in bilateral femoral shaft fractures

    Energy Technology Data Exchange (ETDEWEB)

    Citak, Musa; Jagodzinski, Michael; Krettek, Christian; Huefner, Tobias [Hannover Medical School, Trauma Department, Hannover (Germany); Citak, Mustafa [BG-University Hospital Bergmannsheil, Department of Surgery, Bochum (Germany); Kendoff, Daniel; O' Loughlin, Padhraig F. [Hospital for Special Surgery, Orthopaedic Department, New York, NY (United States); Tavassol, Frank [Hannover Medical School, Department of Oral and Maxillofacial Surgery, Hannover (Germany)

    2009-12-15

    To describe a system for measurement of the pretraumatic femoral antetorsion angle post-bilateral femoral shaft fracture with the use of new imaging software which allows segmentation and three dimensional (3D) reconstruction of DICOM (digital imaging and communications in medicine) images. This case involved a 20-year-old patient with bilateral femoral shaft fractures. Following initial clinical examination, CT scans of both femurs were performed. Subsequently, the DICOM datasets were uploaded to the new software tool. Following segmentation and 3D reconstruction, pretraumatic femoral antetorsion angles were determined. Femoral antetorsion was described and assessed in two ways by referring to the intersection of the posterior condylar plane and (1) a line drawn between the center of the femoral head and femoral neck, (2) a line drawn between the centers of the femoral head and greater trochanter. Using these definitions, values for femoral antetorsion were found to be, respectively, 20 at the right fracture site and 19 on the left site, and 33 bilaterally. The investigators describe in this current technical report the use of new imaging software which enables the calculation of femoral AV following reduction of virtual fracture fragments which are created from standard DICOM images. We believe that this 3D reconstruction method of measuring the antetorsion angle can be integrated into a regular treatment algorithm and may potentially optimize clinical outcomes. (orig.)

  13. Localized cortical thickening of the femoral diaphysis captured on an X-ray before alendronate therapy in two cases of atypical femoral fracture

    Energy Technology Data Exchange (ETDEWEB)

    Iizuka, Yoichi [Gunma University Graduate School of Medicine, Department of Orthopedic Surgery, Maebashi, Gunma (Japan); Shibukawa General Hospital, Department of Orthopedic Surgery, Shibukawa, Gunma (Japan); Takechi, Rumi [Gunma University Graduate School of Medicine, Department of Orthopedic Surgery, Maebashi, Gunma (Japan); Gunma Cardiovascular Center, Department of Orthopaedic Surgery, Maebashi, Gunma (Japan); Iizuka, Haku; Takagishi, Kenji [Gunma University Graduate School of Medicine, Department of Orthopedic Surgery, Maebashi, Gunma (Japan); Omodaka, Takuya [Gunma University Graduate School of Medicine, Department of Orthopedic Surgery, Maebashi, Gunma (Japan); Gunma Central Hospital, Department of Orthopedic Surgery, Maebashi, Gunma (Japan)

    2016-10-15

    We herein report two cases of atypical femoral fracture (AFF). X-ray examinations at the first visit of these two female patients showed a complete fracture of the femoral diaphysis diagnosed as an atypical femoral fracture (AFF). X-rays of these two cases also showed localized cortical thickening of the femoral diaphysis. Both patients had been taking alendronate for more than 3 years because of postmenopausal osteoporosis. We assumed that both of the fractures were associated with the long-term use of alendronate. However, we retrospectively identified localized cortical thickening of the femoral diaphysis on an X-ray taken before the alendronate therapy in both of these cases. Therefore, we suspected a pathogenesis of AFFs in which preexisting stress or an insufficient fracture unrelated to bisphosphonate (BP) therapy and subsequent suppression of bone turnover due to BP administration led to the occurrence of an AFF. The patient underwent surgery using intramedullary nails in both of these cases, followed by the administration of teriparatide, and they were able to walk without any support at the final follow-up examination. (orig.)

  14. [Taking a biopsy, treating ingrown nails. Minor nail surgery in general practice].

    Science.gov (United States)

    Haneke, E

    2003-09-18

    Prior to any surgical operation on fingernails or toenails a diagnosis, or at least a suspected diagnosis, must be established. Suitable material for histopathology can be obtained by various methods: lateral longitudinal biopsy, matrix biopsy, and nail bed or nail wall biopsy. Of the surgical options, nail extraction is rarely indicated, and if at all, should be only partial. In the presence of trauma, a careful examination should be made for fracture of the terminal phalanx; where necessary, the matrix and bed must be sutured. Advanced onychogryposis is treated by applying carbolic acid to the matrix. In the case of ingrown toenails and, where applicable, "tubular nails", surgical nail paring is indicated whenever conservative measures fail.

  15. Optimal management of nail disease in patients with psoriasis

    Directory of Open Access Journals (Sweden)

    Piraccini BM

    2015-01-01

    Full Text Available Bianca Maria Piraccini, Michela Starace Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy Abstract: Psoriasis is a common skin disease, with nail involvement in approximately 80% of patients. Nail psoriasis is often associated with psoriatic arthropathy. Involvement of the nails does not always have relationship with the type, gravity, extension, or duration of skin psoriasis. Nail psoriasis can occur at any age and all parts of the nails and the surrounding structures can be affected. Two clinical patterns of nail manifestations have been seen due to psoriasis: nail matrix involvement or nail bed involvement. In the first case, irregular and deep pitting, red spots of the lunula, crumbling, and leukonychia are seen; in the second case, salmon patches, onycholysis with erythematous border, subungual hyperkeratosis, and splinter hemorrhages are observed. These clinical features are more visible in fingernails than in toenails, where nail abnormalities are not diagnostic and are usually clinically indistinguishable from other conditions, especially onychomycosis. Nail psoriasis causes, above all, psychosocial and aesthetic problems, but many patients often complain about functional damage. Diagnosis of nail psoriasis is clinical and histopathology is necessary only in selected cases. Nail psoriasis has an unpredictable course but, in most cases, the disease is chronic and complete remissions are uncommon. Sun exposure does not usually improve and may even worsen nail psoriasis. There are no curative treatments. Treatment of nail psoriasis includes different types of medications, from topical therapy to systemic therapy, according to the severity and extension of the disease. Moreover, we should not underestimate the use of biological agents and new therapy with lasers or iontophoresis. This review offers an investigation of the different treatment options for nail

  16. Drug delivery to the nail following topical application.

    Science.gov (United States)

    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.

  17. Proximal Focal Femoral Deficiency

    Directory of Open Access Journals (Sweden)

    Vishal Kalia, Vibhuti

    2008-01-01

    Full Text Available Proximal focal femoral deficiency (PFFD is a developmental disorder of the proximal segment of thefemur and of acetabulum resulting in shortening of the affected limb and impairment of the function. It isa spectrum of congenital osseous anomalies characterized by a deficiency in the structure of the proximalfemur. The diagnosis is often made by radiological evaluation which includes identification and descriptionof PFFD and evaluation of associated limb anomalies by plain radiographs. Contrast arthrography orMagnetic Resonance Imaging is indicated when radiological features are questionable and to disclose thepresence and location of the femoral head and any cartilagenous anlage. The disorder is more commonlyunilateral and is apparent at birth. However, bilateral involvement is rarely seen. Therapy of the disorder isdirected towards satisfactory ambulation and specific treatment depending on the severity of dysplasia.

  18. 股骨干骨折合并同侧股骨颈骨折的外科治疗分析%Analysis of the surgical treatment on Femoral fracture merge ipsilateral with femoral neck fracture

    Institute of Scientific and Technical Information of China (English)

    赵钦福; 李云; 汪琪; 朱兰高; 王文

    2013-01-01

    Objective To explore clinical characteristics,misdiagnos reasons,clinical curative effect of the femoral fracture with lateral femoral neck fracture. Methods 22 cases of ipsilateral femoral with lateral femoral neck fracture treatment, 6 patients w ith hollow nail and AO plate fixed, 5 cases of DHS device fixed, 11 cases of femoral reconstruction nail fixed. Results femoral fracture healing time 6-16 months, femoral neck fracture healing 12~24 months. 3 cases of femoral fractures of lower section steel plate fracture delayed healing; 15 cases femoral neck fracture primary healing ,7 patients ischemic necrosis of femoral head ,according to Friedman evaluation criteria good in 15 cases, seven patients (misdiagnosis 5 cases).Conclusion femoral fracture with femoral neck fracture patients should be taken acetabulum X ray film,early diagnosis,early surgical treatment.%  目的探讨股骨干骨折合并同侧股骨颈骨折的临床特点、漏诊原因、临床疗效。方法22例同侧股骨干合并股骨颈骨折患者中6例采用空心钉加 AO 钢板固定,5例采用动力髋螺钉(DHS)装置固定,11例采用股骨重建钉固定。结果股骨干骨折愈合时间为6个月~16个月,股骨颈骨折愈合时间为12个月~24个月;有3例股骨干中下段骨折钢板断裂延迟愈合;股骨颈骨折Ⅰ期愈合15例,股骨头缺血坏死7例,按 Friedman评定标准优良15例,差7例(漏诊5例)。结论股骨干骨折患者应摄髋臼 X 线片,早期确诊,早期行手术治疗。

  19. Proximal Focal Femoral Deficiency

    OpenAIRE

    Vishal Kalia, Vibhuti

    2008-01-01

    Proximal focal femoral deficiency (PFFD) is a developmental disorder of the proximal segment of thefemur and of acetabulum resulting in shortening of the affected limb and impairment of the function. It isa spectrum of congenital osseous anomalies characterized by a deficiency in the structure of the proximalfemur. The diagnosis is often made by radiological evaluation which includes identification and descriptionof PFFD and evaluation of associated limb anomalies by plain radiographs. Contra...

  20. Blood flow and microdialysis in the human femoral head

    DEFF Research Database (Denmark)

    Bøgehøj, Morten; Emmeluth, Claus; Overgaard, Søren

    2007-01-01

    BACKGROUND: If it would be possible to detect lack of flow and/or the development of ischemia in bone, we might have a way of predicting whether a broken bone will heal. We established microdialysis (MD) and laser Doppler (LD) flow measurement in the human femoral head in order to be able to detect...... ischemia and measure changes in blood flow. MATERIAL AND METHODS: In 9 patients undergoing total hip arthroplasty for primary osteoarthrosis, two MD catheters were inserted into the femoral head through two drill holes after the blood flow had been visualized by LD. Then primary samples were collected...... detected within 2 h of cessation of blood flow in most patients....

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

    Science.gov (United States)

    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.

  2. Nail psoriasis – what a rheumatologist should know about

    Science.gov (United States)

    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

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

    Science.gov (United States)

    Nieradko-Iwanicka, Barbara

    2017-01-01

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

  4. A technique to prevent Ender nail back-out.

    Science.gov (United States)

    Yadav, V; Marya, K M

    2003-12-01

    Ender nails are advantageous in the treatment of certain fractures; however, inadequate fixation and back-out are frequent complications. This article presents a simple looping technique that prevents Ender nail back-out.

  5. Heavy Metal Contamination of Popular Nail Polishes in Iran

    OpenAIRE

    Golnaz Karimi; Parisa Ziarati

    2015-01-01

    Background: Toxic and hazardous heavy metals like arsenic, lead, mercury, zinc, chromium and iron are found in a variety of personal care products, e.g. lipstick, whitening toothpaste, eyeliner and nail color. The nails absorb the pigments of nail polishes and vaporized or soluble metals can easily pass it. The goal of this survey was to assess whether the different colors of nail polishes comply with maximum concentrations of heavy metals in the EPA’s guidelines. Methods: 150 samples of d...

  6. PREVALENCE OF NAIL ABNORMALITIES IN PATIENTS WITH PSORIASIS

    OpenAIRE

    Nermina Ovcina-Kurtovic; Emina Kasumagic-Halilovic

    2013-01-01

    Introduction: Psoriasis is a chronic inflammatory skin disease that affects about 2% of general population. Cllinicaly, disease can present with cutaneous and nails lesions. Nail abnormalities can be seen in up to two-thirds of patients with psoriasis and both fingernails and toenails may be affected.Objective: The objectives of our study were to evaluate the frequency and clinical presentations of nail abnormalities in patients with psoriasis. Also, we aimed to find correlation between nail ...

  7. Optimal management of nail disease in patients with psoriasis

    OpenAIRE

    Piraccini BM; Starace M

    2015-01-01

    Bianca Maria Piraccini, Michela Starace Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy Abstract: Psoriasis is a common skin disease, with nail involvement in approximately 80% of patients. Nail psoriasis is often associated with psoriatic arthropathy. Involvement of the nails does not always have relationship with the type, gravity, extension, or duration of skin psoriasis. Nail psoriasis can occur at any age and ...

  8. Infiltration of soft tissue by myeloma after internal fixation of pathologic femoral fracture; Infiltracion de partes blandas por mieloma, tras la fijacion interna de una fractura patologica femoral

    Energy Technology Data Exchange (ETDEWEB)

    Martinez, J.; Escape, I.; Bastart, F.; Solduga, C. [Hospital de Barcelona. Barcelona (Spain)

    2002-07-01

    a 75-year-old man with multiple myeloma presented with a pathologic fracture of distal right femoral diaphysis, which was fixed with Ender nails. Two and a half months later, the patients was readmitted with rapidly progressive swelling of right thigh. Ultrasound computed tomography and magnetic resonance imaging revealed infiltration of anterior right thigh muscles, extending upward to the iliopsoas muscle and retroperitoneal space, above ipsilateral renal vein. Ultrasound-guided biopsy of the soft tissue of the thigh revealed diffuse myelomatous infiltration by plasma blasts. (Author) 9 refs.

  9. Estimation of arsenic in nail using silver diethyldithiocarbamate method

    Directory of Open Access Journals (Sweden)

    Habiba Akhter Bhuiyan

    2015-08-01

    Full Text Available Spectrophotometric method of arsenic estimation in nails has four steps: a washing of nails, b digestion of nails, c arsenic generation, and finally d reading absorbance using spectrophotometer. Although the method is a cheapest one, widely used and effective, it is time consuming, laborious and need caution while using four acids.

  10. A technique for nailing severely shortened and displaced tibia fractures.

    Science.gov (United States)

    Krause, Peter C; Whatley, Adam N; Mautner, James F

    2008-02-01

    Previously described techniques using external fixators or large distractors can simplify the closed nailing of tibia fractures and nonunions. However, delayed intramedullary nailing can be especially challenging when significant shortening or translation has occurred. We present a modification of an old technique for external fixator-assisted closed tibial nailing in these difficult cases.

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

    Science.gov (United States)

    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.

  12. Nobel Prize for work on broken symmetries

    CERN Multimedia

    2008-01-01

    The 2008 Nobel Prize for Physics goes to three physicists who have worked on broken symmetries in particle physics. The announcement of the 2008 Nobel Prize for physics was transmitted to the Globe of Science and Innovation via webcast on the occasion of the preview of the Nobel Accelerator exhibition.On 7 October it was announced that the Royal Swedish Academy of Sciences had awarded the 2008 Nobel Prize for physics to three particle physicists for their fundamental work on the mechanisms of broken symmetries. Half the prize was awarded to Yoichiro Nambu of Fermilab for "the discovery of the mechanism of spontaneous broken symmetry in subatomic physics". The other half is shared by Makato Kobayashi of Japan’s KEK Institute and Toshihide Maskawa of the Yukawa Institute at the University of Kyoto "for the discovery of the origin of the broken symmetry which predicts the existence of at least three families of quarks in Nature". At th...

  13. Juvenile xanthogranuloma of the proximal nail fold.

    Science.gov (United States)

    Piraccini, Bianca Maria; Fanti, Pier Alessandro; Iorizzo, Matilde; Tosti, Antonella

    2003-01-01

    An 18-month-old Caucasian boy presented with a firm 0.5 mm nodule, pink-red in color, with a yellow hue and some telangiectases on the surface, localized on the right thumbnail. The nodule involved all of the proximal nail fold and covered the proximal third of the nail. Pathology showed a dense dermal infiltrate of histiocytes, some of which had foamy nuclei, and multinucleated Touton giant cells. The lesion progressively decreased in size and had completely disappeared after 3 years. Periodic follow-up was important not only to monitor evolution of the juvenile xanthogranuloma, but also to avoid excessive growth of the lesion with possible definitive nail matrix damage.

  14. Cerebral damage caused by nail gun injury

    DEFF Research Database (Denmark)

    Andersen, Chris

    2016-01-01

    . The forensic examination showed lesions of intracranial surgery and minor bruises on the arms. No sign of defense injuries was found. There were no signs of malfunction of the nail gun-wielding robot. On the side of the machine, there were a handheld nail gun and the police investigated the case as a possible......-inflicted or a criminal act. Case presentation A 43-year-old male worker was brought to the emergency department after his coworkers had found him on the floor in the cafeteria at work. He was admitted to the hospital due to a possible apoplexy. The CT scan revealed a nail in his skull and acute surgery was performed...

  15. Femoral shaft fracture osteosynthesis in a critically ill patient under Extracorporeal Membrane Oxygenation (ECMO

    Directory of Open Access Journals (Sweden)

    Calvo Cristobal

    2016-01-01

    Full Text Available Introduction: Extracorporeal Membrane Oxygenation (ECMO is an invasive procedure used in critically ill patients with catastrophic pulmonary failure or cardiogenic shock in which conventional management has failed. These patients are managed with permanent anticoagulation, with increased bleeding risk. Hemorrhage is the main reported complication. Case: A 25-year-old polytraumatized woman, both lower limbs amputated and a left femoral shaft fracture with catastrophic pulmonary failure (Murray score 4 that required intensive management care with ECMO. During her evolution definitive femoral shaft osteosynthesis with a nail as required and the medical team decided to operate on the patient under ECMO. She recovered with fluctuations in her hematocrit, but was hemodynamically stable. The patient recovered satisfactorily, was weaned from ECMO and commenced her rehabilitation program. At 16 months, she was almost autovalent, and full consolidation was achieved, with no complication of the implants. Discussion: ECMO is a life-saving support, but requires permanent anticoagulation, which implies a high risk of hemorrhages, specially for surgical treatment. This patient underwent an osteosynthesis surgery satisfactorily. Hematoma was the only complication of her intramedullary femoral nail, without compromising hemodynamics. This case shows that patients on ECMO can undergo a major orthopedic surgery in selected cases.

  16. Controversies in the treatment of ingrown nails.

    Science.gov (United States)

    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.

  17. Complications Using Bioabsorbable Cross-Pin Femoral Fixation: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Saqib Hasan

    2011-01-01

    Full Text Available The use of bioabsorbable cross-pin transcondylar fixation has remained a viable option for femoral fixation in anterior cruciate ligament reconstruction. Although numerous biomechanical studies have demonstrated high fixation strength and minimal slippage with use of this method of fixation, there have been increasing reports of a variety of clinical complications associated with these implants. We reviewed the literature for all complications associated with the Bio-TransFix implant and present a case report of a patient status after ACL reconstruction using Bio-TransFix cross-pin femoral fixation with iliotibial band friction syndrome from a broken cross-pin four month post-operatively.

  18. NAIL AS A PROMISING DRUG DELIVERY SYSTEM FOR CONTROLLED RELEASE

    Directory of Open Access Journals (Sweden)

    G. Sai Krishna*, P. Prem Kumar, K. Bala Murugan

    2013-03-01

    Full Text Available ABSTRACT: The effectiveness of topical therapies is limited by minimal drug permeability through the nail plate. Nail permeability is however quite low and limits topical therapy to early/mild disease states such as onychomycosis (fungal infections of the nail. Current research on nail permeation that focuses on altering the nail plate barrier by means of chemical treatments, penetration enhancers as well as physical and mechanical methods is reviewed also the recent research into ungual drug delivery is reviewed, a new method of nail sampling is examined. Topical therapy is worth pursuing however, as local action is required in many nail disorders. Drug transport into the nail plate can be assisted by filing the nail plate before topical application of drug formulations as well as by the use of chemical enhancers. Finally limitations of current ungual drug permeability studies are briefly discussed and 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, and 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. The nail plate behaves like a concentrated hydrogel to permeating molecules and diffusion of molecules through the nail plate has been compared to the diffusion of non-electrolytes through polymer gels. Thus, for optimal ungual permeation and uptake, drug molecules must be of small size and be uncharged.

  19. Femoral shaft fracture fixed with intramedullary nailing in a child resulting in femoral neck narrowing deformity and fracture

    Institute of Scientific and Technical Information of China (English)

    WAN Lin; ZHAO Lin; LIU Yan-qing; WANG Xu; LIU Jing-sheng

    2008-01-01

    @@ Treatment of factures in children is different from that of adults because improper internal fixation,including selection of internal fixation device and epiphysis approaching,may cause epiphysis injury,which may result in a series of secondary lesions in bone development,such as growth arrest,limb length discrepancy, osteonecrosis, and other deformities.

  20. 股骨干骨折合并同侧股骨颈或股骨髁上骨折漏诊的诊治%Analysis of misdiagnoses for femoral shaft fracture with ipsilateral femoral neck or femoral fractures

    Institute of Scientific and Technical Information of China (English)

    李守民; 朱晨; 孔荣; 夏睿; 方诗元; 张光平

    2010-01-01

    Objective To analyze the misdiagnoses of femoral shaft fracture combined with ipsilateral femoral neck or femoral fractures.Methods Over the past six years,eight misdiagnosed cases of ipsilateral femoral neck or femoral fractures missed patients,aged 25 to 59 years old(mean:41.7),were treated at our department.An initial diagnosis of femoral shaft fracture was later revised as ipsilateral femoral shaft with supra-condylar fracture of femoral neck or femur.Femoral shaft fracture was fixed with armor plate,3-screw hollow compression fixation of femoral neck;two cases of femoral condylar fractures of distal femoral condyle with anatomical plate fixation and 1 case of intraoperative change into the retrograde femoral intramedullary nail fixation.Results The mean post-operative follow-up was 3.5 years.All fractures healed with excellent hip and knee functions.Conclusion For those with a strong reverse and torsional violence,femoral shaft fracture combined with ipsilateral femoral neck or femoral fractures may be easily misdiagnosed.A preoperative conventional hip-knee X-ray film is an effective way to avoid a misdiagnosis.%目的 对股骨干骨折合并同侧股骨颈或股骨髁上骨折漏诊的治疗进行分析.方法 2002年12月至2008年12月安徽医科大学附属省立医院骨科收治8例股骨干合并同侧股骨颈或股骨髁上骨折漏诊患者,年龄25~59岁,平均41.7岁,初步诊断为股骨干骨折,后修正为股骨干合并同侧股骨颈或股骨髁上骨折.股骨干骨折行钢板内固定.股骨颈骨折行3枚空心加压螺丝钉内固定;股骨髁上骨折2例行股骨远端外髁解剖钢板的内固定,1例术中更改行逆行股骨交锁髓内钉内固定.结果 术后平均随访3.5年,骨折均愈合,髋膝关节功能良好.结论 凡强大暴力及有扭转暴力者股骨干合并同侧股骨颈或股骨髁上骨折易漏诊,术前常规髋膝摄片是避免漏诊的有效方法.

  1. SUPRACONDYLAR FRACTURE FEMUR T REATED WITH INTRAMEDULLARY NAIL : A PROSPECTIVE STUDY

    Directory of Open Access Journals (Sweden)

    Venkateswara Rao

    2015-08-01

    Full Text Available BACKGROUND: Supracondylar fractures are one of the commonest fractures encountered in high velocity trauma which are associated with high morbidity and mortality . 1 Isolated fracture can itself lead to complications such as ARDS and pulmonary embo lism 1 . This necessitates early stabilization of fractures. Internal fixation is the choice of treatment in supracondylar fractures (AO type – A . 2 Retrograde supracondylar nail has shown to give one of the best results in terms of recovery, fracture union, r eturn to work and the functional outcome. METHODS: 20 patients with supracondylar fracture femur were studied (AO type - A. Supracondylar fractures femur were treated by closed or open reduction and internal fixation by Retrograde supracondylar nail inserte d through inter - condylar notch between July 2012 to September 2014 at our institution. The patients were evaluated clinically and radiologically for outcomes. All patients were followed up for an average of 12 months. Outcome was assessed using NEER’S SCOR E . 3 RESULTS: Supracondylar femoral extra - articular fractures in 20 patients were treated in this study with retrograde intramedullary supracondylar nail after closed or open reduction. The AO - ASIF fracture classification was used. All extra - articular fractures were selected for study. Six were compound fractures according to the Gustilo - Anderson classification , 4 the fracture was stabilized with the chosen system at an average of 6.9 days post - trauma, with an average operative time of 65. 9 minutes. In 15 cases closed reduction was possible while 5 required open reduction. Post - operatively all patients were shifted to continuous passive mobilization with early toe touch walking and gradually progressive weight bearing with appearance of clinical and radi ological signs of union. Evaluation was done according to Neer’s rating system . 3 65% excellent results were found. In the present study, road traffic accidents

  2. Nail changes in childhood psoriasis: a study from Kuwait.

    Science.gov (United States)

    Al-Mutairi, Nawaf; Manchanda, Yashpal; Nour-Eldin, Osama

    2007-01-01

    Psoriasis is a widespread skin disorder in which nail involvement can be seen in up to two-thirds of those affected. Childhood psoriasis is a distinct entity and the literature focused on nail changes associated with childhood psoriasis is scant. Our objectives were to evaluate the frequency of nail involvement in childhood psoriatic patients, assess the types of nail changes in childhood psoriasis, and compare our clinical findings with the few reports available in the literature. Two hundred and one consecutive new patients with childhood (age nail changes. The diagnosis of psoriasis was made on clinical grounds. Each patient underwent a thorough dermatologic examination with special attention paid to the nail changes. If a clinical suspicion of fungal infection of the nails existed, further mycologic investigations were performed. We found the prevalence of nail changes to be 37.81% (boys > girls) in children who had psoriasis. Nail pitting was found to be the most common manifestation (61.84%) followed by onycholysis (30.26%), subungual hyperkeratosis (13.16%), and discoloration of the nail plate (7.90%). Nail involvement had no relationship to the type of psoriasis, patient's sex, or duration or extent of disease.

  3. 1st meeting on topical drug delivery to the nail.

    Science.gov (United States)

    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.

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

    Directory of Open Access Journals (Sweden)

    Nida Akhtar

    2016-01-01

    Full Text Available 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.

  5. Femoral pseudoaneurysms in drug addicts

    DEFF Research Database (Denmark)

    Levi-Mazloum, Niels Donald; Rørdam, Peter; Jensen, L P

    1997-01-01

    OBJECTIVE: To evaluate the outcome of treatment of femoral pseudoaneurysms in drug addicts. METHODS: The records of eight patients undergoing vascular surgery for femoral pseudoaneurysms from substance abuse identified from a vascular database were reviewed. RESULTS: Were good in four out of five...

  6. Severe Nail Fold Psoriasis Extending from Nail Psoriasis Resolved with Ustekinumab: Suggestion of a Cytokine Overflow Theory in the Nail Unit

    OpenAIRE

    Byun, Sang Young; Kim, Bo Ri; Choi, Jae Woo; Youn, Sang Woong

    2016-01-01

    Because nail psoriasis is difficult to treat, therapy with many biological drugs has been attempted. Ustekinumab is approved for chronic plaque psoriasis and psoriatic arthritis (PsA), with some trials reporting nail improvement using this agent. A 51-year-old man with severe chronic plaque psoriasis had severe involvement of all fingernails and toenails, with accompanying nail fold psoriasis. He also had PsA of the small joints of the fingers. Despite multiple conventional therapies, the nai...

  7. Interlocking nailing in fractures of distal tibia

    Directory of Open Access Journals (Sweden)

    Akshay Phadke

    2016-04-01

    Conclusions: Intramedullary nailing is an effective alternative for the treatment of distal metaphyseal tibial fractures. A proper patient selection, adjuvant fixation of fibula and use of at least two distal interlocking screws is suggested for better outcome. [Int J Res Med Sci 2016; 4(4.000: 1132-1135

  8. Cerebral damage caused by nail gun injury

    Directory of Open Access Journals (Sweden)

    Andersen Chris Hedeman

    2016-06-01

    Full Text Available Background Accidents with nail guns are rather common, especially in the construction industry. Most injuries involve the extremities and several present with intracerebral injuries. When the patient is unconscious, it can be a big challenge to determine whether the injury is an accident, self-inflicted or a criminal act.

  9. Effect of autocontrol micromotion intramedullary interlocking nail on fracture healing: an experimental study

    Institute of Scientific and Technical Information of China (English)

    XU Wei-zhou; GUO Xiao-dong; ZHAO Ju-cai; WANG Yi-jin

    2006-01-01

    Objective: To investigate the effect of autocontrol micromotion locking nail (AMLN) on experimental fracture healing and its mechanism.Methods: 16 goats undergoing both sides of transverse osteotomy of the femoral shafts were fixed intramedullary with AMLN and Gross-Kempf (GK) nail,respectively. The follow-up time was 7, 14, 28 and 56days. Roentgenographic, biomechanical, histological,scanning electromicroscopic and biochemical analyses were done.Results: ( 1 ) The strength of anticompression,antiflexion and antitorsion in the fractural end in the AMLN-fixed group was higher than that of GK nail-fixed group; whereas, the rate of stress shelter in the fractured end decreased significantly (P < 0.01 ). (2) The content of the total collagen, insoluble collagen, calcium and phosphate in the AMLN-fixed group was higher than that in the GK nail-fixed group ( P < 0.05 ). ( 3 ) Histological observation and quantitative analysis of calluses revealed that AMLN could promote the growth of bridge calluses and periosteum calluses. Hence the facture healing and remolding process achieved early, which was much better than traditional GK nail fixation. (P < 0.05). ( 4 ) 7-14days postoperation, the calluses of AMLN-fixed group was flourish and camellarly arranged and the collagen fibril formed constantly in the absorption lacuna of bone trabecula. 28-56 days postoperation, the collagen fibril was flourish around the absorption lacuna and was parallel to the bone's longitudinal axis. Active bony absorption and formation were seen, so was remolding and rebuilding.Haversian system was intact and the bony structural net was very tenacious because of the deposition of calcium salt.None of the above findings was observed in the GK nailfixed group.Conclusions: The design of AMLN accords well with the plastic fixation theory. As the geometry ametabolic system constituted by the intramedullary fixation instruments and the proximal and distal end of the fracture is very firm and stable

  10. Subtrochanteric Femur Fracture after Slipped Capital Femoral Epiphysis Pinning: A Novel Treatment

    Directory of Open Access Journals (Sweden)

    Michael Paloski

    2011-01-01

    Full Text Available Slipped capital femoral epiphysis is a common injury suffered by adolescents worldwide. Treatment of most slips can be accomplished by percutaneous screw fixation, as this is an accepted and proven method associated with minimal morbidity. Complications, although limited, can be problematic for both the patient and treating physician. These include avascular necrosis, chondrolysis, infection, and fracture. We report a case of an individual who sustained a subtrochanteric femure fracture three weeks after in situ pinning of his left hip treated with a reconstruction intramedullary nail. This option allowed both the subtrochanteric fracture and SCFE to be treated concomitantly with minimized morbidity.

  11. Treatment of a femoral shaft fracture in a patient with congenital hip disease: a case report

    Directory of Open Access Journals (Sweden)

    Koutsostathis Stefanos D

    2010-07-01

    Full Text Available Abstract Introduction We present a rare case of two concomitant morbidities treated in one operation. To our knowledge, this is the first report of its kind in the literature. Case presentation A 57-year-old Greek woman was admitted to the emergency department having sustained a spiral mid-shaft femoral fracture. She also suffered from an ipsilateral hip congenital dysplasia with ankylosed hip joint due to severe arthritis. She was treated with a total hip arthroplasty using a long stem performing as an intramedullary nail. Conclusion We undertook a complex operative treatment of both co-morbidities in a one stage procedure with a satisfactory clinical result.

  12. A study of nail changes in various dermatosis in Punjab, India

    Directory of Open Access Journals (Sweden)

    Neerja Puri

    2012-07-01

    Full Text Available Nails act as a window to diagnosis of skin diseases. Various dermatosis affect the nails and the severity of the skin disorder is reflected in the nails. Nail changes are seen in various dermatosis like psoriasis, lichen planus, onychomycosis, collagen vascular disorders, vescicobullous disorders and other papulosquamous disorders. We will discuss in detail regarding nail changes in various dermatosis.

  13. Softly Broken Supersymmetric Gauge Theories through Compactifications

    CERN Document Server

    Takenaga, K

    1998-01-01

    Effects of boundary conditions of fields for compactified space directions on the supersymmetric gauge theories are discussed. For general and possible boundary conditions the supersymmetry is explicitly broken to yield universal soft supersymmetry breaking terms, and the gauge symmetry of the theory can also be broken through the dynamics of non-integrable phases, depending on number and the representation under the gauge group of matters. The 4-dimensional supersymmetric QCD is studied as a toy model when one of the space coordinates is compactified on $S^1$.

  14. 动力髁螺钉治疗股骨近端不稳定骨折%Dynamic Condylar Screw for Treatment of Unstable Proximal Femoral Fractures

    Institute of Scientific and Technical Information of China (English)

    李明辉; 刘洋

    2011-01-01

    Objective To evaluate the efficacy of operative treatment for the Proximal femoral fracture with dynamic condyle screw (DCS). Methods From January 2004 to June 2009,37 cases of patients with Proximal femoral fracture (Reverse intertrochanteric femur fractures in 16 cases, 21 cases of intertrochanteric fracture ;Male 15,Female 22) was treated by DCS. 34 cases were followed up by 6 to 60 months in average age. The body mass index,operative time,blood loss,X ray projection times,the number of postoperative blood transfusion,postoperative wound drainage,postoperative neck-shaft angle,fracture healing time (patient began full weight bearing time) was statistics,and make Harris score. Results All patients were healed and there are no complications such as broken nails,broken boards,and other nonunion take place. 32 patients were followed up for 11~24 months time,with an average of 13 months.According to Harris score,the result was excellent in 15 cases,good in 12 cases, fair in4 and not satisfied with3. The excellent rate is 79. 41%. Conclusion Dynamic condylar screw is effective methods in treating unstable proximal femoral fractures. Application of DCS should be considered in elderly,obese patients. If you have to use the DCS,full weight-bearing should be extended.%目的 探讨应用动力髁螺钉(dynamic condylar screw,DCS)治疗股骨近端不稳定骨折的方法,评价其术中、术后情况及临床疗效.方法 自2004年1月至2009年6月采用闭合复位动力髁螺钉内固定治疗股骨近端骨折37例,其中男15例,女22例;股骨逆粗隆间骨折16例,股骨粗隆下骨折21例.在患者平均年龄、体重指数、手术时间、术中失血量、X线投照次数、术中及术后输血量、术后伤口引流量、术后颈于角、骨折愈合时间(患者开始完全负重时间)等方面进行统计,并进行Harris评分.结果 37例中34例得到6~60个月的随访,骨折全部愈合,无断钉、断板、骨

  15. Focal femoral condyle resurfacing.

    LENUS (Irish Health Repository)

    Brennan, S A

    2013-03-01

    Focal femoral inlay resurfacing has been developed for the treatment of full-thickness chondral defects of the knee. This technique involves implanting a defect-sized metallic or ceramic cap that is anchored to the subchondral bone through a screw or pin. The use of these experimental caps has been advocated in middle-aged patients who have failed non-operative methods or biological repair techniques and are deemed unsuitable for conventional arthroplasty because of their age. This paper outlines the implant design, surgical technique and biomechanical principles underlying their use. Outcomes following implantation in both animal and human studies are also reviewed. Cite this article: Bone Joint J 2013;95-B:301-4.

  16. Locking intramedullary nailing with and without reaming for open fractures of the tibial shaft. A prospective, randomized study.

    Science.gov (United States)

    Keating, J F; O'Brien, P J; Blachut, P A; Meek, R N; Broekhuyse, H M

    1997-03-01

    Ninety-one patients who had ninety-four open fractures of the tibial shaft were randomized into two treatment groups. Fifty fractures (nine type-I, eighteen type-II, sixteen type-IIIA, and seven type-IIIB fractures, according to the classification of Gustilo et al.) were treated with nailing after reaming, and forty-four fractures (five type-I, sixteen type-II, nineteen type-IIIA, and four type-IIIB fractures) were treated with nailing without reaming. The average diameter of the nail was 11.5 millimeters (range, nine to fourteen millimeters) in the group treated with reaming and 9.2 millimeters (range, eight to ten millimeters) in the group treated without reaming. Follow-up information was adequate for forty-five patients (forty-seven fractures) who had been managed with reaming and forty patients (forty-one fractures) who had been managed without reaming. No clinically important differences were found between the two groups with regard to the technical aspects of the procedure or the rate of early postoperative complications. The average time to union was thirty weeks (range, thirteen to seventy-two weeks) in the group treated with reaming and twenty-nine weeks (range, thirteen to fifty weeks) in the group treated without reaming. Four (9 per cent) of the fractures treated with reaming and five (12 per cent) of the fractures treated without reaming did not unite (p = 0.73). There were two infections in the group treated with reaming and one in the group treated without reaming. Significantly more screws broke in the group treated without reaming (twelve; 29 per cent) than in the group treated with reaming (four; 9 per cent) (p = 0.014). There was no difference between the two groups with regard to the frequency of broken nails (two nails that had been inserted after reaming broke, compared with one that had been inserted without reaming). The functional outcome, in terms of pain in the knee, range of motion, return to work, and recreational activity, did not

  17. RESULTS OF SURGICAL TREATMENT OF PAEDIATRIC DIAPHYSEAL FRACTURES OF LONG BONES USING INTRAMEDULLARY ELASTIC NAIL

    Directory of Open Access Journals (Sweden)

    Arun Kumar

    2015-12-01

    Full Text Available BACKGROUND Among the various methods of treating the long bone fractures in children less than 5yrs (POP cast and adolescents 16yrs (IMN, flexible intramedullary nail has gained importance because of its stability, not violating the physis and less complications and early rehabilitation. Irrespective of mode of treatment, goal shall be to achieve union at fracture site, control length and alignment, minimize the morbidity and complications for patient and their family. MATERIALS AND METHODS A prospective study was conducted on children of both sexes, between the age group of 5-15yrs with diaphyseal fractures of long bones, meeting the inclusion and exclusion criteria during the study period at RRMCH (September 2012 to September 2014. Totally, 30 cases were evaluated clinically and radiologically and followed up at 3, 6, 12, 24 weeks after surgery. Final outcome was assessed using Flynn’s criteria for Tens Scoring System. RESULTS Results of entire, 30 patients were followed up for an average of 6 months, was excellent in 19(63% cases and satisfactory in 11(37% cases and no poor outcome. CONCLUSION Based on this study and result, we found that intramedullary elastic nailing technique is an ideal method for treatment of pediatric femoral and tibial diaphyseal fractures.

  18. X-ray-based machine vision system for distal locking of intramedullary nails.

    Science.gov (United States)

    Juneho, F; Bouazza-Marouf, K; Kerr, D; Taylor, A J; Taylor, G J S

    2007-05-01

    In surgical procedures for femoral shaft fracture treatment, current techniques for locking the distal end of intramedullary nails, using two screws, rely heavily on the use of two-dimensional X-ray images to guide three-dimensional bone drilling processes. Therefore, a large number of X-ray images are required, as the surgeon uses his/her skills and experience to locate the distal hole axes on the intramedullary nail. The long-term effects of X-ray radiation and their relation to different types of cancer still remain uncertain. Therefore, there is a need to develop a surgical technique that can limit the use of X-rays during the distal locking procedure. A robotic-assisted orthopaedic surgery system has been developed at Loughborough University to assist orthopaedic surgeons by reducing the irradiation involved in such operations. The system simplifies the current approach as it uses only two near-orthogonal X-ray images to determine the drilling trajectory of the distal locking holes, thereby considerably reducing irradiation to both the surgeon and patient. Furthermore, the system uses robust machine vision features to reduce the surgeon's interaction with the system, thus reducing the overall operating time. Laboratory test results have shown that the proposed system is very robust in the presence of variable noise and contrast in the X-ray images.

  19. Ratchet due to broken friction symmetry

    DEFF Research Database (Denmark)

    Norden, Bengt; Zolotaryuk, Yaroslav; Christiansen, Peter Leth;

    2002-01-01

    A ratchet mechanism that occurs due to asymmetric dependence of the friction of a moving system on its velocity or a driving force is reported. For this kind of ratchet, instead of a particle moving in a periodic potential, the dynamics of which have broken space-time symmetry, the system must be...

  20. Broken windows, mediocre methods, and substandard statistics

    NARCIS (Netherlands)

    Wicherts, J.M.; Bakker, M.

    2014-01-01

    Broken windows theory states that cues of inappropriate behavior like litter or graffiti amplify norm-violating behavior. In a series of quasi-experiments, Keizer, Lindenberg, and Steg altered cues of inappropriate behavior in public places and observed how many passersby subsequently violated norms

  1. PERIODIC-SOLUTIONS IN SPONTANEOUSLY BROKEN THEORIES

    NARCIS (Netherlands)

    BRIHAYE, Y; KUNZ, J

    1992-01-01

    A class of spontaneously broken field theories is proposed, and the occurrence of their periodic, classical solutions is investigated in detail. The emergence of multiple solutions is observed, their normal modes of oscillation are studied, and the bifurcations of the classical energy functional are

  2. Sarcoidosis: radiographic manifestations in the nails and distal phalanges

    Energy Technology Data Exchange (ETDEWEB)

    Albers, Brittany K.; Garner, Hillary W. [Mayo Clinic, Department of Radiology, Jacksonville, FL (United States); Sluzevich, Jason C. [Mayo Clinic, Department of Dermatology, Jacksonville, FL (United States)

    2016-05-15

    Sarcoidosis is a granulomatous disease which can affect multiple organ systems. Clinical and radiologic manifestations depend on the organ system involved and the chronicity of disease. Nail involvement in sarcoidosis is rare, but is clinically relevant as it indicates chronic systemic disease. Nail abnormalities can be identified radiographically, and when seen in patients with known or suspected sarcoidosis, should prompt careful evaluation of the underlying bone for osseous involvement. We describe a case of sarcoidosis with radiographic findings in the nails and distal phalangeal tufts, which were indicative of nail and osseous sarcoid involvement and strongly supported the presence of chronic systemic disease. Although the nail findings resolved clinically and on radiographs after treatment, the osseous findings showed only minimal improvement. To our knowledge, the radiographic findings of nail sarcoidosis have not been previously addressed in the literature. (orig.)

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

    Science.gov (United States)

    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.

  4. Femoralni trikotnik: The femoral triangle:

    OpenAIRE

    Mlakar, Boštjan; Ravnik, Dean

    1999-01-01

    The topography and structures of the femoral triangle are presented. The femorai triangle lies between the inguinal ligament at the base, the sartoriusmuscle at the lateral border and the long adductor muscle at the medial border. The apex of the femoral triangle is situated at the meeting point of the medial borders of the sartorius and long adductor muscles. The subinguinal space, which is divided into the lacuna musculorum and lacuna vasorum, provides a passageway for the lateral cutaneous...

  5. Nail changes in female pemphigus vulgaris patients on immunosuppressive therapy

    OpenAIRE

    M.M. El-Komy, MD; D.M. Abdel Halim, MD; N. Samir, MD; R.A. Hegazy, MD; H.I. Gawdat, MD; S.A. Shoeb, MD

    2015-01-01

    Background: Pemphigus vulgaris (PV) patients receiving immunosuppressive therapy may develop nail alterations resulting from infection, skin disorder, or drug regimen. Objective: This study aims to describe nail changes in PV female patients receiving immunosuppressive therapy and to report the frequency of associated fungal and bacterial growth in the patients’ nails. Methods: Twenty-five female PV patients who had at least one acquired finger or toenail abnormality and had been admini...

  6. Iontophoretically Enhanced Ciclopirox Delivery into and Across Human Nail Plate

    OpenAIRE

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

    2009-01-01

    Transungual delivery of antifungal drugs is hindered by the low permeability of human nail plates, and as such, repeated dosing over a long period of time is necessary for effective treatment. The objectives of this study were to explore the possibilities of (a) enhancing the delivery of ciclopirox (CIC) across human nail plates and (b) sustaining CIC delivery from the larger resultant drug depot in the nail plates with constant voltage iontophoresis. In vitro passive and 9 V cathodal iontoph...

  7. Head Injury by Pneumatic Nail Gun: A Case Report.

    Science.gov (United States)

    Kim, Tae Woo; Shim, Yu Shik; Oh, Se Yang; Hyun, Dong Keun; Park, Hyeon Seon; Kim, Eun Young

    2014-10-01

    A 56-year-old man had five nail gun-shots on his skull due to attempted suicide and was transferred to the emergency room. Because the nail head played a role as a brake, the launched nail made a hole in the skull but did not entirely pass through it. If major artery or sinuses are not involved, cautious retrieval after a small scalp incision can be performed and prophylactic antibiotics be administered for treatment.

  8. Biomechanical rationale for implant choices in femoral neck fracture fixation in the non-elderly.

    Science.gov (United States)

    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. Intramedullary nailing in distal tibial fracture

    Directory of Open Access Journals (Sweden)

    Damian Arroquy

    2015-11-01

    Methods The inclusion criteria of this study were skeletally mature patients with displaced fractures of the distal tibia treated with intramedullary nail with a minimum follow up of one year. Gustilo III open fractures and type C fractures of the AO classification (complete articular Stroke were excluded. The sample comprised 35 patients remained. The follow-up was 29.2 months. We evaluated the time of consolidation, malunion and complications. The functional results were described according to the AOFAS score. Results Of the 35 patients with fracture of the distal third of the tibia all of them presented fracture healing. The average time to union was 17.2 weeks (range: 11-26. Of the total sample, 5 patients had delayed union, requiring dynamic nail on average at 12 weeks. The malunion was present in 4 (11.4% patients. We found no  difference (p = 0.201 in the time to union between fractures associated with fractures of the fibula treated (13sem or not (17sem. The AOFAS score was 86 points. Conclusion Intramedullary nailing with multiple distal locks like a good alternative treatment for distal tibia fractures AO type A or B, with low complication rate and a high rate of consolidation.

  10. Prophylactic intramedullary nailing in monostotic fibrous dysplasia.

    Science.gov (United States)

    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.

  11. Tibial lengthening over nails in children using modified Ender nails: preliminary results of a new treatment.

    Science.gov (United States)

    Saraph, Vinay; Roposch, Andreas; Zwick, Ernst-Bernhard; Linhart, Wolfgang E

    2004-11-01

    Tibial lengthening over nails, using modified Ender nails, was performed in nine children whose mean age at surgery was 12.8 years. The prerequisite for using this technique was the absence of axial malalignment and an indication for tibial lengthening only. Lengthening was not performed in one case due to the development of a compartment syndrome after the tibial osteotomy. Breakage of one interlocking screw without loss of alignment or length was observed in one case. Superficial pin tract infections were observed in two cases. An average of 4.1 cm (range 3-4.5 cm) lengthening of the tibia was achieved in eight of the nine cases. The modified Ender nails used permitted locking at both ends after achieving the desired distraction and permitted early removal of the external fixator. The advantage of this technique is that it permits early removal of the fixator and thus decreases the incidence of fixator related problems and facilitates early rehabilitation.

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

    Science.gov (United States)

    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. Yellow nail syndrome following thoracic surgery: A new association?

    Directory of Open Access Journals (Sweden)

    Banta D

    2009-01-01

    Full Text Available An 80-year-old man presented with the characteristic triad of yellow nail syndrome (chronic respiratory disorders, primary lymphedema and yellow nails in association with coronary artery bypass graft surgery. Treatment with mechanical pleurodesis and vitamin E resulted in near complete resolution of the yellow nails, pleural effusions, and lower extremity edema. The etiology of the yellow nail syndrome has been described as an anatomical or functional lymphatic abnormality. Several conditions have previously been described as associated with this disease. This is the first report of the association of this syndrome with thoracic surgery.

  14. Unusual nail pigmentation following cyclophosphamide-containing chemotherapy regimen

    Directory of Open Access Journals (Sweden)

    Kumar Santosh

    2010-01-01

    Full Text Available Cyclophosphamide therapy may rarely cause pigmentation of the nails which is of different patterns. We report a patient who developed pigmentation of nails after six cycles of cyclophosphamide, methotrexate, and 5-flourouracil chemotherapy, each repeated after 28 days for breast cancer. The patient developed nail pigmentation that started proximally and spread distally and involved all the nails of both hands and feet except the second and third toenails of right foot. Using Naranjo ADR Probability Scale, the case revealed a "probable" association with cyclophosphamide.

  15. Broken Ergodicity in Ideal, Homogeneous, Incompressible Turbulence

    Science.gov (United States)

    Morin, Lee; Shebalin, John; Fu, Terry; Nguyen, Phu; Shum, Victor

    2010-01-01

    We discuss the statistical mechanics of numerical models of ideal homogeneous, incompressible turbulence and their relevance for dissipative fluids and magnetofluids. These numerical models are based on Fourier series and the relevant statistical theory predicts that Fourier coefficients of fluid velocity and magnetic fields (if present) are zero-mean random variables. However, numerical simulations clearly show that certain coefficients have a non-zero mean value that can be very large compared to the associated standard deviation. We explain this phenomena in terms of broken ergodicity', which is defined to occur when dynamical behavior does not match ensemble predictions on very long time-scales. We review the theoretical basis of broken ergodicity, apply it to 2-D and 3-D fluid and magnetohydrodynamic simulations of homogeneous turbulence, and show new results from simulations using GPU (graphical processing unit) computers.

  16. Simple Technique for Removing Broken Pedicular Screws

    Directory of Open Access Journals (Sweden)

    A Agrawal

    2014-03-01

    Full Text Available The procedure for removing a broken pedicle screw should ideally be technically easy and minimally invasive, as any damage to the pedicle, during removal of the broken screw, may weaken the pedicle, thus compromising on the success of re-instrumentation. We describe the case of a 32-year old man who had undergone surgery for traumatic third lumbar vertebral body fracture three years prior to current admission and had developed the complication of pedicle screw breakage within the vertebral body. The patient underwent re-exploration and removal of the distal screws. Through a paravertebral incision and muscle separation, the screws and rods were exposed and the implants were removed.

  17. Nail bed expansion: A new technique for correction of multiple isolated congenital micronychia

    Directory of Open Access Journals (Sweden)

    Gholamhossein Ghaffarpour

    2014-01-01

    Full Text Available Congenital micronychia may involve big toes or may involve other nails. The etiology of micronychia is not clear but amniotic bands, teratogens (drugs, alcohol, Nail Patella Syndrome etc. A 44-year-old woman with multiple isolated congenital micronychia over her hands and feet was selected. The major affected nails were thumbs and Index fingers. Surgical method were done step by step: Anesthesia of the area, extraction of short nail, elevation of nail bed, longitudinal nail bed incisions, suturing the lateral nail bed to the nail wall, covering the nail bed by a splint of plastic suction tube, bandage with gauze Vaseline. Finally, we hypnotized that in congenital micronychia, the main pathology is in nail bed; through this theory by nail bed expansion better outcomes are coming.

  18. MANAGEMENT OF PERIPROSTHETIC DISTAL FEMORAL FRACTURE AFTER TOTAL KNEE ARTHROPLASTY USING MINIMALLY INVASIVE PLATE OSTEOSYNTHESIS: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Reddy

    2015-07-01

    Full Text Available CONTEXT: The approximate incidence of periprosthetic supracondylar femur fractures after total knee arthroplasty ranges from 0.3 to 2.5 percent. Various methods of treatment of these fractures have been suggested in the past, such as conservative management, open reduction and plate fixation and intramedullary nailing. However, there were complications like pain, stiffness, infection and delayed union. Minimally invasive plate osteosynthesis (MIPO is a relatively newer technique in the treatment of distal femoral fractures, as it preserves the periosteal blood supply an d bone perfusion as well as minimizes soft tissue dissection. AIM: To evaluate the effectiveness of MIPO technique in the treatment of periprosthetic distal femoral fracture. SETTINGS AND DESIGN : In this study, we present a case report of a 54 year old female patient who sustained type 2 (Rorabeck et al. classification periprosthetic distal femoral fractures after TKA. Her fracture fixation was done with distal femoral locking plates using minimally invasive technique. METHODS AND MATERIAL : We evaluated the clinical (using Oxford knee scoring system and radiological outcomes of the patient till six months post - operatively. Radiologically, the fracture showed complete union and she regained her full range of knee motion by the end of three months. CONCLUSION: We conclude that MIPO can be considered as an effective surgical treatment option in the management of periprosthetic distal femoral fractures after TKA

  19. A new, lateral, continuous, combined, femoral–sciatic nerve approach via a single skin puncture for postoperative analgesia in intramedullary tibial nail insertion

    Directory of Open Access Journals (Sweden)

    Imbelloni LE

    2013-02-01

    Full Text Available Luiz Eduardo Imbelloni,1,2 Carlos Rava,1,3 Marildo A Gouveia21Faculdade de Medicina Nova Esperança, 2Institute for Regional Anesthesia, 3Complexo Hospitalar de Mangabeira Governador Tarcisio Burity, João Pessoa, BrazilBackground: The prevalence of anterior knee pain following intramedullary tibial nail insertion is high. Continuous peripheral nerve blockade is an alternative method of pain control to opiods. This case illustrates the use of femoral nerve and sciatic nerve peripheral catheters with an elastomeric infusion pump for major intramedullary nailing surgery.Case report: A 36-year-old male with fractures to the left leg bones presented for placement of an intramedullary nail under spinal anesthesia. At the end of the procedure, access to the lateral femoral and sciatic continuous nerve block was achieved by using a stimulator connected to a 110 mm 18G Tuohy needle. Postoperative analgesia was provided with a 40-hour infusion of 0.1% bupivacaine (400 mL at a rate of 10 mL hour-1 with an elastomeric pump. Anesthetic dispersion and contrast were investigated. The analog scale remained with scores below 3 during the 40 hours after surgery, and boluses were not necessary.Conclusion: The use of a femoral and sciatic nerve peripheral catheter offered an alternative to conventional pain control. Continuous femoral–sciatic peripheral blockade via a skin puncture with an infusion of 0.1% bupivacaine with elastomeric pumps is a safe and effective procedure in adults.Keywords: local anesthetic, bupivacaine, continuous peripheral nerve block, orthopedic surgery, tibia, elastomeric pump

  20. Reference values for the nickel concentration in human finger nails

    DEFF Research Database (Denmark)

    Gammelgaard, Bente; Peters, K; Menné, T

    1991-01-01

    A reference value for the nickel concentration in finger nails from people who are not occupationally exposed to nickel was determined on the basis of nail samples from 95 healthy individuals. The mean +/- standard deviation was 1.19 +/- 1.61 mg/kg and the median was 0.49 mg/kg (range 0.042-7.50 mg...

  1. Iontophoretically enhanced ciclopirox delivery into and across human nail plate.

    Science.gov (United States)

    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.

  2. NAIL KERATIN AS MONITOR-TISSUE FOR SELENIUM EXPOSURE

    NARCIS (Netherlands)

    VANNOORD, PAH; MAAS, MJ; DEBRUIN, M

    1992-01-01

    Nail clippings might provide a way to monitor exposure to selenium in the recent past of an individual, since a clipping collected from a toe would reflect exposures months before actual clipping date. The relation between levels of exogenous selenium exposure and selenium levels in nail keratin was

  3. An unusual foreign body in urethra: nail clippers.

    Science.gov (United States)

    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.

  4. An unusual foreign body in urethra: nail clippers

    OpenAIRE

    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.

  5. Strength Assessment of Broken Rock Postgrouting Reinforcement Based on Initial Broken Rock Quality and Grouting Quality

    Directory of Open Access Journals (Sweden)

    Hongfa Xu

    2017-01-01

    Full Text Available To estimate postgrouting rock mass strength growth is important for engineering design. In this paper, using self-developed indoor pressure-grouting devices, 19 groups of test cubic blocks were made of the different water cement ratio grouting into the broken rock of three kinds of particle sizes. The shear strength parameters of each group under different conditions were tested. Then this paper presents a quantitative calculation method for predicting the strength growth of grouted broken rock. Relational equations were developed to investigate the relationship between the growth rates of uniaxial compressive strength (UCS, absolute value of uniaxial tensile strength (AUTS, internal friction angle, and cohesion for post- to pregrouting broken rock based on Mohr-Coulomb strength criterion. From previous test data, the empirical equation between the growth rate of UCS and the ratio of the initial rock mass UCS to the grout concretion UCS has been determined. The equations of the growth rates of the internal friction coefficient and UCS for grouting broken rock with rock mass rating (RMR and its increment have been established. The calculated results are consistent with the experimental results. These observations are important for engineered design of grouting reinforcement for broken rock mass.

  6. Safe surgical technique: intramedullary nail fixation of tibial shaft fractures.

    Science.gov (United States)

    Zelle, Boris A; Boni, Guilherme

    2015-01-01

    Statically locked, reamed intramedullary nailing remains the standard treatment for displaced tibial shaft fractures. Establishing an appropriate starting point is a crucial part of the surgical procedure. Recently, suprapatellar nailing in the semi-extended position has been suggested as a safe and effective surgical technique. Numerous reduction techiques are available to achieve an anatomic fracture alignment and the treating surgeon should be familiar with these maneuvers. Open reduction techniques should be considered if anatomic fracture alignment cannot be achieved by closed means. Favorable union rates above 90 % can be achieved by both reamed and unreamed intramedullary nailing. Despite favorable union rates, patients continue to have functional long-term impairments. In particular, anterior knee pain remains a common complaint following intramedullary tibial nailing. Malrotation remains a commonly reported complication after tibial nailing. The effect of postoperative tibial malalignment on the clinical and radiographic outcome requires further investigation.

  7. Recurrent femoral hernia and associated ovarian pathology.

    Science.gov (United States)

    Gately, Ryan Patrick; Concannon, Elizabeth Sarah; Hogan, A; Ryan, R S; O'Leary, M; Barry, K

    2012-08-27

    The following case describes an ovarian tumour presenting in a highly unusual manner-in the form of a recurrent femoral hernia. Recurrent femoral herniae are unusual and should prompt awareness of underlying pathology causing increased intra-abdominal pressure.

  8. Onychophagia (Nail biting), anxiety, and malocclusion.

    Science.gov (United States)

    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. Femoral hernia; Clinical significance of radiologic diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Bergenfeldt, M.; Lasson, A. (Lund University (Sweden). Department of Surgery Malmo General Hospital (Sweden)); Ekberg, O.; Kesek, P. (Lund University (Sweden). Department of Radiology Malmo General Hospital (Sweden))

    A retrospective study of 18 patients with femoral hernia assessed by herniography is presented. Although a palpable lump was present in 11 patients (61%), the diagnosis of a femoral hernia was not made before herniography. Surgical exploration was performed in 12 patients and a femoral hernia was found and repaired with beneficial outcome in 9 of them. In conclusion: herniography is of value for the diagnosis of a femoral hernia in patients with obscure groin pain. (author). 14 refs.; 2 figs.

  10. Broken Lifshitz invariance, spin waves and hydrodynamics

    CERN Document Server

    Roychowdhury, Dibakar

    2016-01-01

    In this paper, based on the basic principles of thermodynamics, we explore the hydrodynamic regime of interacting Lifshitz field theories in the presence of broken rotational invariance. We compute the entropy current and discover new dissipative effects those are consistent with the principle of local entropy production in the fluid. In our analysis, we consider both the parity even as well as the parity odd sector upto first order in the derivative expansion. Finally, we argue that the present construction of the paper could be systematically identified as that of the hydrodynamic description associated with \\textit{spin waves} (away from the domain of quantum criticality) under certain limiting conditions.

  11. Spontaneously broken Lorentz symmetry and gravity

    CERN Document Server

    Jacobson, T; Jacobson, Ted; Mattingly, David

    2000-01-01

    We study a generally covariant model in which local Lorentz invariance is broken "spontaneously" by a dynamical unit timelike vector field $u^a$---the "aether". Such a model makes it possible to study the gravitational and cosmological consequences of preferred frame effects, such as ``variable speed of light" or high frequency dispersion, while preserving a generally covariant metric theory of gravity. In this paper we restrict attention to an action for an effective theory of the aether which involves only the antisymmetrized derivative $\

  12. Broken safety pin in bronchus - Anaesthetic considerations

    Directory of Open Access Journals (Sweden)

    Roona Shad

    2012-01-01

    Full Text Available Safety pins are not commonly aspirated objects in infants and form only a small fraction of all the metallic foreign body (FB which accounts for 4.4% of all foreign bodies found in tracheobronchial tree. Bronchoscopy procedure has various complications, in addition to failure to remove FB due to its impaction, especially with metallic pointed objects ending up in open surgical removal. Infant with inhaled foreign body are always a challenge to anaesthetist. We had one such case of broken safety pin impacted in the wall of right bronchus of an infant with failure to remove on repeated attempts at rigid bronchoscopy.

  13. Broken safety pin in bronchus - Anaesthetic considerations.

    Science.gov (United States)

    Shad, Roona; Agarwal, Aditya

    2012-11-01

    Safety pins are not commonly aspirated objects in infants and form only a small fraction of all the metallic foreign body (FB) which accounts for 4.4% of all foreign bodies found in tracheobronchial tree. Bronchoscopy procedure has various complications, in addition to failure to remove FB due to its impaction, especially with metallic pointed objects ending up in open surgical removal. Infant with inhaled foreign body are always a challenge to anaesthetist. We had one such case of broken safety pin impacted in the wall of right bronchus of an infant with failure to remove on repeated attempts at rigid bronchoscopy.

  14. Rotating optical microcavities with broken chiral symmetry

    CERN Document Server

    Sarma, Raktim; Wiersig, Jan; Cao, Hui

    2014-01-01

    We demonstrate in open microcavities with broken chiral symmetry, quasi-degenerate pairs of co-propagating modes in a non-rotating cavity evolve to counter-propagating modes with rotation. The emission patterns change dramatically by rotation, due to distinct output directions of CW and CCW waves. By tuning the degree of spatial chirality, we maximize the sensitivity of microcavity emission to rotation. The rotation-induced change of emission is orders of magnitude larger than the Sagnac effect, pointing to a promising direction for ultrasmall optical gyroscopes.

  15. Comments on Holography with Broken Lorentz Invariance

    CERN Document Server

    Gordeli, Ivan

    2009-01-01

    Recently a family of solutions of the Einstein equations in backgrounds with broken Lorentz invariance was found ArXiv:0712.1136. We show that the gravitational solution recently obtained by Kachru, Liu and Mulligan in ArXiv:0808.1725 is a part of the former solution which was derived earlier in the framework of extra dimensional theories. We show how the energy-momentum and Einstein tensors are related and establish a correspondence between parameters which govern Lorentz invariance violation. At the end we speculate on relations between the RG flow of a boundary theory and asymptotic behavior of gravitational solutions in the bulk.

  16. Neutrino masses and spontaneously broken flavor symmetries

    Energy Technology Data Exchange (ETDEWEB)

    Staudt, Christian

    2014-06-16

    We study the phenomenology of supersymmetric flavor models. We show how the predictions of models based on spontaneously broken non-Abelian discrete flavor symmetries are altered when we include so-called Kaehler corrections. Furthermore, we discuss anomaly-free discrete R symmetries which are compatible with SU(5) unification. We find a set of symmetries compatible with suppressed Dirac neutrino masses and a unique symmetry consistent with the Weinberg operator. We also study a pseudo-anomalous U(1){sub R} symmetry which explains the fermion mass hierarchies and, when amended with additional singlet fields, ameliorates the fine-tuning problem.

  17. Spontaneous Hemarthrosis of the Knee - Late Complication of Flexible Femur Nailing: A Case Report

    Science.gov (United States)

    Kushare, Indranil V; Oetgen, Matthew E; Walters, Suzanne J

    2016-01-01

    We present a case report of acute spontaneous knee hemarthosis due to erosion of the nail through the knee joint capsule in a boy, seven months following retrograde flexible nailing for fractured femur. Careful positioning of the location of the insertion site of flexible nails and proper nail tip management are important to avoid this rare late complication. PMID:28180118

  18. Spontaneous Hemarthrosis of the Knee - Late Complication of Flexible Femur Nailing: A Case Report

    OpenAIRE

    Kushare; Oetgen; Walters

    2016-01-01

    We present a case report of acute spontaneous knee hemarthosis due to erosion of the nail through the knee joint capsule in a boy, seven months following retrograde flexible nailing for fractured femur. Careful positioning of the location of the insertion site of flexible nails and proper nail tip management are important to avoid this rare late complication.

  19. Spontaneous Hemarthrosis of the Knee - Late Complication of Flexible Femur Nailing: A Case Report.

    Science.gov (United States)

    Kushare, Indranil V; Oetgen, Matthew E; Walters, Suzanne J

    2016-09-01

    We present a case report of acute spontaneous knee hemarthosis due to erosion of the nail through the knee joint capsule in a boy, seven months following retrograde flexible nailing for fractured femur. Careful positioning of the location of the insertion site of flexible nails and proper nail tip management are important to avoid this rare late complication.

  20. Spontaneous Hemarthrosis of the Knee - Late Complication of Flexible Femur Nailing: A Case Report

    Directory of Open Access Journals (Sweden)

    Kushare

    2016-03-01

    Full Text Available We present a case report of acute spontaneous knee hemarthosis due to erosion of the nail through the knee joint capsule in a boy, seven months following retrograde flexible nailing for fractured femur. Careful positioning of the location of the insertion site of flexible nails and proper nail tip management are important to avoid this rare late complication.

  1. Femoral Reconstruction Using External Fixation

    Directory of Open Access Journals (Sweden)

    Yevgeniy Palatnik

    2011-01-01

    Full Text Available Background. The use of an external fixator for the purpose of distraction osteogenesis has been applied to a wide range of orthopedic problems caused by such diverse etiologies as congenital disease, metabolic conditions, infections, traumatic injuries, and congenital short stature. The purpose of this study was to analyze our experience of utilizing this method in patients undergoing a variety of orthopedic procedures of the femur. Methods. We retrospectively reviewed our experience of using external fixation for femoral reconstruction. Three subgroups were defined based on the primary reconstruction goal lengthening, deformity correction, and repair of nonunion/bone defect. Factors such as leg length discrepancy (LLD, limb alignment, and external fixation time and complications were evaluated for the entire group and the 3 subgroups. Results. There was substantial improvement in the overall LLD, femoral length discrepancy, and limb alignment as measured by mechanical axis deviation (MAD and lateral distal femoral angle (LDFA for the entire group as well as the subgroups. Conclusions. The Ilizarov external fixator allows for decreased surgical exposure and preservation of blood supply to bone, avoidance of bone grafting and internal fixation, and simultaneous lengthening and deformity correction, making it a very useful technique for femoral reconstruction.

  2. Absorption of solar radiation in broken clouds

    Energy Technology Data Exchange (ETDEWEB)

    Zuev, V.E.; Titov, G.A.; Zhuravleva, T.B. [Institute of Atmospheric Optics, Tomsk (Russian Federation)

    1996-04-01

    It is recognized now that the plane-parallel model unsatisfactorily describes the transfer of radiation through broken clouds and that, consequently, the radiation codes of general circulation models (GCMs) must be refined. However, before any refinement in a GCM code is made, it is necessary to investigate the dependence of radiative characteristics on the effects caused by the random geometry of cloud fields. Such studies for mean fluxes of downwelling and upwelling solar radiation in the visible and near-infrared (IR) spectral range were performed by Zuev et al. In this work, we investigate the mean spectral and integrated absorption of solar radiation by broken clouds (in what follows, the term {open_quotes}mean{close_quotes} will be implied but not used, for convenience). To evaluate the potential effect of stochastic geometry, we will compare the absorption by cumulus (0.5 {le} {gamma} {le} 2) to that by equivalent stratus ({gamma} <<1) clouds; here {gamma} = H/D, H is the cloud layer thickness and D the characteristic horizontal cloud size. The equivalent stratus clouds differ from cumulus only in the aspect ratio {gamma}, all the other parameters coinciding.

  3. Assessment of the geometry of proximal femur for short cephalomedullary nail placement: An observational study in dry femora and living subjects

    Science.gov (United States)

    Pathrot, Devendra; Ul Haq, Rehan; Aggarwal, Aditya N; Nagar, Mahindra; Bhatt, Shuchi

    2016-01-01

    Background: Intramedullary devices have increasingly become popular and are widely used for fixation of unstable intertrochanteric and subtrochanteric fractures. These implants have been designed taking into consideration of the anthropometry of the western population which varies from those of other ethnic groups. This study was carried out to assess the geometry of proximal femur for the placement of short cephalomedullary nails in our subset of patients and suggest suitable design modifications based on these parameters. Materials and Methods: The study was conducted in the following three groups: (1) Anthropometric study of 101 adult human dry femora, (2) radiographs of the same femora, and (3) radiographs of the contralateral uninjured limb of 102 patients with intertrochanteric or subtrochanteric fractures. In Group 1, standard anthropometric techniques were used to measure neck shaft angle (NSA), minimal neck width (NW), trochanteric offset, and distance from the tip of greater trochanter (GT) to the lower border of lesser trochanter on the femoral shaft axis (distance X). In Group 2 and 3, the NSA, minimal NW, NW at 130° and 135°, trochanteric shaft angle (TSA), trochanteric offset, distance X, distance between the tip of GT and the point where the neck axis crosses the line joining the tip of the GT to the lower border of the lesser trochanter on the femoral shaft axis (distance Y), and canal width at 10, 15, and 20 cm from tip of GT were measured on standard radiographs. The values obtained in these three groups were pooled to obtain mean values. Various parameters of commonly used short cephalomedullary nails available for fixation of pertrochanteric fractures were obtained. These were compared to the results obtained to suggest suitable modifications in the nail designs for our subset of patients. Results: The mean parameters observed were as follows: NSA 128.07° ± 4.97 (range 107°–141°), minimum NW 29.0 ± 2.8 mm (range 22–42 mm), NW at 130

  4. Assessment of the geometry of proximal femur for short cephalomedullary nail placement: An observational study in dry femora and living subjects

    Directory of Open Access Journals (Sweden)

    Devendra Pathrot

    2016-01-01

    Full Text Available Background: Intramedullary devices have increasingly become popular and are widely used for fixation of unstable intertrochanteric and subtrochanteric fractures as well. These implants have been designed taking into consideration the anthropometry of the western population whose anthropometry varies from those of other ethnic groups. This study was carried out to assess the geometry of proximal femur for the placement of short cephalomedullary nails in our subset of patients and suggest suitable design modifications based on these parameters. Materials and Methods: The study was conducted in the following three groups: (1 Anthropometric study of 101 adult human dry femora, (2 radiographs of the same femora, and (3 radiographs of the contralateral uninjured limb of 102 patients with intertrochanteric or subtrochanteric fractures. In Group 1, standard anthropometric techniques were used to measure neck shaft angle (NSA, minimal neck width (NW, trochanteric offset, and distance from the tip of greater trochanter (GT to the lower border of lesser trochanter on the femoral shaft axis (distance X. In Group 2 and 3, the NSA, minimal NW, NW at 130° and 135°, trochanteric shaft angle (TSA, trochanteric offset, distance X, distance between the tip of GT and the point where the neck axis crosses the line joining the tip of the GT to the lower border of the lesser trochanter on the femoral shaft axis (distance Y, and canal width at 10, 15, and 20 cm from tip of GT were measured on standard radiographs. The values obtained in these three groups were pooled to obtain mean values. Various parameters of commonly used short cephalomedullary nails available for fixation of pertrochanteric fractures were obtained. These were compared to the results obtained to suggest suitable modifications in the nail designs for our subset of patients. Results: The mean parameters observed were as follows: NSA 128.07° ± 4.97 (range 107°–141°, minimum NW 29.0 ± 2.8 mm

  5. Enhancing the nail permeability of topically applied drugs.

    Science.gov (United States)

    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.

  6. HEMATOMA OF THE PROXIMAL NAIL FOLD. REPORT OF 41 CASES

    Directory of Open Access Journals (Sweden)

    Chang Patricia

    2011-04-01

    Full Text Available Background: The proximal fold is an important part of the nail apparatus it contributes to the formation of the nail plate and through the cuticle acts as an impermeable barrier protecting it from any cause.Objective: To know the proximal nail fold hematoma caused by the use of pulse oximeter.Material and Methods: A descriptive study was conducted in 41 patients with proximal nail hematoma secondary to the use of oximetry in patients hospitalized in the Intermediate and Intensive Care Unit at the Hospital General de Enfermedades from December 1, 2007 to December 31, 2010.Results: We studied 41 patients with proximal nail fold hematoma secondary to the use of oximeter, 30 (73.1% were males and 11 (26.8% females. The numbers of fingers affected by pulse oximeter were in one digit. 30 (73.1% cases, in two digits 6 (14.6%, in three digits 3 (7.3%, in 4 digits 1 (2.4% and in 5 digits 1 (2.4% case. The most affected proximal nail fold was right index: 24 (58.5%, right middle 11 (26.8%, right ring 6 (14.6%, left index 12 (29.2%, and left middle 6 (14.6% cases.Conclusions: Hematomas of the proximal nail fold may be caused by different traumatisms. The use of pulse oximeter is one of them.

  7. Development of a fixation device for robot assisted fracture reduction of femoral shaft fractures: a biomechanical study.

    Science.gov (United States)

    Weber-Spickschen, T S; Oszwald, M; Westphal, R; Krettek, C; Wahl, F; Gosling, T

    2010-01-01

    Robot assisted fracture reduction of femoral shaft fractures provides precise alignment while reducing the amount of intraoperative imaging. The connection between the robot and the fracture fragment should allow conventional intramedullary nailing, be minimally invasive and provide interim fracture stability. In our study we tested three different reduction tools: a conventional External Fixator, a Reposition-Plate and a Three-Point-Device with two variations (a 40 degrees and a 90 degrees version). We measured relative movements between the tools and the bone fragments in all translation and rotation planes. The Three-Point-Device 90 degrees showed the smallest average relative displacement and was the only device able to withstand the maximum applied load of 70 Nm without failure of any bone fragment. The Three-Point-Device 90 degrees complies with all the stipulated requirements and is a suitable interface for robot assisted fracture reduction of femoral shaft fractures.

  8. Nail lichen planus in a patient with alopecia totalis.

    Science.gov (United States)

    Ginsberg, Brian A; Yost, John Montgomery; Lewin, Jesse; Hale, Christopher S; Meehan, Shane A; Carucci, John A; Ramachandran, Sarika

    2014-12-16

    A 67-year-old man with a three-year history of non-scarring alopecia that progressed to alopecia totalis despite intralesional glucocorticoid injections is presented. He developed 20-nail dystrophy that was recalcitrant to antifungal and anti-inflammatory treatments. Biopsy of the nail matrix showed histopathologic features of lichen planus. Alopecia totalis and isolated lichen planus of the nails are uncommon subtypes of common dermatologic disorders. Rarely reported concurrently, we provide a review of the literature of their association, which is most likely attributed to their autoimmune pathogeneses.

  9. The pattern of femoral diaphyseal fractures in children admitted in Sarawak General Hospital.

    Science.gov (United States)

    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.

  10. Foreign body reaction after PLC reconstruction caused by a broken PLLA screw.

    Science.gov (United States)

    Kim, Tae-Kwon; Jeong, Tae-Wan; Lee, Dae-Hee

    2014-12-01

    Foreign body reactions may occur in patients who receive bioabsorbable implants during orthopedic surgery for fractures and ligament repair. The authors describe a 34-year-old man who presented with a palpable tender mass on the lateral aspect of the left knee of 1 month's duration. He underwent posterior cruciate ligament and posterolateral corner reconstruction 3 years earlier. Physical examination showed a 1×1-cm soft, nontender mass without localized warmth on the lateral epicondyle of the distal femur. Magnetic resonance imaging showed a broken screw fragment surrounded by a cyst-like mass. Under general anesthesia, the surgeon excised the screw fragment and the fibrotic mass, enclosing it in the subcutaneous tissue at the lateral epicondyle, the site at which a poly-L-lactic acid bioabsorbable screw had been inserted to fix the graft for posterolateral corner reconstruction. Histologic evaluation showed a foreign body reaction to the degraded screw particles. To the authors' knowledge, this report is the first description of a patient presenting with a delayed foreign body reaction to a broken poly-L-lactic acid bioabsorbable screw at the lateral femoral epicondyle after posterolateral corner reconstruction. Because delayed foreign body reactions can occur at any site of poly-L-lactic acid bioabsorbable screw insertion, care should be taken to avoid screw protrusion during ligament reconstruction because it can lead to screw breakage and delayed foreign body reaction.

  11. Humeral shaft fractures treated by dynamic compression plates, Ender nails and interlocking nails.

    Science.gov (United States)

    Chao, Ting-Cheng; Chou, Wen-Ying; Chung, Jui-Chang; Hsu, Chien-Jen

    2005-04-01

    Between January 1991 and December 2002, we treated 92 acute, displaced, closed humeral shaft fractures (AO classification type A). We used three fixation methods: dynamic compression plates (DCP) in 36 patients, Ender nails (EN) in 32 patients and interlocking nails (ILN) in 24 patients. The patients were followed for a minimum of 24 months. At one year, all fractures except two (one DCP/one ILN) had united. Patients treated with EN had shorter mean operation time, 51 (35-110) min; less mean blood loss, 70 (30-170) ml and shorter mean hospital stay, 5.8 (3-12) days. There were three iatrogenic radial nerve palsies: two in the DCP group and one in the ILN group. There was one wound infection. There were three cases with impingement of the shoulder but range of motion was restored after nail removal. For patients with multiple trauma or high operative risk, EN fixation served as a safer and faster procedure. ILN fixation offered a stable fixation via a smaller incision but more fracture comminution might happen.

  12. Elastic stable intramedullary nailing in paediatric traumatology at Yopougon Teaching Hospital (Abidjan

    Directory of Open Access Journals (Sweden)

    T H Odéhouri-Koudou

    2011-01-01

    Full Text Available Context : Elastic stable intramedullary nailing has revolutionised the treatment of fractures in children. Aim : To report our experience with this current technique of management of fractures in children. Methods and Materials : A retrospective study of all children with fractures treated by this method from November 2003 to June 2006 at the Paediatric Surgery Department of Yopougon Teaching Hospital, Abidjan, Côte d′Ivoire. Data were recorded from their medical charts regarding demographics, fracture patterns, associated injuries, morbidity, and outcome. Results : A total of 38 children (14 boys; mean age, 11.7 years; range, 9-15 years with 41 fractures, sited at femur (n=15, humerus (n=8, tibia and fibula (n=6, forearm (n=7, and radial neck (n=5, associated with other injuries in 7 cases, were enrolled in the study. The mean interval for surgery was 6.8 days. Open reduction was required 5 times (12.1%. The hospital stay was in the range 5-12 days. Minor adverse events were 1 (2.4% early tibial loss of reduction, 3 (7.3% skin irritations and 2 (4.8% transient knee limitations. Complications (17.3% included 2 axial (4.8% and 1 rotational (2.4% femoral malunions below 15°; 3 elbow (7.3% and 1 knee stiffness (2.4% in openly reduced cases. Solid consolidation was achieved in all cases, with no disturbance in standard union times. At a mean follow-up period of 16 months (range, 9-28 months, all but 3 patients with opened joints recovered full range of motion, and none showed either limp and gait anomalies or re-fracture after removal of wires. Conclusion : Elastic stable intramedullary nailing in children fractures is easy to perform and has little complications if a proper technique is used.

  13. Restoring broken entanglement by injecting separable correlations

    CERN Document Server

    Pirandola, Stefano

    2012-01-01

    The distribution of entanglement is central in many protocols of quantum information and computation. However it is also known to be a very fragile process when loss and noise come into play. The inevitable interaction of the quantum systems with the external environment induces effects of decoherence which may be so strong to destroy any input entanglement, a phenomenon known as "entanglement breaking". Here we study this catastrophic process in a correlated-noise environment showing how the presence of classical-type correlations can restore the distribution of entanglement. In particular, we consider a Gaussian environment whose thermal noise is strong enough to break the entanglement of two bosonic modes of the electromagnetic field. In this scenario, we show that the injection of separable correlations from the same environment is able to reactivate the broken entanglement. This paradoxical effect happens both in schemes of direct distribution, where a third party (Charlie) broadcasts entangled states to...

  14. Effective Action of Softly Broken Supersymmetric Theories

    CERN Document Server

    Nibbelink, S G; Nibbelink, Stefan Groot; Nyawelo, Tino S.

    2007-01-01

    We study the renormalization of (softly) broken supersymmetric theories at the one loop level in detail. We perform this analysis in a superspace approach in which the supersymmetry breaking interactions are parameterized using spurion insertions. We comment on the uniqueness of this parameterization. We compute the one loop renormalization of such theories by calculating superspace vacuum graphs with multiple spurion insertions. To preform this computation efficiently we develop algebraic properties of spurion operators, that naturally arise because the spurions are often surrounded by superspace projection operators. Our results are general apart from the restrictions that higher super covariant derivative terms and some finite effects due to non-commutativity of superfield dependent mass matrices are ignored. One of the soft potentials induces renormalization of the Kaehler potential.

  15. Nonreciprocal Multiferroic Superlattices with Broken Parity Symmetry

    Science.gov (United States)

    Tang, Zhenghua; Zhang, Weiyi

    Multiferroic materials are characterized by the coexistence of ferroelectric and ferromagnetic (or antiferromagnetic) orders, the coupling to lattice vibration can be invoked either through piezoelectric or piezomagnetic effects. In this paper, the polaritonic band structures of multiferroic superlattices composed of oppositely polarized domains are investigated using the generalized transfer matrix method. For the primitive cell with broken parity symmetry, the polaritonic band structure is asymmetrical with respect to the forward and backward propagation directions (nonreciprocality). In particular, the band extreme points move away from the Brillouin zone center. This asymmetry in band-gap positions and widths can be used to design compact one-way optical isolators, while the extremely slow light velocities near the asymmetrical upper edges of lower bands includes the essential ingredients for designing slow light devices.

  16. Effects of broken affordance on visual extinction.

    Science.gov (United States)

    Wulff, Melanie; Humphreys, Glyn W

    2015-01-01

    Previous studies have shown that visual extinction can be reduced if two objects are positioned to "afford" an action. Here we tested if this affordance effect was disrupted by "breaking" the affordance, i.e., if one of the objects actively used in the action had a broken handle. We assessed the effects of broken affordance on recovery from extinction in eight patients with right hemisphere lesions and left-sided extinction. Patients viewed object pairs that were or were not commonly used together and that were positioned for left- or right-hand actions. In the unrelated pair conditions, either two tools or two objects were presented. In line with previous research (e.g., Riddoch et al., 2006), extinction was reduced when action-related object pairs and when unrelated tool pairs were presented compared to unrelated object pairs. There was no significant difference in recovery rate between action-related (object-tool) and unrelated tool pairs. In addition, performance with action-related objects decreased when the tool appeared on the ipsilesional side compared to when it was on the contralesional side, but only when the tool handle was intact. There were minimal effects of breaking the handle of an object rather than a tool, and there was no effect of breaking the handle on either tools or objects on single item trials. The data suggest that breaking the handle of a tool lessens the degree to which it captures attention, with this attentional capture being strongest when the tool appears on the ipsilesional side. The capture of attention by the ipsilesional item then reduces the chance of detecting the contralesional stimulus. This attentional capture effect is mediated by the affordance to the intact tool.

  17. Effects of broken affordance on visual extinction

    Directory of Open Access Journals (Sweden)

    Melanie eWulff

    2015-09-01

    Full Text Available Previous studies have shown that visual extinction can be reduced if two objects are positioned to afford an action. Here we tested if this affordance effect was disrupted by breaking the affordance – if one of the objects actively used in the action had a broken handle. We assessed the effects of broken affordance on recovery from extinction in eight patients with right hemisphere lesions and left-sided extinction. Patients viewed object pairs that were or were not commonly used together and that were positioned for left- or right-hand actions. In the unrelated pair conditions, either two tools or two objects were presented. In line with previous research (e.g., Riddoch et al., 2006, extinction was reduced when action-related object pairs and when unrelated tool pairs were presented compared to unrelated object pairs. There was no significant difference in recovery rate between action-related (object-tool and unrelated tool-tool pairs. In addition, performance with action-related objects decreased when the tool appeared on the ipsilesional side compared to when it was on the contralesional side, but only when the tool handle was intact. There were minimal effects of breaking the handle of an object rather than a tool, and there was no effect of breaking the handle on either tools or objects on single item trials. The data suggest that breaking the handle of a tool lessens the degree to which it captures attention, with this attentional capture being strongest when the tool appears on the ipsilesional side. The capture of attention by the ipsilesional item then reduces the chance of detecting the contralesional stimulus. This attentional capture effect is mediated by the affordance to the intact tool.

  18. Modified broken rice starch as fat substitute in sausages

    Directory of Open Access Journals (Sweden)

    Valéria Maria Limberger

    2011-09-01

    Full Text Available The demand for low-fat beef products has led the food industry to use fat substitutes such as modified starch. About 14% of broken rice is generated during processing. Nevertheless, this by-product contains high levels of starch; being therefore, great raw material for fat substitution. This study evaluated the applicability of chemically and physically modified broken rice starch as fat substitute in sausages. Extruded and phosphorylated broken rice was used in low-fat sausage formulation. All low-fat sausages presented about 55% reduction in the fat content and around 28% reduction in the total caloric value. Fat replacement with phosphorylated and extruded broken rice starch increased the texture acceptability of low-fat sausages, when compared to low-fat sausages with no modified broken rice. Results suggest that modified broken rice can be used as fat substitute in sausage formulations, yielding lower caloric value products with acceptable sensory characteristics.

  19. 不同内固定器固定股骨髁上骨折的生物力学比较%Biomechanical study of different internal fixations in the treatment of supracondylar femoral fractures

    Institute of Scientific and Technical Information of China (English)

    杨青; 郭卫春; 刘洋; 谭俊峰; 张觅; 李明辉; 张红旗

    2015-01-01

      结果与结论:在实验载荷条件下,逆行交锁髓内钉组和LISS钢板组骨折断端和钉道周围应力均随着轴向载荷和扭转载荷的增大而增大。在同一轴向载荷下,逆行交锁髓内钉组较LISS钢板组在6个测试应变点应变值大(P OBJECTIVE:To compare the biomechanical properties of two fixations in the treatment of supracondylar femoral fractures, explore the stress distribution differences of two fixations for supracondylar femoral fractures, and provide clinical basis for the selection of ideal fixation. METHODS:Twelve sets of adult cadaveric femoral bone were selected, and the supracondylar femoral bone was sawn with an electric saw to establish supracondylar femoral fracture models. After anatomic reduction, the fracture samples were fixed with less invasive stabilization system (LISS) plates and retrograde interlocking intramedul ary nails, respectively. Six strain gages were mounted near the fracture plane and pin track, then the fracture models were placed in the Zwick Z100 electronic universal material test machine and torisional testing machine (RNJ-500), receiving a linear load of 0-400 N and a torisional load of 0-20 N·m. Local stresses were detected, and their distributions under the same load in the two fixations were also measured. RESULTS AND CONCLUSION:In the experimental loading condition, the stress at the fracture end and around the pin track increased with the increase of the load both in the LISS plate groups and retrograde interlocking intramedul ary nail groups. In the same linear loading, the strain value at six testing points in the retrograde interlocking intramedul ary nail groups was higher than that in the LISS plate groups (P<0.01);in the same torsional loading, the LISS plate groups showed high strain value than the retrograde interlocking intramedul ary nail groups in the six test points (P<0.01). Retrograde interlocking intramedul ary nails can obviously reduce stress

  20. Fracture Union in Closed Interlocking Nail in Humeral Shaft Fractures

    Directory of Open Access Journals (Sweden)

    Ramji Lal Sahu

    2015-01-01

    Conclusions: The results of the present study indicates that in the presence of proper indications, reamed antegrade intramedullary interlocked nailing appears to be a method of choice for internal fixation of osteoporotic and pathologic fractures.

  1. Coexistence of nail lichen planus and lichen planus pigmentosus*

    Science.gov (United States)

    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.

  2. Intravital microscopy and capillaroscopically guided nail fold biopsy in scleroderma.

    OpenAIRE

    von Bierbrauer, A F; Mennel,H. D.; Schmidt, J A; von Wichert, P

    1996-01-01

    OBJECTIVES: To describe the frequency, extent, and nature of microvascular lesions in patients with scleroderma by means of capillaroscopy and capillaroscopically guided nail fold biopsy, and to determine the diagnostic value of the two methods and the pathophysiological significance of the lesions described. METHODS: A cohort study was made of 24 consecutive patients with scleroderma and 10 healthy controls, using standardised clinical, serological, capillaroscopic, and histological (nail fo...

  3. Bilateral atypical femoral subtrochanteric fractures in a premenopausal patient receiving prolonged bisphosphonate therapy: evidence of severely suppressed bone turnover.

    Science.gov (United States)

    Kondo, Naoki; Yoda, Takuya; Fujisawa, Junichi; Arai, Katsumitsu; Sakuma, Mayumi; Ninomiya, Hiroshi; Sano, Hiroshige; Endo, Naoto

    2015-01-01

    We report a case of bilateral atypical femoral fractures that occurred in a patient who had been taking bisphosphonate long-term. A 36-year-old premenopausal female diagnosed with systemic lupus erythematosus and dermatomyositis had been treated with glucocorticoid and alendronate (5 mg/day) to prevent glucocorticoid-induced osteoporosis. She was taken to our hospital because she could not walk immediately after falling down from the standing position. A plain radiograph showed a subtrochanteric fracture of the left femur. Four months later, she fell again and sustained a contralateral subtrochanteric fracture. For each fracture, a femoral intramedullary nail was inserted. Delayed union was detected in both sides, and revision surgery with an iliac bone graft was required for implant breakage in the right side. Histomorphometric findings for the ilium revealed remarkably decreased osteoid volume with no osteoclasts and a minimally eroded surface, suggesting that bone turnover was severely suppressed. However, histology of the delayed union site revealed callus formation and some osteoclast appearance, suggesting that fracture healing was occurring. In total, it took 29 months (left) and 24 months (right) until fracture healing was achieved, showing delayed union. This case is extremely rare in that patient who presented with atypical femoral fractures in spite of her premenopausal status. The bone histomorphometric findings from this case suggest that severely suppressed bone turnover is associated with atypical femoral subtrochanteric fracture and can cause delayed union in patients treated with alendronate long-term.

  4. Treatment of patellar instability in a case of hereditary onycho-osteodysplasia (nail-patella syndrome) with medial patellofemoral ligament reconstruction: A case report.

    Science.gov (United States)

    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.

  5. Heavy Metal Contamination of Popular Nail Polishes in Iran

    Directory of Open Access Journals (Sweden)

    Golnaz Karimi

    2015-06-01

    Full Text Available Background: Toxic and hazardous heavy metals like arsenic, lead, mercury, zinc, chromium and iron are found in a variety of personal care products, e.g. lipstick, whitening toothpaste, eyeliner and nail color. The nails absorb the pigments of nail polishes and vaporized or soluble metals can easily pass it. The goal of this survey was to assess whether the different colors of nail polishes comply with maximum concentrations of heavy metals in the EPA’s guidelines. Methods: 150 samples of different popular brands of nail polishes in 13 colors (yellow, beige, silver, pink, white, violet, brown, golden, green, black, colorless, red and blue were randomly purchased from beauty shops in Tehran City, Iran, in 2014. Microwave digestion EPA method 3051 was used by a microwave oven to determine the amount of 5 heavy metals; Nickel, Chromium, Lead, Arsenic and Cadmium. One-way ANOVA, Two-way ANOVA, hierarchical cluster, and principal component analyses were applied by Statistica 7.0 software. Results: The concentrations of chrome, lead, nickel and arsenic showed significant differences between the colors (p<0.05. In all studied samples, the level of cadmium was beyond the safe maximum permissible limit (MPS, but no significance difference in the cadmium content was identified. Conclusion: Due to the high concentrations of toxic metals in many brands of nail polishes, meticulous quality control is recommended for these beauty products.

  6. Role of nail biopsy as a diagnostic tool

    Directory of Open Access Journals (Sweden)

    Chander Grover

    2012-01-01

    Full Text Available Nail biopsy (NB is an investigation that is not routinely resorted to by most of the dermatologists. The commonly cited reasons are the complexity of the procedure, risk of scarring and the reluctance of the patient. However, in cases with isolated nail psoriasis, isolated nail lichen planus, onychomycosis not confirmed on direct microscopy and culture, or longitudinal melanonychia, the treating dermatologist is left with no choice but to resort to this procedure. Nail as a unit, is capable of projecting only a limited number of clinical manifestations. This is responsible for the more or less similar clinical presentation of many different nail disorders. Hence, a practical knowledge of the indications, appropriate patient selection, procedural details and histopathological interpretation of a NB is a must-have for any practicing dermatologist. The risk of scarring is none to minimal if appropriate type of biopsy is performed, not to mention the wealth of histopathological data that can be retrieved from the nail unit. This article aims to explore the various practical do′s and don′ts for the NB and tells us what to expect from of the procedure.

  7. Development of a locking femur nail for mice.

    Science.gov (United States)

    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, pfracture 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 (pfractures can be fixed with rotation stability, the herein introduced model may represent an ideal tool to study bone healing in transgenic and knockout mice.

  8. COEXISTENCE YELLOW NAIL SYNDROME WITH SYSTEMIC SYMPTOMS - PRESENTATION OF CASES

    Directory of Open Access Journals (Sweden)

    Brzeziński Piotr

    2010-10-01

    Full Text Available Nail changes can accompany many systemic diseases and very often indicate the ongoing systemic process of illness. The yellow nail syndrome (YNS is very rare clinical entity characterized by marked thickening and yellow to yellow-green discoloration of the nails. Congenitally hypoplastic lymphostasis plays a major role in the clinical manifestation of that disease. Syndrome includes pleural effusions, lymphedema and yellow dystrophic nails. The pathogenesis stays still unknown.Aim: Presentation the coexistence of YNS with the systemic symptoms by analyzing cases of 3 patients.Material and methods: The analysis involved 3 patients with YNS (2 women and 1 man aged from 43 to 48 years.Results: We confirmed 3 cases of YNS, with the characteristic nails changes (yellow-greenish discoloration, absence of lunula, etc.. None of the patients had a family history of YNS. All suffered from chronic diseases: the first patient suffered from lymphedema and diabetes mellitus, second - from rheumatoid arthritis and the third complained of a chronic caught and sinusitis. All YNS`s symptoms occurred in the patients` forties. We observed fingers and toes involvement on 7-8 nails in each patient.Conclusions: The YNS offen associated with systemic disease, most commonly lymphedema and bronchiectasis. However, the literature describes some connections with carcinoma and autoimmune diseases. Therefore, each patient with YNS should be examined for cancer detection and stay under periodic medical control.

  9. Dose-Effect Relationships for Femoral Fractures After Multimodality Limb-Sparing Therapy of Soft-Tissue Sarcomas of the Proximal Lower Extremity

    Energy Technology Data Exchange (ETDEWEB)

    Pak, Daniel; Vineberg, Karen A. [Department of Radiation Oncology, University of Michigan, Ann Arbor, MI (United States); Griffith, Kent A. [Biostatistics Unit, Comprehensive Cancer Center, University of Michigan, Ann Arbor, MI (United States); Sabolch, Aaron [Department of Radiation Oncology, University of Michigan, Ann Arbor, MI (United States); Chugh, Rashmi [Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI (United States); Ben-Josef, Edgar [Department of Radiation Oncology, University of Michigan, Ann Arbor, MI (United States); Biermann, Janet Sybil [Department of Orthopedic Surgery, University of Michigan, Ann Arbor, MI (United States); Feng, Mary, E-mail: maryfeng@umich.edu [Department of Radiation Oncology, University of Michigan, Ann Arbor, MI (United States)

    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.

  10. Different implant fixation repairs femoral neck combined with ipsilateral subtrochanteric fractures:comparisons of biomechanical properties%不同植入物内固定修复股骨颈合并同侧转子下骨折:生物力学性能比较

    Institute of Scientific and Technical Information of China (English)

    王延军; 侯军; 万博; 刘刚; 牛刚; 张扬; 党晓谦

    2016-01-01

    背景:选择强度和刚度良好的内固定器植入物是修复股骨颈合并同侧转子下骨折的关键。目的:比较不同植入物内固定修复股骨颈不和同侧转子下骨折的生物力学性能。方法:将24根成年防腐尸体标本制作成为股骨颈骨折合并同侧转子下内侧皮质缺损5 cm的骨折模型,并按照随机数字表法将其均分为股骨近端锁定板组、加长型股骨近端防旋髓内钉组和加长型股骨近端髓内钉组,比较3组轴向压缩实验、扭转实验以及轴向压缩破坏实验结果。结果与结论:加长型股骨近端防旋髓内钉组轴向抗压刚度、破坏载荷大于股骨近端锁定板组和加长型股骨近端髓内钉组,加长型股骨近端髓内钉组大于股骨近端锁定板组,差异有显著性意义(P 0.05)。一定程度上讲,加长型股骨近端防旋髓内钉内固定股骨颈合并同侧转子下骨折相对股骨近端锁定板和加长型股骨近端髓内钉而言,更具有生物力学方面的优势。%BACKGROUND:Choosing internal fixator implants with good strength and stiffness is the key to repair femoral neck combined with ipsilateral subtrochanteric fractures. OBJECTIVE:To compare the biomechanical properties of different implant fixation for femoral neck combined with ipsilateral subtrochanteric fractures. METHODS:Totaly 24 adult antiseptic cadaver specimens were used to produce fracture models with femoral neck fracture combined with 5 cm of ipsilateral subtrochanteri medical cortical defect, and were divided into femoral proximal locking plate group, lengthening proximal femur anti-rotation intramedulary nail group and lengthening proximal femoral nail group according to the random number table method. The results of axial compression test, torsion test and axial compression failure rest in three groups were compared. RESULTS AND CONCLUSION: The axial compressive stiffness and failure load in lengthening proximal femur anti

  11. Risk of femoral hernia after inguinal herniorrhaphy

    DEFF Research Database (Denmark)

    Mikkelsen, T; Bay-Nielsen, M; Kehlet, H

    2002-01-01

    BACKGROUND: Small case series have suggested an increased risk of femoral hernia after previous inguinal herniorrhaphy, but no large-scale data with complete follow-up are available. METHODS: Data were extracted from the Danish Hernia Database covering the interval from 1 January 1998 to 1 July...... 2001, and included 34 849 groin hernia repairs. RESULTS: Of 1297 femoral hernia repairs, 71 patients had previously had an operation for inguinal hernia within the observation period. These 71 femoral hernias represented 7.9 per cent of all reoperations for groin hernia recorded in the database....... The median time to reoperation for a 'recurrent' femoral hernia after previous inguinal herniorrhaphy was 7 months, compared with 10 months for inguinal recurrences. The risk of developing a 'recurrent' femoral hernia after previous inguinal herniorrhaphy was 15 times higher than the rate of femoral hernia...

  12. Nail apparatus melanoma initially diagnosed as nail matrix blue nevus: a case report with dermatoscopy and dermatopathology

    Science.gov (United States)

    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

  13. Efficacy of Topical Anesthetics in the Treatment of Ingrown Nail

    Directory of Open Access Journals (Sweden)

    Fatma Gülru Erdoğan

    2011-06-01

    Full Text Available Background and Design: One of the reasons for preferring conservative methods for ingrown nails is lack of local anesthesia for the painful step. Moreover, ingrown nail is a painful condition per se. It may be very difficult to intervene patients with high basal pain levels. Here, we aimed to assess the efficacy of topical anesthetics (2.5% lidocaine, 2.5% prilocaine mixture and 20% benzocaine gel by determining basal pain level and pain during and after manipulation in patients with severe pain who applied with ingrown nail complaint.Material and Method: In this study, we included a total of 29 patients (12 male, 17 female who had complaint of ingrown nail and for whom nail brace treatment was planned. The patients were divided randomly into two groups regardless of the stage of ingrown nail: with lidocain-prilocain mixture application and with benzocaine gel application. Benzocaine gel was applied 10 minutes before the procedure and lidocaine-prilocaine mixture was applied under occlusion, 2 hours prior to the procedure. Pain levels were evaluated on a numerical pain rating scale before and after topical anesthesia as well as during and half an hour after the procedure in both groups.Results: Statistical difference was not detected between the pain levels of the two groups before and after topical anesthesia and during and half an hour after the procedure. Regardless of the stage of ingrown nail, the pain levels after topical anesthesia and half an hour after procedure were found to decrease significantly compared to the levels before topical anesthesia in both groups. Pain levels of both groups increased during the procedure and were similar to the basal levels. Considering the stage of ingrown nail, while lidocaine-prilocaine mixture did not decrease pain significantly in the cases with stage 2-3, benzocaine did. Conclusion: Due to ease of application and especially to efficacy in stage 2-3 ingrown nails, 20% benzocaine gel may help in

  14. Femoral rotation unpredictably affects radiographic anatomical lateral distal femoral angle measurements

    DEFF Research Database (Denmark)

    Miles, James Edward

    2016-01-01

    Objective: To describe the effects of internal and external femoral rotation on radiographic measurements of the anatomical lateral distal femoral angle (a-LDFA) using two methods for defining the anatomical proximal femoral axis (a-PFA). Methods: Digital radiographs were obtained of 14 right fem...

  15. Planck driven by vision, broken by war

    CERN Document Server

    Brown, Brandon R

    2015-01-01

    Planck's Law, an equation used by physicists to determine the radiation leaking from any object in the universe, was described by Albert Einstein as "the basis of all twentieth-century physics." Max Planck is credited with being the father of quantum theory, and his work laid the foundation for our modern understanding of matter and energetic processes. But Planck's story is not well known, especially in the United States. A German physicist working during the first half of the twentieth century, his library, personal journals, notebooks, and letters were all destroyed with his home in World War II. What remains, other than his contributions to science, are handwritten letters in German shorthand, and tributes from other scientists of the time, including his close friend Albert Einstein. In Planck: Driven by Vision, Broken by War, Brandon R. Brown interweaves the voices and writings of Planck, his family, and his contemporaries-with many passages appearing in English for the first time-to create a portrait of...

  16. The wave has finally broken: now what?

    Science.gov (United States)

    Simborg, Donald W; Detmer, Don Eugene; Berner, Eta S

    2013-06-01

    In 2005, the authors published a paper, 'Will the wave finally break? A brief view of the adoption of electronic medical records in the United States', which predicted that rapid adoption of electronic health records (EHR) would occur in the next 5 years given appropriate incentives. The wave has finally broken with the stimulus of the health information technology for economic and clinical health legislation in 2009, and there have been both positive and negative developments in the ensuing years. The positive developments, among others described, are increased adoption of EHR, the emergence of a national network infrastructure and the recognition of clinical informatics as a medical specialty. Problems that still exist include, among others described, continued user interface problems, distrust of EHR-generated notes and an increased potential for fraud and abuse. It is anticipated that in the next 5 years there will be near universal EHR adoption, greater emphasis on standards and interoperability, greater involvement of Congress in health information technology (IT), breakthroughs in user interfaces, compelling online medical and IT education, both increased use of data analytics for personalized healthcare and a realization of the difficulties of this approach, a blurring of the distinction between EHR and telemedicine, a resurgence of computer-assisted diagnosis and the emergence of a 'continuously learning' healthcare system.

  17. Primary versus secondary distal femoral arthroplasty for treatment of total knee arthroplasty periprosthetic femur fractures.

    Science.gov (United States)

    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.

  18. Osteonecrosis of Femoral Head Occurred after Stent Placement of Femoral Artery

    Directory of Open Access Journals (Sweden)

    Akiyoshi Shimatani

    2014-01-01

    Full Text Available We present a case of osteonecrosis of femoral head (ONFH that occurred after stent angiography of femoral artery for the treatment of arteriosclerosis obliterans (ASO of left inferior limb in a 76-year-old woman. No case of late collapse of femoral head as a complication of endovascular procedure such as stent placement has been previously documented. We considered that ONFH occurred after detaining stent at a junction of left deep femoral artery for the treatment of the ischemia of left lateral and medial femoral circumflex artery.

  19. Preoperative determination of tibial nail length: An anthropometric study

    Institute of Scientific and Technical Information of China (English)

    Renjit Thomas Issac; Hitesh Gopalan; Mathew Abraham; Cherian John; Sujith Mathew Issac; Diju Jacob

    2016-01-01

    Objective:To assess the correlation between five anthropometric parameters and the distance from tibial tuberosity to medial malleolus in 100 volunteers.Methods:Six anthropometric parameters were measured in 50 male and 50 female medical students using a metallic scale:medial knee joint line to ankle joint line (K-A),medial knee joint line to medial malleolus (K-MM),tibial tuberosity to ankle joint (TT-A),tibial tuberosity to medial malleolus (TT-MM),olecranon to 5th metacarpal head (O-MH) and body height (BH).Nail size predicted based upon TT-MM measurement was chosen as ideal nail size.A constant was derived for each of the six anthropometric parameters which was either added or subtracted to each measurement to derive nail size.A regression equation was applied to BH measurements.Nail sizes calculated were compared with that obtained from TT-MM measurement and accuracy was evaluated.Accuracy of O-MH and BH regression equations recommended by other authors were calculated in our data.Results:Adding 11 mm to TT-A distance had highest accuracy (81%) and correlation (0.966) in predicting nails correctly.Subtracting 33 mm from K-MM measurement and 25 mm from K-A distance derived accurate sizes in 69% and 76% respectively.Adding 6 mm to O-MH distance had a poor accuracy of 51%.Nail size prediction based upon body height regression equation derived correct nail sizes in only 34% of the cases.Regression equation analysis by other authors based on O-MH and BH distances yielded correct sizes in 11% and 5% of the cases respectively.Conclusion:TT-A,K-A and K-MM measurements can be used simultaneously to increase accuracy of nail size prediction.This method would be helpful in determining nail size preoperatively especially when one anatomic landmark is difficult to palpate.

  20. Femoral revision surgery with impaction bone grafting

    NARCIS (Netherlands)

    B.L.E.F. ten Have (Bas); R.W. Brouwer (Reinoud); F.C. van Biezen (Frans); J.A.N. Verhaar (Jan)

    2012-01-01

    textabstractThe purpose of this prospective study was to evaluate the long-term clinical and radiological outcomes of revision of the femoral component of a total hip replacement using impaction bone grafting. Femoral revision with an impacted allograft was performed on 29 patients (31 hips). In all

  1. The femoral sulcus in total knee arthroplasty.

    Science.gov (United States)

    Lingaraj, Krishna; Bartlett, John

    2009-05-01

    The position of the femoral sulcus relative to the midline of the distal femoral resection in total knee arthroplasty (TKA) was studied to determine if centralized placement of the femoral component on the distal femur was justified in terms of aligning the prosthetic sulcus with the native femoral sulcus. The location of the femoral sulcus was studied in 112 consecutive patients undergoing TKA. The mean sulcus position was 0.7 mm lateral to the midline of the distal femoral resection (SD 1.4, 95% CI, 0.5-1.0 mm). However, the variation in sulcus positions ranged from 4 mm medial to 4 mm lateral to the midline. The mean sulcus position in valgus knees was 1.0 mm lateral to the midline (SD 1.8), and that in varus knees was 0.7 mm lateral to the midline (SD 1.2) (P = 0.501). It appears prudent to centre the femoral component on the native sulcus rather than the midline of the distal femoral resection, so as to ensure accurate alignment of the prosthetic sulcus with the native sulcus and to encourage normal patella tracking.

  2. Nail psoriasis successfully treated with intralesional methotrexate: case report.

    Science.gov (United States)

    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.

  3. Intramedullary nailing of the proximal humerus: evolution, technique, and results.

    Science.gov (United States)

    Dilisio, Matthew F; Nowinski, Robert J; Hatzidakis, Armodios M; Fehringer, Edward V

    2016-05-01

    Proximal humerus fractures are the third most common fracture in the elderly. Although most fractures can be treated conservatively with acceptable outcomes, certain fracture patterns are at high risk for progression to humeral malunions, nonunions, stiffness, and post-traumatic arthrosis. The goal of antegrade humeral nailing of proximal humerus fractures is to provide stability to a reduced fracture that allows early motion to optimize patient outcomes. Certain technical pearls are pivotal in managing these difficult fractures with nails; these include rotator cuff management, respect of the soft tissues, anatomic tuberosity position, blood supply maintenance, knowledge of the deforming forces on the proximal humerus, fracture reduction, and rehabilitation strategies. Modern proximal humeral nail designs and techniques assist the surgeon in adhering to these principles and have demonstrated promising outcomes. Humeral nail designs have undergone significant innovation during the past 40 years and now can provide stable fixation in the humeral shaft distally as well as improved stability in the head and tuberosity fragments, which were the common site of fixation failure with earlier generation implants. Compared with other fixation strategies, such as locking plate fixation, no compelling evidence exists to suggest one technique over another. The purpose of this review is to describe the history, results, new designs, and techniques that make modern intramedullary nailing of proximal humerus fractures a viable treatment option.

  4. Diffusion of uncharged solutes through human nail plate.

    Science.gov (United States)

    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.

  5. Comparative study of nail sampling techniques in onychomycosis.

    Science.gov (United States)

    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.

  6. Systematic investigation of different formulations for drug delivery through the human nail plate "in vitro"

    OpenAIRE

    Vejnoviċ, Ivana

    2010-01-01

    Human nails do not have only protective and decorative role, but can also be considered as an alternative pathway for drug delivery, especially in nail diseases such as onychomycosis or psoriasis. These nail diseases are widely spread in the population, particularly among elderly and immunocompromised patients. Oral therapies are accompanied by systemic side effects and drug interactions, while topical therapies are limited by the low permeation rate through the nail plate. For the successful...

  7. Classification of subtrochanteric femoral fractures.

    Science.gov (United States)

    Loizou, C L; McNamara, I; Ahmed, K; Pryor, G A; Parker, M J

    2010-07-01

    A review of the literature identified 15 different classification methods for subtrochanteric femoral fractures. Only eight of those classifications defined the area of bone, which constituted a subtrochanteric fracture. The actual length of femur defined as the subtrochanteric zone varied from 3 cm up to the level of the femoral isthmus. There was no agreement between the different classifications regarding the proximal and distal border or for those fractures, which traverse anatomical boundaries. In the various classifications, fractures were subdivided into 2-15 subgroups. The majority of the identified studies were unable to find the classifications useful in either determining treatment or predicting the outcome after treatment. We subdivided subtrochanteric fractures into three types based on the degree of fracture comminution. We examined the inter- and intra-observer agreement of our recommended classification. One orthopaedic consultant, one specialist hip fracture surgeon, two trainee registrar orthopaedic surgeons and one specialty trainee in orthopaedics, on two different occasions, 8 weeks apart, independently classified the radiographs of 20 patients with a subtrochanteric fracture. The mean kappa value for inter- and intra-observer variation was 0.71 and 0.79, respectively, with both showing substantial agreement and, therefore, this simpler classification is recommended. Based on the review of previous classification methods, we also recommend that the subtrochanteric zone be defined as the one in which the fracture line crossing the femur is predominantly within the area of bone extending 5 cm below the lower border of the lesser trochanter.

  8. Incarcerated Femoral Hernia Containing Ipsilateral Fallopian Tube

    Directory of Open Access Journals (Sweden)

    Stefanos Atmatzidis

    2010-01-01

    Full Text Available Femoral hernias are more common in women and lead to a substantial higher rate for an emergency operation, due to strangulation. Incarcerated femoral hernia with fallopian tube as a content is an extremely rare condition. A 20-year-old woman presented to the emergency department complaining of a 6-day right groin swelling, which became painful and tender to palpation during the last 48 hours. Preoperative ultrasonography detected an oedematous hernia sac, above the femoral vessels, suggesting the presence of an incarcerated femoral hernia. The patient eventually underwent emergency surgery and the diagnosis of a strangulated femoral hernia sac, containing fallopian tube, was established. No resection of the uterine tube was performed and the hernia was repaired with polypropylene plug. The postoperative period was uneventful and the woman was discharged on the second postoperative day.

  9. 78 FR 40172 - Steel Nails From China; Institution of a Five-Year Review

    Science.gov (United States)

    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...

  10. Preoperative estimation of tibial nail length--because size does matter.

    LENUS (Irish Health Repository)

    Galbraith, J G

    2012-11-01

    Selecting the correct tibial nail length is essential for satisfactory outcomes. Nails that are inserted and are found to be of inappropriate length should be removed. Accurate preoperative nail estimation has the potential to reduce intra-operative errors, operative time and radiation exposure.

  11. A SURVEY OF NAIL INFECTION AND AWARENESS AMONG NON-DIABETIC PATIENTS IN MAURITIUS

    Directory of Open Access Journals (Sweden)

    Jeewon Rajesh

    2013-07-01

    Full Text Available Introduction: Nail infection like onychomycosis is mainly caused by dermatophytes and account for almost half of all nail disorders. Prevalence of nail infection has been attributed to several factors such as age, gender, socioeconomic status and predisposition to diabetes amongst others. This study aims at determining the prevalence and level of awareness of non-diabetics towards nail infections in Mauritius.Material and Methods: A survey was carried out among 471 participants of the non-diabetic population of Mauritius. Data on socio demographic factors, awareness, level of hygiene, family history and quality of life were obtained via questionnaire based studies. Data was analysed using the SPSS software.Results: Results show almost the same ratio of female to male was affected with nail infection but varies gender wise. Participants within the age group 20-60 with less than US 500 monthly income had a higher incidence of nail infection. No significant relation was obtained between nail infection and education level. A significant relationship was obtained between nail infection and occupation as well as quality of life. More than half of participants did not know about the routes of nail infections or the precautions needed to avoid spreading. However, good level of hygiene was observed among the participants.Conclusion: Factors like age, gender and socio economic status had a significant relationship on nail infection. Nail infection affects the Quality of Life (QoL and manual workers or even professionals are prone to nail infections.

  12. Primary unreamed intramedullary locked nailing in open fractures of tibia

    Directory of Open Access Journals (Sweden)

    Jain Vineet

    2005-01-01

    Full Text Available Background: Fractures of tibia are among the commonest fractures sustained in road traffic accidents. They are frequently open and contaminated. Unreamed nails are considered superior to external fixator in the management of open fractures of tibia. Method: Forty patients with open fractures of tibia, grade I, II, IIIa, IIIb were included in the study. They were managed by primary unreamed intramedullary nailing with adequate soft tissue management. Results: Functional results were excellent in 26 cases, good in 10 cases and fair in 4 cases. Four cases had delayed union. Average time of union was 16.9 weeks. Conclusion: Primary unreamed intramedullary nailing offers advantage of rigid fixation, low incidence of infection, non-union, good functional results and early return to work. An adequate soft tissue management is mandatory in treatment of these fractures.

  13. [Outcome of treatment of ingrown toe nails in the child].

    Science.gov (United States)

    Heymanns, M; Berger, S; Würfel, A

    1997-11-01

    Difficulties encountered and long-term results of surgical treatment of ingrown toenails are well documented in the adult patient. In infants and children, however, little is known about this problematic entity. We therefore performed a follow-up study in 91 out of 99 ingrowing toenails in children up to 14 years. The patients were treated in our department from 1990 to 1994 mainly by wedge resection. 64 nail folds remained free of symptoms after single surgical treatment. Recurrence of infection or nail spikes was found in 21 out of 85 nail folds. In children, conservative treatments with antimicrobial ointments, gutter treatment, and in selected cases systemic antibiotics, are more promising than in adults. If these efforts remain unsuccessful, the only reliable surgical approach is a radical wedge resection.

  14. Road Nail: Experimental Solar Powered Intelligent Road Marking System

    Science.gov (United States)

    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.

  15. Nail Assessment in Psoriasis and Psoriatic Arthritis (NAPPA)

    DEFF Research Database (Denmark)

    Augustin, M; Blome, C; Costanzo, A;

    2013-01-01

    BACKGROUND: Existing tools for nail psoriasis are complex and may not adequately measure outcomes that are important to patients. OBJECTIVES: We have developed and validated a new tool, the Nail Assessment in Psoriasis and Psoriatic Arthritis (NAPPA), with three components: a questionnaire...... assessing quality of life (NAPPA-QoL), a two-part questionnaire assessing patient-relevant treatment benefits (the Patient Benefit Index, NAPPA-PBI) and a psoriasis Clinical Assessment of Severity (NAPPA-CLIN). METHODS: Development of the questionnaires involved multiple steps: (i) collection of items about...... nail psoriasis-related impairments and treatment goals; (ii) selection of 48 items by an expert panel, including patients; (iii) translation into eight languages; (iv) feasibility testing and (v) longitudinal validation in six countries. RESULTS: Patients found the questionnaires clear (84...

  16. Black yeast-like fungi in skin and nail

    DEFF Research Database (Denmark)

    Saunte, D M; Tarazooie, B; Arendrup, M C

    2011-01-01

    Black yeast-like fungi are rarely reported from superficial infections. We noticed a consistent prevalence of these organisms as single isolations from mycological routine specimens. To investigate the prevalence of black yeast-like fungi in skin, hair and nail specimens and to discuss the probab......Black yeast-like fungi are rarely reported from superficial infections. We noticed a consistent prevalence of these organisms as single isolations from mycological routine specimens. To investigate the prevalence of black yeast-like fungi in skin, hair and nail specimens and to discuss...... prevalent species were Phialophora europaea (n = 29), Coniosporium epidermidis (n = 12), Ochroconis cf. humicola (n = 6) and Cladophialophora boppii (n = 4). These are not common saprobes and thus less likely to be coincidental colonizers. In 10/30 cases, discolouration of nail/skin had been noticed...

  17. Airborne contact dermatitis and asthma in a nail art operator

    Directory of Open Access Journals (Sweden)

    Mario Vaccaro

    2014-02-01

    Full Text Available Nail art (creation and decoration of artificial nails is a growing fashion trend. Proportionally to its popularity, the number of allergic reactions to the materials used has recently increased. We report the case of a nail art operator who developed occupational allergy to acrylates, manifested with the unusual simultaneous presence of asthma and dermatitis. Cutaneous lesions only affected areas not covered by individual protection devices or clothes, even if such areas were not in direct contact with acrylates, suggesting airborne allergic contact dermatitis. While respiratory problems were solved with the correct use of a mask at the workplace, facial dermatitis proved impossible to avoid or control and, for this reason, the patient had to change her work.

  18. Effect of dynamic hip system blade on the treatment of femoral neck fractures in elderly patients with osteoporosis

    Institute of Scientific and Technical Information of China (English)

    Zhao Wenbo; Liu Lei

    2014-01-01

    Objective:To discuss the curative effect of the dynamic hip system blade (DHS-blade) on the treatment of femoral neck fractures in elderly patients with osteoporosis.Methods:A retrospective study was conducted to analyse the clinical data of 60 elderly patients with osteoporosis who had been treated for femoral neck fractures with DHS-blade in our department between September 2012 and February 2014.There were 22 males and 38 females with a mean age of (66.8±3.2) years.According to the Singh Index Classification,all the patients' Singh index was below level 3.The Harris criterion and function recovery after operation were analysed.Results:All patients were followed up for 12-17 months (mean 14 months).No femoral head necrosis,femoral neck shortening,internal fixation loosening or backing out of the nails occurred.Bone nonunion was found in one case and he had a good recovery after total hip arthroplasty.The time for fracture healing ranged from 3-6 months (average 3.5 months).According to Harris criterion,35 cases were rated as excellent,22 good,2 fair and 1 poor.The Harris scale was significantly improved from 28.46±2.35 preoperatively to 91.98±3.26 at 6 months postoperatively (P<0.05).Conclusion:DHS-blade,being minimally invasive,allowing earlier postoperative exercise and avoiding the complications elicited by traditional internal fixation,is advisable for treatment of femoral neck fractured patients with osteoporosis.

  19. A novel intramedullary nail for micromotion stimulation of tibial fractures.

    LENUS (Irish Health Repository)

    Dailey, Hannah L

    2011-09-20

    BACKGROUND: Animal studies and clinical trials have suggested that early application of controlled axial micromotion can accelerate healing of long bone fractures compared to rigid fixation. However, experimental investigations of micromotion constructs have been limited to external fixators, which have a higher incidence of complications than intramedullary nails. The purpose of this study was to assess whether a novel intramedullary nail design can generate stimulatory micromotion under minimal weight-bearing loads typical of the early healing period. METHODS: Eight cadaver tibiae were reamed, osteotomised, and implanted with commercially-available IM nails fitted with a custom insert that allowed 1mm of axial micromotion after proximal\\/distal interlocking. Specimens were mounted in a materials testing machine and subjected to cyclic axial loading while interfragmentary motion was measured using an extensometer. Implants were also tested in standard statically-locked mode. FINDINGS: The average force required to cause distraction of the fracture gap in micromotion mode was 37.0 (SD 21.7) N. The mean construct stiffness was 1046.8 (SD 193.6) N\\/mm in static locking mode and 512.4 (SD 99.6) N\\/mm in micromotion mode (significantly different, P<0.001). INTERPRETATION: These results support the development of a micromotion-enabled IM nail because the forces required to cause interfragmentary movements are very low, less than the weight of the hanging shank and foot. In contrast to rigid-fixation nails, which require significant weight-bearing to induce interfragmentary motion, the micromotion-enabled nail may allow movement in non-weight-bearing patients during the early healing period when the benefits of mechanical stimulation are most critical.

  20. A Note on a Broken-Cycle Theorem for Hypergraphs

    Directory of Open Access Journals (Sweden)

    Trinks Martin

    2014-08-01

    Full Text Available Whitney’s Broken-cycle Theorem states the chromatic polynomial of a graph as a sum over special edge subsets. We give a definition of cycles in hypergraphs that preserves the statement of the theorem there

  1. Tension free femoral hernia repair with plug

    Institute of Scientific and Technical Information of China (English)

    Milivoje Vukovi; Neboja Moljevi; Sinia Crnogorac

    2013-01-01

    Objective: To investigate the conventional technique involves treatment of femoral hernia an approximation inguinal ligament to pectineal ligament. In technique which uses mesh closure for femoral canal without tissue tension. Method: A prospective study from January 01. 2007-May 30. 2009. We analyzed 1 042 patients with inguinal hernia, of which there were 83 patients with 86 femoral hernia. Result: Femoral hernias were present in 7.96% of cases. Males were 13 (15.66%) and 70 women (84.34%). The gender distribution of men: women is 1:5.38. Urgent underwent 69 (83%), and the 14 election (17%) patients. Average age was 63 years, the youngest patient was a 24 and the oldest 86 years. Ratio of right: left hernias was 3.4:1. With bilateral femoral hernias was 3.61% of cases. In 7 patients (8.43%) underwent femoral hernia repair with 9 Prolene plug. Conclusions: The technique of closing the femoral canal with plug a simple. The plug is made from monofilament material and is easily formed. This technique allows the reduction of recurrence and can be used safely, quickly and easily in elective and emergency situations.

  2. Offline detection of broken rotor bars in AC induction motors

    Science.gov (United States)

    Powers, Craig Stephen

    ABSTRACT. OFFLINE DETECTION OF BROKEN ROTOR BARS IN AC INDUCTION MOTORS. The detection of the broken rotor bar defect in medium- and large-sized AC induction machines is currently one of the most difficult tasks for the motor condition and monitoring industry. If a broken rotor bar defect goes undetected, it can cause a catastrophic failure of an expensive machine. If a broken rotor bar defect is falsely determined, it wastes time and money to physically tear down and inspect the machine only to find an incorrect diagnosis. Previous work in 2009 at Baker/SKF-USA in collaboration with the Korea University has developed a prototype instrument that has been highly successful in correctly detecting the broken rotor bar defect in ACIMs where other methods have failed. Dr. Sang Bin and his students at the Korea University have been using this prototype instrument to help the industry save money in the successful detection of the BRB defect. A review of the current state of motor conditioning and monitoring technology for detecting the broken rotor bar defect in ACIMs shows improved detection of this fault is still relevant. An analysis of previous work in the creation of this prototype instrument leads into the refactoring of the software and hardware into something more deployable, cost effective and commercially viable.

  3. Broken Ergodicity in Two-Dimensional Homogeneous Magnetohydrodynamic Turbulence

    Science.gov (United States)

    Shebalin, John V.

    2010-01-01

    Two-dimensional (2-D) homogeneous magnetohydrodynamic (MHD) turbulence has many of the same qualitative features as three-dimensional (3-D) homogeneous MHD turbulence.The se features include several ideal invariants, along with the phenomenon of broken ergodicity. Broken ergodicity appears when certain modes act like random variables with mean values that are large compared to their standard deviations, indicating a coherent structure or dynamo.Recently, the origin of broken ergodicity in 3-D MHD turbulence that is manifest in the lowest wavenumbers was explained. Here, a detailed description of the origins of broken ergodicity in 2-D MHD turbulence is presented. It will be seen that broken ergodicity in ideal 2-D MHD turbulence can be manifest in the lowest wavenumbers of a finite numerical model for certain initial conditions or in the highest wavenumbers for another set of initial conditions.T he origins of broken ergodicity in ideal 2-D homogeneous MHD turbulence are found through an eigen analysis of the covariance matrices of the modal probability density functions.It will also be shown that when the lowest wavenumber magnetic field becomes quasi-stationary, the higher wavenumber modes can propagate as Alfven waves on these almost static large-scale magnetic structures

  4. Variations of femoral condyle shape.

    Science.gov (United States)

    Biscević, Mirza; Hebibović, Mujo; Smrke, Dragica

    2005-12-01

    The aim of this study is to mathematically approximate the shape of the femoral articulating line and compare radiuses of condylar curves within and between males and females. Ten male and ten female participants were included in the study. Radiuses of medial and lateral condylar curves were calculated from the side view knee X-ray by original mathematical equation. Average radiuses of condylar curves were between 4.5 and 1.7 cm medially, and between 3.2 and 1.8 cm laterally, for 0 degrees and 90 degrees flexion contact point respectively. Males had longer curve radiuses of both condyles (p knee geometry, and other ellipsoidal structures in human body, like wrist, scull segments, dental arches, etc.

  5. Stiffness Analysis of Nail-Plate Joints Subjected to Short-Term Loads

    DEFF Research Database (Denmark)

    Nielsen, Jacob

    with beams connected in joints with glue or a mechanical fastener. The types of mechanical fasteners are: nails, staples, bolts, dowels, screws and nail-plates. Bolts and dowels are generally applied to joints in solid structures, and the other fasteners are used in all kinds of light structures. Especially...... types of plates. There are two main types of nail-plates: steel plates perforated with holes in which separate nails are used and steel plates perforated by a stamping machine, so the nails are made from the plate, see figur 1.2 on page 7. This type is sometimes called "punching metal plate...

  6. Nail in the Fence%栅栏上的钉子

    Institute of Scientific and Technical Information of China (English)

    张顺生

    2006-01-01

    @@ There once was a little boy who had a bad temper. His father gave him a bag of nails and told him that every time he lost his temper, he must hammer a nail into1 the back of the fence. The first day the boy had driven 37 nails into the fence. Over the next few weeks, as he learned to control his anger, the number of nails hammered daily gradually dwindled down2. He discovered it was easier to hold his temper than to drive those nails into the fence. Finally the day came when the boy didn't lose his temper at all.

  7. Randomized controlled trial of a water-soluble nail lacquer based on hydroxypropyl-chitosan (HPCH, in the management of nail psoriasis

    Directory of Open Access Journals (Sweden)

    Cantoresi F

    2014-05-01

    Full Text Available Franca Cantoresi,1 Maurizio Caserini,2 Antonella Bidoli,1 Francesca Maggio,1 Raffaella Marino,1 Claudia Carnevale,1 Paola Sorgi,1 Renata Palmieri21Department of Dermatology, Sapienza University, Rome, Italy; 2Scientific Department, Polichem SA, Lugano, Switzerland Background: Nail psoriasis occurs in up to 50% of patients affected by psoriasis, with a significant impact on quality of life that leads to a real clinical need for new therapeutic options. Aim: To confirm whether the strengthening and hardening properties of the hydroxypropyl-chitosan (HPCH nail lacquer could improve the structure of the nail plates on psoriatic nails. Materials and methods: A randomized, double-blind, placebo controlled, parallel-group trial was carried out to evaluate the efficacy and tolerability of a hydrosoluble nail lacquer containing HPCH, Equisetum arvense, and methylsulfonylmethane on nail psoriasis. The test product or a placebo was applied once daily for 24 weeks to all fingernails. Efficacy assessments were performed on the target fingernail by means of the modified Nail Psoriasis Severity Index score. A cut-off score of 4 was considered to define the clinical cure rate (ie, Cure ≤4, Failure >4. Results: After 24 weeks, the clinical cure rate showed the statistically significant superiority of the HPCH nail lacquer compared to placebo in both the intention-to-treat (Fisher's exact test, P=0.0445 and the per protocol population (Fisher's exact test, P=0.0437. This superiority was already present after 16 weeks of treatment. Moreover, the analysis of the modified Nail Psoriasis Severity Index-50 showed a statistically significant clinical improvement after 12 weeks of treatment in comparison to the results obtained after 8 weeks (Fisher's exact test, P<0.05. Conclusion: The trial showed that HPCH nail lacquer could be a new, valid, effective, and safe option for decreasing the signs of nail dystrophy in psoriatic patients. Keywords: nail psoriasis

  8. Femoral hernia sac laparoscopy: a case report.

    Science.gov (United States)

    Ramirez Valderrama, Alexander; Ruiz, Dan; Malik, Manmeet; Tiszenkel, Howard

    2014-01-01

    We present the case of a 64-year-old female with an incarcerated right femoral hernia, associated with a small bowel obstruction that was successfully treated with an open femoral hernia repair with plug. At the same time we performed a hernia sac laparoscopy to evaluate the viability of the previously reduced small bowel. The hernioscopy was performed with a 0° 5 mm scope with reliable evaluation of the peritoneal cavity. We confirm that hernioscopy is a safe and feasible procedure and provides useful information for the appropriate management of acute incarcerated femoral/inguinal hernias.

  9. Treatment of ingrown nail with a special device composed of shape-memory alloy.

    Science.gov (United States)

    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.

  10. Brushes and picks used on nails during the surgical scrub to reduce bacteria: a randomised trial.

    Science.gov (United States)

    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.

  11. Nickel in nails, hair and plasma from nickel-hypersensitive women

    DEFF Research Database (Denmark)

    Gammelgaard, Bente; Veien, Niels

    1990-01-01

    The concentrations of nickel in finger-nails, toe-nails, hair and plasma from 71 nickel-hypersensitive women and 20 non-hypersensitive women were determined. Nickel concentrations in finger-nails were significantly higher than in toe-nails in both the nickel-hypersensitive group and the control...... group. Nickel-sensitive women had significantly higher levels of nickel in toe-nails, hair and plasma than had control subjects, whereas there was no significant difference in nickel concentration in finger-nails between the two groups. No correlation could be demonstrated between nickel levels in any...... combination of nails, hair and plasma in the nickel-hypersensitive or in the control group....

  12. Lichen nitidus presenting with nail changes--case report and review of the literature.

    Science.gov (United States)

    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.

  13. Internal derangement of the knee after ipsilateral femoral shaft fracture: MR imaging findings

    Energy Technology Data Exchange (ETDEWEB)

    Blacksin, M.F.; Zurlo, J.V. [Department of Radiology, University of Medicine and Dentistry of New Jersey, Newark, NJ (United States); Levy, A.S. [Department of Orthopedic Surgery, University of Medicine and Dentistry of New Jersey, University Hospital, Newark, NJ 07103-2426 (United States)

    1998-08-01

    Objective. This study uses magnetic resonance (MR) imaging to delineate the types and frequencies of injuries seen in the knee after ipsilateral femoral shaft fracture. We also compare the results of the orthopedic knee examination with the MR findings. Design and patients. MR imaging of the ipsilateral knee was performed on 34 patients with closed femoral shaft fractures. Indications for knee MR imaging included knee pain at the time of fracture, soft tissue swelling or an effusion of the knee, or a positive knee examination under anesthesia. The patients had a mean age of 27 years and all were stabilized with intramedullary nails. Imaging was performed a mean time of 2.5 days after surgery. All patients had knee examinations done under anesthesia, and the MR results were compiled and compared with the clinical examinations. Results. Ninety-seven percent of patients demonstrated knee effusions. Twenty-seven percent of patients demonstrated meniscal tears, with the posterior horn of the medial meniscus most frequently torn. The medial collateral ligament was the most frequent site of ligamentous injury (38%) followed by the posterior cruciate ligament (21%). Fifty percent of patients had injuries of the extensor mechanism. Bone bruises were noted in 32% of patients. Articular cartilage injuries were confined to the patella in four cases. One occult tibial plateau fracture and one meniscocapsular separation were seen. Conclusions. There is a common incidence of both ligamentous and meniscal injury to the knee after ipsilateral femoral shaft fracture. MR imaging can be useful in assessing the extent of injury, and may reveal findings unsuspected after clinical examination of the knee. (orig.) With 4 figs., 2 tabs., 13 refs.

  14. The Comet With a Broken Heart

    Science.gov (United States)

    2006-04-01

    ). Fragment B seems to have fragmented again, bringing the total of fragments close to 40, some being most probably very small, boulder-sized objects with irregular and short-lived activity. The new observations reveal that this new small fragment has split again! The image clearly reveals that below the main B fragment, there is a small fragment that is divided into two and a careful analysis reveals five more tiny fragments almost aligned. Thus, this image alone shows at least 7 fragments. The comet has thus produced a whole set of mini-comets! ESO PR Photo 15b/06 ESO PR Photo 15b/06 Broken Fragments of Comet SW-3 Will the process continue? Will more and more fragments form and will the comet finally disintegrate? How bright will the fragments be when the comet will be the closest to the Earth, on 11 to 14 May, and how many new fragments will have appeared before the comet reaches its closest approach to the Sun, around 7 June? Fragment C of the comet should be the closest to Earth on 11 May, when it will be about 12 million km away, while fragment B will come as 'close' as 10 million km from Earth on 14 May. Although this is the closest a comet ever approached Earth in more than twenty years - even Comet Hyakutake's smallest distance was 15 million km - this is still 26 times the distance between the Earth and the Moon and therefore does not pose any threat to our planet. ESO PR Photo 15/06 ESO PR Photo 15c/06 Mini-Comets coming off Comet SW-3 If nothing else happens, at the time of closest approach, fragment B will be just visible with unaided eye by experienced observers. It should be an easy target however to observe with binoculars. If we are lucky, however, fragment B presents another outburst, becoming a magnificent sight in the night sky. On the other hand, it could just as well fade away into oblivion. But then, the main fragment C should still be visible, even possibly with the unaided eye. ESO telescopes will observe the comet in the greatest detail at the end of

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

    Science.gov (United States)

    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.

  16. Nail penetrating trauma:a rare cause of vesicovaginal fistula

    Institute of Scientific and Technical Information of China (English)

    Mohammad Asl Zare; Ali Kamalati; Saeed Esmailnia

    2014-01-01

    Vesicovaginal fistula (VVF) may be caused by prolonged obstructed labor, gynecologic, urologic, or other pelvic surgery, malignancy, radiation, infection and trauma. Here we report a case of VVF caused by nail penetrating trauma in a young woman with genital bleeding after first intercourse. This is a rare etiology of VVF. We also explain the operative technique used to repair the fistula.

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

    Science.gov (United States)

    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.

  18. Ingrown toenails (unguis incarnatus): Nail braces/bracing treatment

    Science.gov (United States)

    Chiriac, Anca; Solovan, Caius

    2014-01-01

    Nail bracing is a safe, simple, and inexpensive treatment option that avoids surgery, requires no anesthetic, requires no recovery period, allows wearing the existing shoes, offers immediate relief from pain, and allows the practice of daily activities. Braces can be used for prolonged periods of times. If recurrence occurs, reapplication of bracing is usually required. PMID:24688206

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

    Directory of Open Access Journals (Sweden)

    Anderson Duane Ray

    2016-01-01

    Full Text Available 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.

  20. A case of ectopic cilia in nail-patella syndrome.

    Science.gov (United States)

    Edmunds, Matthew R; Kipioti, Athina; Colloby, Peter S; Reuser, Tristan T Q

    2012-06-01

    Both ectopic cilia and nail-patella syndrome (NPS) are rare entities. To our knowledge we report the first case of the two anomalies coexisting in one patient. We present the case of a 2-year-old girl, with no other ophthalmic complication of NPS, who had an excellent cosmetic outcome and no lesion recurrence following surgical excision of ectopic cilia.

  1. Multiple intramedullary nailing of proximal phalangeal fractures of hand

    Directory of Open Access Journals (Sweden)

    Patankar Hemant

    2008-01-01

    Full Text Available Background: Proximal phalangeal fractures are commonly encountered fractures in the hand. Majority of them are stable and can be treated by non-operative means. However, unstable fractures i.e. those with shortening, displacement, angulation, rotational deformity or segmental fractures need surgical intervention. This prospective study was undertaken to evaluate the functional outcome after surgical stabilization of these fractures with joint-sparing multiple intramedullary nailing technique. Materials and Methods: Thirty-five patients with 35 isolated unstable proximal phalangeal shaft fractures of hand were managed by surgical stabilization with multiple intramedullary nailing technique. Fractures of the thumb were excluded. All the patients were followed up for a minimum of six months. They were assessed radiologically and clinically. The clinical evaluation was based on two criteria. 1. total active range of motion for digital functional assessment as suggested by the American Society for Surgery of Hand and 2. grip strength. Results: All the patients showed radiological union at six weeks. The overall results were excellent in all the patients. Adventitious bursitis was observed at the point of insertion of nails in one patient. Conclusion: Joint-sparing multiple intramedullary nailing of unstable proximal phalangeal fractures of hand provides satisfactory results with good functional outcome and fewer complications.

  2. Hydration of human nails investigated by NIR-FT-Raman spectroscopy.

    Science.gov (United States)

    Wessel, S; Gniadecka, M; Jemec, G B; Wulf, H C

    1999-08-17

    The human nail, although it is usually stable against outer influences, becomes soft and flexible after soaking in water. Frequent washing increases brittleness of nails. Hydration of nails is thought to be the most important factor influencing the physical properties of nails and possibly acts through changes in keratin structure. Here NIR-FT-Raman has been used to examine molecular structural changes of intact moisten nails. Raman spectra were obtained both in vitro from nail samples and in vivo before and after soaking in water. The water uptake of normal nail samples during the first 15 min was reflected in the increasing intensity ratio of the nu(OH)/nu(CH(2)) bands. A saturating effect appeared soon after 10 min which is explained by a defined water holding capacity. R(nu) representation of the low frequency range of the Raman spectra showed that mainly bound water is found both in dry and in wet nails. This implies water-protein interaction. Protein backbone vibration at 932 cm(-1) indicating alpha-helical proteins increased in intensity in the wet nails. The nu(S-S) which is sensitive to changes in conformation of proteins showed a 4% higher intensity. Additional protein-water interactions could lead to a slight change of the dihedral angle of the C-S-S-C bonds and to geometric changes in coiling behavior of the alpha-helical protein. Suggesting a separation between matrix proteins and fiber proteins giving them a greater freedom of flexibility. The in vivo spectra detected from the distal part of the nail resembled spectra in vitro. Raman spectra of the proximal part of the nail showed that it was fully saturated with water. The proximal part of the nail did not show changes in water content and protein structure during nail moisturizing in the Raman spectra. Our results suggest that the softening of the nail following hydration may be due to changed matrix protein molecular structure induced by water.

  3. Drug permeation through the three layers of the human nail plate.

    Science.gov (United States)

    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.

  4. Comparative microscopic analysis of nail clippings from patients with cutaneous psoriasis and psoriatic arthritis*

    Science.gov (United States)

    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

  5. Hydrocoele of a femoral hernia sac.

    Science.gov (United States)

    Mote, D G; Chakravarty, K B

    2009-12-01

    Hydrocoele of a femoral hernia sac is an extremely rare entity. Extensive literature review and Internet searching revealed only a few authentically reported cases. It mostly occurs in females during the fourth to sixth decades of life. The most common clinical presentation is groin swelling. It is diagnosed as an irreducible or incarcerated femoral hernia or subcutaneous lipoma. In almost all of the reported cases, the diagnosis of hydrocoele of a femoral hernia sac has been made only after surgical exploration. The present case is a 40-year-old lady who presented with a painless lump in the right groin and was diagnosed as a case of hydrocoele of a femoral hernia sac only after exploration.

  6. Herniography off femoral, obturator and perineal hernias

    Energy Technology Data Exchange (ETDEWEB)

    Ekberg, O.; Nordblom, I.; Fork, F.T.; Gullmo, A.

    1985-08-01

    Positive contrast herniography was used in the workup of 550 patients with unclear groin pain. The majority of these patients had rather characteristic hernias of indirect, direct or femoral type. However, now and then diagnostic problems arose. A femoral hernia may look like a direct or even obturator hernia. There is also a variety of multilocular femoral hernias and other types. A femoral hernia may be present together with other hernias in the ipsilateral or contralateral groin. Obturator hernias are usually small but are always confined to the obturator canal laterally in the obturator foramen. Abnormalities in the pouch of Douglas may include a deep rectogenital pouch, diverticula and true herniations. These uncommon herniographic findings are described and discussed.

  7. Acute appendicitis in a femoral hernia

    Directory of Open Access Journals (Sweden)

    Zdravković Darko

    2007-01-01

    Full Text Available INTRODUCTION Acute appendicitis in a femoral hernia is an uncommon condition that can be serious. Complications are more frequent if the diagnosis is delayed and surgery is not performed on time. CASE REPORT We present a 71-year-old man with a painful swollen mass. The patient presented with fatigue and loss of appetite, while body temperature was normal. The abdomen was not painful, and peristaltic was normal. All laboratory findings were normal. After anamnesis and physical examination, the presumed diagnosis was incarcerated femoral hernia and the patient was sent to the operating room. Intraoperative findings revealed an incarcerated femoral hernia within a phlegmonous inflammated appendix. Appendectomy and McVay hernioplastics were done. The postoperative course was without complications. CONCLUSION It is very important to bear in mind that right femoral hernia with signs of incarceration and inflammation may contain an acutely inflamed appendix. Delayed diagnosis and misdiagnosis cause greater morbidity and mortality.

  8. Limited Quadricepsplasty for Contracture during Femoral Lengthening

    OpenAIRE

    Khakharia, Saurabh; Fragomen, Austin T.; Rozbruch, S. Robert

    2009-01-01

    Extension contracture of the knee is a common complication of femoral lengthening. Knee flexion exercises to stretch the contracture with physical therapy can be effective but take a prolonged amount of time to work and place increased stress across the patellofemoral joint. We developed a minimal-incision limited quadricepsplasty surgical technique to treat knee extension contracture secondary to femoral lengthening and retrospectively reviewed 16 patients treated with this procedure. The me...

  9. Use of the gamma3™ nail in a teaching hospital for trochanteric fractures: mechanical complications, functional outcomes, and quality of life

    Directory of Open Access Journals (Sweden)

    Buecking Benjamin

    2012-11-01

    Full Text Available Abstract Background Trochanteric fractures are common fractures in the elderly. Due to characteristic demographic changes, the incidence of these injuries is rapidly increasing. Treatment of these fractures is associated with high rates of complications. In addition, the long-term results remain poor, with high morbidity, declines in function, and high mortality. Therefore, in this study, complication rates and patients’ outcomes were evaluated after fixation of geriatric trochanteric fractures using the Gamma3™ nail. Methods Patients aged 60 years old or older, with pertrochanteric and subtrochanteric femoral fractures, were included. Patients with polytrauma or pathological fractures were excluded. Age, sex, and fracture type were collected on admission. In addition, data were recorded concerning the surgeon (resident vs. consultant, time of operation, and local or systemic perioperative complications. Complications were also collected at the 6- and 12-month follow-ups after trauma. Barthel Index, IADL, and EQ-5D measurements were evaluated retrospectively on admission, as well as at discharge and during the follow-up. Results Ninety patients were prospectively included between April 2009 and September 2010. The patients’ average age was 81 years old, and their average ASA score was 3. The incision/suture time was 53 min (95% CI 46–60 min. Hospital mortality was 4%, and overall mortality was 22% at the 12-month follow-up. Eight local complications occurred (4 haematomas, 1 deep infection, 1 cutting out, 1 irritation of the iliotibial tract, 1 periosteosynthetic fracture. The incidence of relevant systemic complications was 6%. Forty-two percent of the patients were operated on by residents in training, without significant differences in duration of surgery, complication rate, or mortality rate. The Barthel Index (82 to 71, p p = .0195 and EQ-5-D (0.75 to 0.66, p = .068 values did not reach pre-fracture levels during the follow

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

    Science.gov (United States)

    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.

  11. Femoral nerve entrapment: a new insight.

    Science.gov (United States)

    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.

  12. Bifurcation and catastrophe of seepage flow system in broken rock

    Institute of Scientific and Technical Information of China (English)

    MIAO Xie-xing; LI Shun-cai; CHEN Zhan-qing

    2009-01-01

    The study of dynamical behavior of water or gas flows in broken rock is a basic research topic among a series of key projects about stability control of the surrounding rocks in mines and the prevention of some disasters such as water inrush or gas outburst and the protection of the groundwater resource. It is of great theoretical and engineering importance in respect of promo-tion of security in mine production and sustainable development of the coal industry. According to the non-Darcy property of seepage flow in broken rock dynamic equations of non-Darcy and non-steady flows in broken rock are established. By dimensionless transformation, the solution diagram of steady-states satisfying the given boundary conditions is obtained. By numerical analysis of low relaxation iteration, the dynamic responses corresponding to the different flow parameters have been obtained. The stability analysis of the steady-states indicate that a saddle-node bifurcaton exists in the seepage flow system of broken rock. Consequently, using catastrophe theory, the fold catastrophe model of seepage flow instability has been obtained. As a result, the bifurcation curves of the seepage flow systems with different control parameters are presented and the standard potential function is also given with respect to the generalized state variable for the fold catastrophe of a dynamic system of seepage flow in broken rock.

  13. Broken-Rotor-Bar Diagnosis for Induction Motors

    Science.gov (United States)

    Wang, Jinjiang; Gao, Robert X.; Yan, Ruqiang

    2011-07-01

    Broken rotor bar is one of the commonly encountered induction motor faults that may cause serious motor damage to the motor if not detected timely. Past efforts on broken rotor bar diagnosis have been focused on current signature analysis using spectral analysis and wavelet transform. These methods require accurate slip estimation to localize fault-related frequency. This paper presents a new approach to broken rotor bar diagnosis without slip estimation, based on the ensemble empirical mode decomposition (EEMD) and the Hilbert transform. Specifically, the Hilbert transform first extracts the envelope of the motor current signal, which contains broken rotor fault-related frequency information. Subsequently, the envelope signal is adaptively decomposed into a number of intrinsic mode functions (IMFs) by the EEMD algorithm. Two criteria based on the energy and correlation analyses have been investigated to automate the IMF selection. Numerical and experimental studies have confirmed that the proposed approach is effective in diagnosing broken rotor bar faults for improved induction motor condition monitoring and damage assessment.

  14. Neutrino Mixing: from the Broken \\mu-\\tau Symmetry to the Broken Friedberg-Lee Symmetry

    CERN Document Server

    Xing, Z

    2007-01-01

    I argue that the observed flavor structures of leptons and quarks might imply the existence of certain flavor symmetries. The latter should be a good starting point to build realistic models towards deeper understanding of the fermion mass spectra and flavor mixing patterns. The \\mu-\\tau permutation symmetry serves for such an example to interpret the almost maximal atmospheric neutrino mixing angle (\\theta_23 \\sim 45^\\circ) and the strongly suppressed CHOOZ neutrino mixing angle (\\theta_13 < 10^\\circ). In this talk I like to highlight a new kind of flavor symmetry, the Friedberg-Lee symmetry, for the effective Majorana neutrino mass operator. Luo and I have shown that this symmetry can be broken in an oblique way, such that the lightest neutrino remains massless but an experimentally-favored neutrino mixing pattern is achievable. We get a novel prediction for \\theta_13 in the CP-conserving case: \\sin\\theta_13 = \\tan\\theta_12 |(1- \\tan\\theta_23)/ (1+ \\tan\\theta_{23})|. Our scenario can simply be generalize...

  15. Neutrino Mixing:. from the Broken μ-τ Symmetry to the Broken Friedberg-Lee Symmetry

    Science.gov (United States)

    Xing, Zhi-Zhong

    I argue that the observed flavor structures of leptons and quarks might imply the existence of certain flavor symmetries. The latter should be a good starting point to build realistic models towards deeper understanding of the fermion mass spectra and flavor mixing patterns. The μ-τ permutation symmetry serves for such an example to interpret the almost maximal atmospheric neutrino mixing angle (θ23 ~ 45°) and the strongly suppressed CHOOZ neutrino mixing angle (θ13 Friedberg-Lee symmetry, for the effective Majorana neutrino mass operator. Luo and I have shown that this symmetry can be broken in an oblique way, such that the lightest neutrino remains massless but an experimentally-favored neutrino mixing pattern is achievable. We get a novel prediction for θ13 in the CP-conserving case: sinθ13 = tanθ12|(1 - tanθ23)/(1 + tanθ23)|. Our scenario can simply be generalized to accommodate CP violation and be combined with the seesaw mechanism. Finally I stress the importance of probing possible effects of μ-τ symmetry breaking either in terrestrial neutrino oscillation experiments or with ultrahigh-energy cosmic neutrino telescopes.

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

    Directory of Open Access Journals (Sweden)

    Hitomi Sano, MD

    2014-03-01

    Full Text Available 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.

  17. Misunderstanding that the Effective Action is Convex under Broken Symmetry

    CERN Document Server

    Asanuma, Nobu-Hiko

    2016-01-01

    The widespread belief that the effective action is convex and has a flat bottom under broken global symmetry is shown to be wrong. We show spontaneous symmetry breaking necessarily accompanies non-convexity in the effective action for quantum field theory, or in the free energy for statistical mechanics, and clarify the magnitude of non-convexity. For quantum field theory, it is also explicitly proved that translational invariance breaks spontaneously when the system is in the non-convex region, and that different vacua of spontaneously broken symmetry cannot be superposed. As applications of non-convexity, we study the first-order phase transition which happens at the zero field limit of spontaneously broken symmetry, and we propose a simple model of phase coexistence which obeys the Born rule.

  18. Strongly broken Peccei-Quinn symmetry in the early Universe

    Energy Technology Data Exchange (ETDEWEB)

    Takahashi, Fuminobu [Department of Physics, Tohoku University,Sendai, Miyagi 980-8578 (Japan); Kavli IPMU (WPI), TODIAS, The University of Tokyo,Kashiwa, Chiba 277-8583 (Japan); Yamada, Masaki [Kavli IPMU (WPI), TODIAS, The University of Tokyo,Kashiwa, Chiba 277-8583 (Japan); Institute for Cosmic Ray Research, ICRR, The University of Tokyo,Kashiwa, Chiba 277-8582 (Japan)

    2015-10-06

    We consider QCD axion models where the Peccei-Quinn symmetry is badly broken by a larger amount in the past than in the present, in order to avoid the axion isocurvature problem. Specifically we study supersymmetric axion models where the Peccei-Quinn symmetry is dynamically broken by either hidden gauge interactions or the SU(3){sub c} strong interactions whose dynamical scales are temporarily enhanced by the dynamics of flat directions. The former scenario predicts a large amount of self-interacting dark radiation as the hidden gauge symmetry is weakly coupled in the present Universe. We also show that the observed amount of baryon asymmetry can be generated by the QCD axion dynamics via spontaneous baryogenesis. We briefly comment on the case in which the PQ symmetry is broken by a non-minimal coupling to gravity.

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

    Science.gov (United States)

    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.

  20. Experimental Study on the Porosity Creep Properties of Broken Limestone

    Directory of Open Access Journals (Sweden)

    Li Shun-cai

    2016-01-01

    Full Text Available In the underground engineering, the long-term stability of the surrounding rocks (especially the broken rocks containing water and the ground settlement resulted from the seepage-creep coupling above goaf have been the important research subjects concerning the deep mining. For the broken rock, its porosity is an important structural parameter determining its creep properties, and the porosity change rate is more superior to describe the creep characteristics compared with the strain change rate at a certain direction. In this paper, MTS815.02 Rock Mechanics Test System is used to carry out the creep experiments on water-saturated broken limestone, and then the time curves of porosity and of the porosity change rate are obtained. By regression, we have got the relation equation between the porosity change rate with the instant porosity and the stress level during the creep. The study indicates that when the stress retains a constant level, the relation between the porosity change rate and the instant porosity can be fitted with a cubical polynomial. The obtained creep relation equation between the porosity change rate and the instant porosity and the instant stress provides a necessary state equation for studying the coupling between the seepage and the creep of the broken rock. Furthermore, the seepage in the broken rock has been verified to satisfy the Forchheimer’s non-Darcy flow according to our previous studies, and its seepage properties, k, β and ca can all be expressed respectively as the polynomial of the porosity, so, by combining with these three state equations we have obtained the four essential state equations for solving the coupling problems of the seepage and the creep for the broken rocks.

  1. Evaluation of a pig femoral head osteonecrosis model

    Directory of Open Access Journals (Sweden)

    Kim Harry

    2010-03-01

    Full Text Available Abstract Background A major cause of osteonecrosis of the femoral head is interruption of a blood supply to the proximal femur. In order to evaluate blood circulation and pathogenetic alterations, a pig femoral head osteonecrosis model was examined to address whether ligature of the femoral neck (vasculature deprivation induces a reduction of blood circulation in the femoral head, and whether transphyseal vessels exist for communications between the epiphysis and the metaphysis. We also tested the hypothesis that the vessels surrounding the femoral neck and the ligamentum teres represent the primary source of blood flow to the femoral head. Methods Avascular osteonecrosis of the femoral head was induced in Yorkshire pigs by transecting the ligamentum teres and placing two ligatures around the femoral neck. After heparinized saline infusion and microfil perfusion via the abdominal aorta, blood circulation in the femoral head was evaluated by optical and CT imaging. Results An angiogram of the microfil casted sample allowed identification of the major blood vessels to the proximal femur including the iliac, common femoral, superficial femoral, deep femoral and circumflex arteries. Optical imaging in the femoral neck showed that a microfil stained vessel network was visible in control sections but less noticeable in necrotic sections. CT images showed a lack of microfil staining in the epiphysis. Furthermore, no transphyseal vessels were observed to link the epiphysis to the metaphysis. Conclusion Optical and CT imaging analyses revealed that in this present pig model the ligatures around the femoral neck were the primary cause of induction of avascular osteonecrosis. Since the vessels surrounding the femoral neck are comprised of the branches of the medial and the lateral femoral circumflex vessels, together with the extracapsular arterial ring and the lateral epiphyseal arteries, augmentation of blood circulation in those arteries will improve

  2. Elastoconductivity as a probe of broken mirror symmetries

    Energy Technology Data Exchange (ETDEWEB)

    Hlobil, Patrik; Maharaj, Akash V.; Hosur, Pavan; Shapiro, M. C.; Fisher, I. R.; Raghu, S.

    2015-07-27

    We propose the possible detection of broken mirror symmetries in correlated two-dimensional materials by elastotransport measurements. Using linear response theory we calculate the“shear conductivity” Γ x x , x y , defined as the linear change of the longitudinal conductivity σ x x due to a shear strain ε x y . This quantity can only be nonvanishing when in-plane mirror symmetries are broken and we discuss how candidate states in the cuprate pseudogap regime (e.g., various loop current or charge orders) may exhibit a finite shear conductivity. We also provide a realistic experimental protocol for detecting such a response.

  3. Aetiology of femoral hernias revisited: bilateral femoral hernia in a young male (two cases).

    Science.gov (United States)

    Kochupapy, R T; Ranganathan, G; Dias, S; Shanahan, D

    2013-01-01

    Bilateral femoral hernias are less common in men than in women and rare in young adults. Only one case of a bilateral femoral hernia in a young man has been reported in the literature before. Three main theories have been postulated for femoral hernias. The theory that they are an acquired disease is the most accepted due to the common occurrence of such hernias in multiparous women but the theory lacks enough evidence. We report two cases in young men. Anatomical variations in the femoral canal could be the primary aetiological factor in these patients. A unilateral femoral hernia in young men with acquired aetiological factors requires a clinical examination of the opposite side.

  4. Ender nail fixation for pediatric femoral shaft fractures%Ender钉治疗儿童股骨干骨折

    Institute of Scientific and Technical Information of China (English)

    冯林; 王晓东; 张锡庆; 王科文

    2005-01-01

    目的探讨Ender钉治疗儿童股骨干骨折的疗效. 方法对24例儿童股骨干骨折采用小切口Ender钉内固定,术后单侧髋人字石膏固定患肢4周. 结果随访 6个月~2年,无一例出现骨折不愈合、延迟愈合 .有4例出现双下肢不等长,均小于1 cm.无明显跛行,下肢功能完全正常. 结论只要严格掌握其适应证和禁忌证,Ender钉治疗5~10岁儿童股骨干骨折具有切口小,解剖复位,不破坏骨膜、利于骨折修复,住院时间短,功能恢复快等优点.

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

    Directory of Open Access Journals (Sweden)

    Gursimrat Singh Cheema

    2012-01-01

    Results: The bending moment of the PFN group was approximately 50% less than that of the DCS group (P<0.0001. The PFN group resisted more number of cycles than the DCS group (P=0.03 and showed lesser number of component failures as compared with the DCS group (P=0.003. Conclusions: The PFN is biomechanically superior to DCS for the fixation of reverse oblique trochanteric fractures of femur.

  6. The new diagnosing method basing on the frequency analysis of human's nails in T-RAY

    Science.gov (United States)

    Ma, Pengcheng; Xiao, Long

    2011-02-01

    It has been reported that many kinds of sickness can be reflected in one's nails. And because of the special composition and structure of nails, they are very suitable for T-ray detecting. Therefore we want to see whether we can diagnose some sickness by only analyzing the transmission of the nails. The experiments consist of three parts. In the first part, we took 200 samples which came from about 20 years old people. By that way, we got that the peak transmission wavelengths of human's nail is about 1.7THz and we almost acknowledged the characteristics of nails. Then we changed our samples coming from different ages, and some interesting phenomenon were coming out. Lastly, by detecting the nails which are taken from special patients, we discovered some sickness can be detected using T-ray.

  7. Management of a Low-Energy Penetrating Brain Injury Caused by a Nail

    Directory of Open Access Journals (Sweden)

    V. R. Ferraz

    2016-01-01

    Full Text Available Low-energy penetrating nail injury to the brain is an extremely rare neurosurgical emergency. The most common cause of nail gun injury is work related accidents; other causes result from accidental firing of a nail gun, suicide attempts by firing nail guns into the brain, and bomb blasts containing pieces of nails. Neurosurgical treatment performed by craniotomy still seems to be the safest one; there are reports of complications such as subdural hematoma and intraparenchymal hemorrhages following the blind removal of foreign bodies leading to suggestions that all penetrating foreign bodies should be removed under direct vision. We report a rarely described neurosurgical approach for removal of a penetrating nail from the brain and skull without evidence of associated hematoma and other brain lesions.

  8. A RARE FAMILIAL CASE REPORT OF NAIL-PATELLA SYNDROME

    Directory of Open Access Journals (Sweden)

    Rakesh

    2014-10-01

    Full Text Available Nail-patella syndrome is a rare genetic disorder, which is inherited as an autosomal dominant trait. This condition is also known as hereditary osteo-onychodysplasia (HOOD syndrome, Fong’s syndrome, Turner-Kieser syndrome. (1 Posterior iliac horns are commonly found in this syndrome and are considered pathognomonic. In this case report we have described almost all the radiographic features of nail-patella syndrome including the pathognomic iliac horns and other skeletal features including absent or hypoplastic patellae, elbow abnormalities, as seen on radiographs. The magnetic resonance imaging (MRI of the features of this syndrome has been mentioned in only one report, (2 however, no images were actually presented. Considering the hereditary nature (autosomal dominant of the syndrome we wanted to rule out whether any other member in the family are involved and to our surprise we found two other members(mother and elder brother in the family with similar features.

  9. Quantum restoration of broken symmetry in onedimensional loop space

    Indian Academy of Sciences (India)

    Pinaki Patra; Tanmay Mandal; Jyoti Prasad Saha

    2014-06-01

    For one-dimensional loop space, a nonlinear nonlocal transformation of fields is given to make the action of the self-interacting quantum field to the free one. A specific type of classically broken symmetry is restored in quantum theory. One-dimensional sine-Gordon system and sech interactions are treated as the explicit examples.

  10. Bags in relativistic quantum field theory with spontaneously broken symmetry

    Energy Technology Data Exchange (ETDEWEB)

    Wadati, M.; Matsumoto, H.; Umezawa, H.

    1978-08-15

    Presented is a microscopic derivation of bags from a relativistic quantum theory with spontaneously broken symmetry. The static energy of a bag whose singularity is the surface of a sphere coincides with the volume tension in the MIT bag theory. A similarity between the bags and the point defects in crystals is pointed out.

  11. Dynamically broken Anti-de Sitter action for gravity

    CERN Document Server

    Tresguerres, Romualdo

    2008-01-01

    Due to a suitable Higgs mechanism, a standard Anti-de Sitter gauge theory becomes spontaneously broken. The resulting Lorentz invariant gravitational action includes the Hilbert-Einstein term of ordinary Einstein-Cartan gravity with cosmological constant, plus contributions quadratic in curvature and torsion, and a scalar Higgs sector.

  12. A case of ingrown toenail accompanied by extreme soft tissue hypertrophy to the extent of invisible nail.

    Science.gov (United States)

    Seyfettinoğlu, Fırat; Sünneli, Özgür; Dülgeroğlu, Ali; Bora, Osman Arslan

    2012-01-01

    Ingrown nails occur when the nail fold grows inwards into the nail bed. This condition affects daily life and causes a loss of labor, and therefore, should be meticulously tackled and immediately treated. Ingrown nail is categorized in three stages based on pain, erythema, infection, drainage, and the presence of granulation tissue. We present hypertrophic tissue excision and bilateral partial matrix excision in an unclassified case of ingrown toenail in which the bilateral side wall hypertrophy covered the entire nail; normal tissue of the nail was invisible, along with first year follow-up results.

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

    Science.gov (United States)

    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.

  14. The Investigation of Nail Disorders in Patients with Chronic Renal Failure Undergoing Hemodialysis

    Directory of Open Access Journals (Sweden)

    Murat Kalender

    2012-06-01

    Full Text Available Objective: Nail changes are often observed in patients with end-stage renal disease. These changes may occur due to chronic renal failure itself or to the treatment. This study aims to investigate the frequency of nail findings in patients undergoing hemodialysis therapy and to compare with healthy controls.Methods: One hundred and four patients with chronic renal failure treated with hemodialysis, and 104 healthy controls without any dermatological and sistemic diseases, were examined for nail signs. Groups were compared for the incidence of nail findings. Results: 74.4% of hemodialysis patients, and 51.9% of controls had at least one nail finding. The most common signs in hemodialysis patients were (58.7% absence of lunula, (40.5% streaking, (15.7% terry nail and (14.9% half and half nail. In the control group, the most common signs were vertical streaking (36.5%, absence of lunula (8.7% and coilonichi (2.9%. In hemodialysis patients, absence of lunula, beau lines, onycomycosis, terry nail, half and half nail and splinter hemorrhages were found to be significantly higher (p<0.05.Conclusion: The frequency of nail diseases in hemodialysis patients is higher than in the healthy control group. In our study, absence of lunula is the most frequently observed finding in hemodialysis patients. Although the second most common nail change was vertical streaking, it was not different from the control group statistically. We recommend that, when hemodialysis patients are examined, nail examination (as a part of physical examination should be performed.

  15. The Investigation of Nail Disorders in Patients with Chronic Renal Failure Undergoing Hemodialysis

    Directory of Open Access Journals (Sweden)

    Perihan Öztürk

    2012-06-01

    Full Text Available Objective: Nail changes are often observed in patients with end-stage renal disease. These changes may occur due to chronic renal failure itself or to the treatment. This study aims to investigate the frequency of nail findings in patients undergoing hemodialysis therapy and to compare with healthy controls. Methods: One hundred and four patients with chronic renal failure treated with hemodialysis, and 104 healthy controls without any dermatological and sistemic diseases, were examined for nail signs. Groups were compared for the incidence of nail findings. Results: 74.4% of hemodialysis patients, and 51.9% of controls had at least one nail finding. The most common signs in hemodialysis patients were (58.7% absence of lunula, (40.5% streaking, (15.7% terry nail and (14.9% half and half nail. In the control group, the most common signs were vertical streaking (36.5%, absence of lunula (8.7% and coilonichi (2.9%. In hemodialysis patients, absence of lunula, beau lines, onycomycosis, terry nail, half and half nail and splinter hemorrhages were found to be significantly higher (p<0.05. Conclusion: The frequency of nail diseases in hemodialysis patients is higher than in the healthy control group. In our study, absence of lunula is the most frequently observed finding in hemodialysis patients. Although the second most common nail change was vertical streaking, it was not different from the control group statistically. We recommend that, when hemodialysis patients are examined, nail examination (as a part of physical examination should be performed. (Turk J Dermatol 2012; 6: 35-8

  16. Human Nail Plate Modifications Induced by Onychomycosis: Implications for Topical Therapy

    OpenAIRE

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

    2014-01-01

    Purpose Through the characterisation of the human onchomycotic nail plate this study aimed to inform the design of new topical ungual formulations. Methods The mechanical properties of the human nail were characterised using a Lloyd tensile strength tester. The nail’s density was determined via pycnometry and the nail’s ultrastructure by electron microscopy. Raman spectroscopy analysed the keratin disulphide bonds within the nail and its permeability properties were assessed by quantifying wa...

  17. Cephalomedullary fixation for femoral neck/intertrochanteric and ipsilateral shaft fractures: surgical tips and pitfalls

    Institute of Scientific and Technical Information of China (English)

    Kamal Bali; Nitesh Gahlot; Sameer Aggarwal; Vijay Goni

    2013-01-01

    Objective:Surgical management options for femoral shaft fracture and ipsilateral proximal femur fracture vary from single-implant to double-implant fixation.Cephalomedullary fixation in such fractures has relative advantages over other techniques especially because of less soft tissue dissection and immediate postoperative weight beating with accelerated rehabilitation.However,the surgery is technically demanding and there is a paucity of literature describing the surgical techniques for this fixation.The aim of the study was to describe the surgical technique of cephalomedullary fixation for femoral shaft fracture and ipsilateral proximal femur fracture.Methods:Sixteen cases (10 males and 6 females with a mean age of 41.8 years) ofipsilateral proximal femur and shaft fractures were treated by single-stage cephalomedullary fixation at tertiary level trauma center in northern India.The fractures were classified according to AO classification.An intraoperative record of duration of surgery as well as technical challenges unique to each fracture pattern was kept for all the patients.ResuRs:The most common proximal femoral pattern was AO B2.1 observed in 9 of our patients.The AO B2.3 fractures were seen in 4 patients while the AO A1.2 fractures in 3 patients.Four of the AO B2.1 and 2 of the AO B2.3 fractures required open reduction with Watson-Jones approach.The mean operative time was around 78 minutes,which tended to decrease as the surgical experience increased.There was only one case of malreduction,which required revision surgery.Conclusion:Combination of ipsilateral femoral shaft fracture and neck/intertrochanteric fracture is a difficult fracture pattern for trauma surgeons.Cephalomedullary nail is an excellent implant for such fractures but it requires careful insertion to avoid complications.Surgery is technically demanding with a definite learning curve.Nevertheless,a majority of these fractures can be surgically managed by singleimplant cephaiomedullary

  18. Irritant nail dermatitis of chemical depilatory product presenting with koilonychia.

    Science.gov (United States)

    Pancar, Gunseli Sefika; Kalkan, Goknur

    2014-03-01

    Chemical hair removal products are available as creams, gels, powders, aerosols and roll-ons and all of these forms work in the same way by breaking chemical bonds between sulfur atoms in the protein. Currently, the common active ingredients of these products are calcium thioglycolate, potassium thioglycolate, arsenic and sulfur minerals. Sulfur and arsenic containing products are important toxic chemicals which are mainly used for removing hair in developing countries. Irritant contact dermatitis accounts for 80% of all contact dermatitis reactions which are often occupation-related. Toluene sulfonamide, formaldehyde resin, acrylates and ethylcyanoacrylate are the most common irritants. Irritant nail dermatitis with plants has been well defined with Lobelia richardii flower, Compositae family and garlic. Although allergic dermatitis, irritant dermatitis and irritant nail dermatitis have been well demonstrated with chemicals, koilonychia is unusual presentation of irritant dermatitis. Here we describe a case of nail irritant dermatitis due to application of chemical depilatory product for hair removal presented with koilonychias. To our knowledge this is the first case of such presentation with koilonychia in the English literature.

  19. Fracture Union in Closed Interlocking Nail in Humeral Shaft Fractures

    Institute of Scientific and Technical Information of China (English)

    Ramji Lal Sahu; Rajni Ranjan; Ajay Lal

    2015-01-01

    Background:Fracture shaft humerus is a major cause of morbidity in patients with upper extremity injuries.The aim of this study was to evaluate the outcome of interlocking nail in humeral shaft fractures.Methods:This study was conducted in the Department of Orthopedic Surgery in SMS and R Sharda University from January 2010 to November 2013.Seventy-eight patients were recruited from emergency and out-patient department having a close fracture of humerus shaft.All patients were operated under general anesthesia and closed reamed interlocking nailing was done.All patients were followed for 9 months.Results:Out of 78 patients,69 patients underwent union in 90-150 days with a mean of 110.68 days.Complications found in four patients who had nonunion,and five patients had delayed union,which was treated with bone grafting.All the patients were assessed clinically and radiologically for fracture healing,joint movements and implant failure.The results were excellent in 88.46% and good in 6.41% patients.Complete subjective,functional,and clinical recovery had occurred in almost 100% of the patients.Conclusions:The results of the present study indicates that in the presence of proper indications,reamed antegrade intramedullary interlocked nailing appears to be a method of choice for internal fixation of osteoporotic and pathologic fractures.

  20. Nail polish as a source of exposure to triphenyl phosphate.

    Science.gov (United States)

    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 (ppolish may be a significant source of short-term TPHP exposure and a source of chronic exposure for frequent users or those occupationally exposed.

  1. Effects of Organic Solvents on the Barrier Properties of Human Nail

    OpenAIRE

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

    2011-01-01

    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. 3H–water, 14C–urea, and 14C–tetraethylammonium ions were the probes in the nail uptake and transport experiments to study the effect(s) of organic solvents on nail hy...

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

    Science.gov (United States)

    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.

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

    Directory of Open Access Journals (Sweden)

    Amir Bazrafshan

    2013-06-01

    Full Text Available 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.

  4. Intramedullary nailing of clavicular midshaft fractures in adults using titanium elastic nail

    Institute of Scientific and Technical Information of China (English)

    CHEN Qing-yu; PENG Lei; L(U) Chuan-zhu; KOU Dong-quan; CHENG Xiao-jie; ZHANG Wei; WANG Wei; LIN Zhang-qin; CHENG Shao-wen; SHEN Yue; YING Xiao-zhou

    2011-01-01

    Objective: Studies showed elastic stable intramedullary nailing (ESIN) of displaced midclavicular fractures has excellent outcomes, as well as high complication rates and specific problems. The aim was to discuss ESIN of midshaft clavicular fractures.Methods: Totally 60 eligible patients (aged 18-63 years) were randomized to either ESIN group or non-operative group between January 2007 and May 2008. Clavicular shortening was measured after trauma and osseous consolidation.Radiographic union and complications were assessed. Function analysis including Constant shoulder scores and disabilities of the arm, shoulder and hand (DASH) scores were performed after a 15-month follow-up.Results: ESIN led to a signifcantly shorter time to union, especially for simple fractures. In ESIN group, all patients got fracture union, of which 5 cases had medial skin irritation and 1 patient needed revision surgery because of implant failure. In the nonoperative group, there were 3 nonunion cases and 2 symptomatic malunions developed requiring corrective osteotomy. At 15 months after intramedullary stabilization, patients in the ESIN group were more satisfied with the appearance of the shoulder and overall outcome, and they benefited a lot from the great improvement of post-traumatic clavicular shortening. Furthermore,DASH scores were lower and Constant scores were significantly higher in contrast to the non-operative group.Conclusion: ESIN is a safe minimally invasive surgical technique with lower complication rate, faster return to daily activities, excellent cosmetic and better functional results,restoration of clavicular length for treating mid-shaft clavicular fractures, resulting in high overall satisfaction, which can be regard as an alternative to plate fixation or nonoperative treatment of mid-shaft clavicular fractures.

  5. Femoral hernia: a review of 83 cases.

    Science.gov (United States)

    Alimoglu, O; Kaya, B; Okan, I; Dasiran, F; Guzey, D; Bas, G; Sahin, M

    2006-03-01

    We evaluate the factors that affect morbidity and mortality in patients who underwent surgery due to femoral hernia. The medical records of 83 patients who underwent femoral hernia repair between January 1996 and June 2004 were retrospectively analyzed. The femoral hernias were repaired either with McVay or mesh plug hernioplasty. Sex, age, surgical repair technique, presence of incarceration/strangulation, incarcerated/strangulated organs, postoperative complications, duration of hospitalization, recurrence rate, and factors that affect mortality and morbidity were studied. There were 83 patients with femoral hernia in our study. Patients' age ranged from 10 to 75 years (mean age was 46.84) with a predominance of female (71%). Thirty-six patients (40%) underwent emergency surgery with the diagnosis of strangulation or incarceration of femoral hernia. Seventeen patients had strangulation and underwent resection; eleven of these patients had omentum in the hernial sac, whereas six patients had intestines. Four of these patients underwent laparotomy. The remaining 19 patients had incarceration and underwent simple reduction of hernial sac content without resection. Forty-seven (60%) patients underwent elective surgery. McVay technique was used for 79 patients, while the other four patients were treated with mesh-plug. Twelve patients (15%) developed a variety of complications (nine patients (25%) in emergency, three patients (6%) in elective group). There was one mortality. Recurrences occurred in two patients. Femoral hernia is an important surgical pathology with high rates of incarceration/strangulation and intestinal resection. Emergency surgery can increase morbidity and mortality especially in the elderly. Early elective surgery may reduce complication.

  6. Femoral component loosening after hip resurfacing arthroplasty

    Energy Technology Data Exchange (ETDEWEB)

    Zustin, Jozef; Sauter, Guido [University Medical Centre Hamburg-Eppendorf, Institute of Pathology, Hamburg (Germany); Hahn, Michael [University Medical Centre Hamburg-Eppendorf, Center for Biomechanics and Skeletal Biology, Hamburg (Germany); Morlock, Michael M. [TUHH Hamburg University of Technology, Biomechanics Section, Hamburg (Germany); Ruether, Wolfgang [University Medical Centre Hamburg-Eppendorf, Department of Orthopaedics, Hamburg (Germany); Amling, Michael [University Medical Centre Hamburg-Eppendorf, Center for Biomechanics and Skeletal Biology, Hamburg (Germany); University Medical Centre Hamburg-Eppendorf, Department of Trauma, Hand and Reconstructive Surgery, Hamburg (Germany)

    2010-08-15

    Before the re-introduction of the current generation of total hip resurfacing arthroplasty, component loosening and osteolysis were of great concern to the orthopaedic community. Early, mid- and long-term clinical results are encouraging, but component loosening still exists. Macroscopic, contact radiographic and histopathological analyses after undecalcified preparation of bone tissue specimens were performed. To investigate the frequency and morphological patterns of the loosening of the femoral component, we analysed a series of 190 retrieved femoral remnants that were revised for aseptic failures. Thirty-five (18.4%) hips were revised for clinical and/or radiographic loosening of the femoral component. Pseudoarthrosis (n = 17; median in situ time: 16 weeks, interquartile range [IQR]: 9 to 34), collapsed osteonecrosis (n = 5; median in situ time: 79 weeks, IQR: 63 to 97), cement-socket debonding (n = 3; median in situ time: 89 weeks, IQR: 54 to 97) and at later follow-up bone-cement loosening (n = 10; median in situ time: 175 weeks; IQR 112 to 198; p =0.005) were distinct patterns of the femoral remnant-implant loosening. Fibrocartilaginous metaplasia of interface bone trabeculae (n = 38; median in situ time: 61 weeks, IQR: 32 to 138) was strongly associated with femoral component loosening (p = 0.009). Both the trabecular hyperosteoidosis (n = 32; median in situ time: 71 weeks, IQR 50 to 129) and excessive intraosseous lymphocyte infiltration (n = 12; median in situ time: 75 weeks, IQR 51 to 98) at the bone-cement interface correlated strongly with fibrocartilaginous metaplasia (p = 0.001 and p = 0.016 respectively) and all three lesions were associated with the female gender (p = 0.021, p = 0.009, and p = 0.051). Femoral component loosening at early follow-up was mostly caused by pathological changes of the femoral remnant bone tissue: pseudoarthrosis and collapsed osteonecrosis. Fibrocartilaginous metaplasia was frequently observed in hips with femoral

  7. Nail Changes in End-Stage Renal Failure Patients on Hemodialysis

    Directory of Open Access Journals (Sweden)

    Jamal Arshad

    2000-01-01

    Full Text Available To evaluate the fingernail changes in patients with end-stage renal failure (ESRF on regular hemodialysis (HD, we reviewed 69 patients (male 25, female 44; age 40 ± 14.8 years who have been on HD at Samtah General Hospital, Gizan, Kingdom of Saudi Arabia for a mean of 4.3 ± 3.06 years. They were free from congenital, systemic or primary skin disorders contributing to nail changes. The patients were also free from ornamental dyes like henna, traumatic injuries or infections in the fingernails. They were also clinically free from features suggestive of the carpal tunnel syndrome or vascular steal syndrome secondary to arteriovenous fistula (AVF created for vascular access. Their nails were examined under bright day light by the authors independently. The findings consistent among all three observers were taken for analysis. Hemoglobin and serum albumin levels were also estimated. We compared these changes according to age, sex, and duration on chronic hemodialysis, AVF, and the levels of serum albumin and hemoglobin. One or more nail changes were observed in 44/69 (64% patients. The commonest abnormality was the so-called "Half-and-half nail changes", which was observed in the finger nails of 18/69 (26% of the study patients (males to female ratio was 2:1. Typically, the half-and-half nails are nails where the distal portion of the nail bed is red, pink or brown, occupies 20-60% of the total nail length and is always sharply demarcated with the proximal portion. The latter has a dull whitish ground glass appearance and when pressure is applied, the distal discoloration does not fade completely. Non-specific nail changes were observed 26/69 (38% patients. The hemoglobin and serum albumin levels were not significantly different of those with ′half-and-half′ nail, non-specific nail changes or no nail changes. We conclude that various fingernail changes are observed in ESRF patients on HD. These nail changes are independent of the age of the

  8. Radographic changes of the revascularized femoral head

    Energy Technology Data Exchange (ETDEWEB)

    Rindell, K. (Orthopaedic Hospital of the Invalid Foundation, Helsinki (Finland). Department of Orthopeadic Surgery); Tallroth, K. (Orthopaedic Hospital of the Invalid Foundation, Helsinki (Finland). Department of Radiology); Lindholm, T.S. (Tampere University Central Hospital (Finland). Department of Surgery, Section of Orthopaedics and Traumatology)

    Twenty-two nerotic femoral heads in young adults were radiologically followed-up after grafting with vascularized bone by comparing the preoperative and the postoperative state of the hip joint. Three parameters were observed and followed; the flattening of the femoral head: the degree of osteoarthrosis of the joints; and the degree of incorporation of the graft into the recipient bone. The results, expressed by index figures, showed that the femoral head flattened during the first two years postoperatively; that the maximal incorporation occurred during the same period of time; and that the appearance of postoperative osteoarthrosis was slow during the first year and increased subsequently. This numerical characterization of radiological finding allows systematic individual analysis after revascularization of the femoral head with bone grafts. It is also suited for comparisons between patients, between series of patients and of various treatment techniques. Furthermore, this quatification provides a numerical index that seems to correlate with the outcome of the treated hip joint. (author). 12 refs.; 6 figs.; 1 tab.

  9. Postmortem Femoral Blood Concentrations of Risperidone

    DEFF Research Database (Denmark)

    Linnet, Kristian; Johansen, Sys Stybe

    2014-01-01

    Postmortem femoral blood concentrations of the antipsychotic drug risperidone and the active metabolite 9-hydroxyrisperidone were determined by an achiral LC-MS/MS method in 38 cases. The cause of death was classified as unrelated to risperidone in 30 cases, in which the sum of the concentration ...

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

    Science.gov (United States)

    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.

  11. Atypical subtrochanteric and diaphyseal femoral fractures

    DEFF Research Database (Denmark)

    Shane, Elizabeth; Burr, David; Abrahamsen, Bo;

    2014-01-01

    that distinguish AFFs from ordinary osteoporotic femoral diaphyseal fractures and to provide guidance on the importance of their transverse orientation. The requirement that fractures be noncomminuted was relaxed to include minimal comminution. The periosteal stress reaction at the fracture site was changed from...

  12. Tension free femoral hernia repair with plug

    Directory of Open Access Journals (Sweden)

    Milivoje Vuković

    2013-01-01

    Conclusions: The technique of closing the femoral canal with plug a simple. The plug is made from monofilament material and is easily formed. This technique allows the reduction of recurrence and can be used safely, quickly and easily in elective and emergency situations.

  13. Corneoscleral abscess resulting from a broken suture after cataract surgery.

    Science.gov (United States)

    Cameron, J A; Huaman, A

    1994-01-01

    An 82-year-old man had pain and decreased vision in his right eye 15 months after uncomplicated cataract surgery. Examination revealed a large corneoscleral abscess with a 2 mm x 1 mm area of fluorescein staining at the base of a broken protruding 10-0 nylon suture. Streptococcus pneumoniae was isolated from both the suture and base of the ulcer. Despite intensive topical, subconjunctival, and systemic antibiotics, a large corneal perforation developed, necessitating a 10 mm tectonic penetrating keratoplasty. Long-term follow-up of patients after cataract surgery is important and should include an inspection of the limbal wound and removal of loose or broken exposed sutures. Suture-related complications will be eliminated if clinical studies prove the safety and efficacy of sutureless cataract surgery.

  14. Consistency condition for inflation from (broken) conformal symmetry

    Energy Technology Data Exchange (ETDEWEB)

    Schalm, Koenraad; Aalst, Ted van der [Instituut-Lorentz for Theoretical Physics, Universiteit Leiden, Niels Bohrweg 2, Leiden (Netherlands); Shiu, Gary, E-mail: kschalm@lorentz.leidenuniv.nl, E-mail: shiu@physics.wisc.edu, E-mail: vdaalst@lorentz.leidenuniv.nl [Department of Physics, University of Wisconsin-Madison, Madison, WI 53706 (United States)

    2013-03-01

    We investigate the symmetry constraints on the bispectrum, i.e. the three-point correlation function of primordial density fluctuations, in slow-roll inflation. It follows from the defining property of slow-roll inflation that primordial correlation functions inherit most of their structure from weakly broken de Sitter symmetries. Using holographic techniques borrowed from the AdS/CFT correspondence, the symmetry constraints on the bispectrum can be mapped to a set of stress-tensor Ward identities in a weakly broken 2+1-dimensional Euclidean CFT. We construct the consistency condition from these Ward identities using conformal perturbation theory. This requires a second order Ward identity and the use of the evolution equation. Our result also illustrates a subtle difference between conformal perturbation theory and the slow-roll expansion.

  15. Adiabatic approximation for the Rabi model with broken inversion symmetry

    Science.gov (United States)

    Shen, Li-Tuo; Yang, Zhen-Biao; Wu, Huai-Zhi

    2017-01-01

    We study the properties and behavior of the Rabi model with broken inversion symmetry. Using an adiabatic approximation approach, we explore the high-frequency qubit and oscillator regimes, and obtain analytical solutions for the qubit-oscillator system. We demonstrate that, due to broken inversion symmetry, the positions of two potentials and zero-point energies in the oscillators become asymmetric and have a quadratic dependence on the mean dipole moments within the high-frequency oscillator regime. Furthermore, we find that there is a critical point above which the qubit-oscillator system becomes unstable, and the position of this critical point has a quadratic dependence on the mean dipole moments within the high-frequency qubit regime. Finally, we verify this critical point based on the method of semiclassical approximation.

  16. Afterglow Light Curves and Broken Power Laws: A Statistical Study

    CERN Document Server

    J'ohannesson, G; Gudmundsson, E H; J\\'ohannesson, Gudlaugur; Bj\\"ornsson, Gunnlaugur; Gudmundsson, Einar H.

    2006-01-01

    In gamma-ray burst research it is quite common to fit the afterglow light curves with a broken power law to interpret the data. We apply this method to a computer simulated population of afterglows and find systematic differences between the known model parameters of the population and the ones derived from the power law fits. In general, the slope of the electron energy distribution is overestimated from the pre-break light curve slope while being underestimated from the post-break slope. We also find that the jet opening angle derived from the fits is overestimated in narrow jets and underestimated in wider ones. Results from fitting afterglow light curves with broken power laws must therefore be interpreted with caution since the uncertainties in the derived parameters might be larger than estimated from the fit. This may have implications for Hubble diagrams constructed using gamma-ray burst data.

  17. Anomalous dimensions in CFT with weakly broken higher spin symmetry

    Science.gov (United States)

    Giombi, Simone; Kirilin, Vladimir

    2016-11-01

    In a conformal field theory with weakly broken higher spin symmetry, the leading order anomalous dimensions of the broken currents can be efficiently determined from the structure of the classical non-conservation equations. We apply this method to the explicit example of O( N) invariant scalar field theories in various dimensions, including the large N critical O( N) model in general d, the Wilson-Fisher fixed point in d = 4 - ɛ, cubic scalar models in d = 6 - ɛ and the nonlinear sigma model in d = 2 + ɛ. Using information from the d = 4 - ɛ and d = 2 + ɛ expansions, we obtain some estimates for the dimensions of the higher spin operators in the critical 3d O( N) models for a few low values of N and spin.

  18. The Low Keratin Affinity of Efinaconazole Contributes to Its Nail Penetration and Fungicidal Activity in Topical Onychomycosis Treatment

    OpenAIRE

    Sugiura, Keita; Sugimoto, Noriaki; Hosaka, Shinya; Katafuchi-Nagashima, Maria; Arakawa, Yoshio; TATSUMI, Yoshiyuki; Jo Siu, William; Pillai, Radhakrishnan

    2014-01-01

    Onychomycosis is a common fungal nail disease that is difficult to treat topically due to the deep location of the infection under the densely keratinized nail plate. Keratin affinity of topical drugs is an important physicochemical property impacting therapeutic efficacy. To be effective, topical drugs must penetrate the nail bed and retain their antifungal activity within the nail matrix, both of which are adversely affected by keratin binding. We investigated these properties for efinacona...

  19. Ipsilateral Acetabular and Femoral Neck and Shaft Fractures

    Directory of Open Access Journals (Sweden)

    Hideto Irifune

    2015-01-01

    Full Text Available Floating hip injuries and ipsilateral femoral neck and shaft fractures are rare. Additionally, the simultaneous occurrence of these injuries is extremely rare, and only one case report of the simultaneous occurrence of these injuries has been published. Here, we report the case of a patient with ipsilateral acetabular and femoral neck and shaft fractures following a suicide attempt. The patient experienced nonunion of the femoral neck and shaft after the initial operation and therefore underwent reconstruction using a femoral head prosthesis with a long stem and interlocking screws. Our procedure may be used in primary and/or secondary reconstruction for ipsilateral acetabular and femoral neck and shaft fractures.

  20. Mass Formulae for Broken Supersymmetry in Curved Space-Time

    CERN Document Server

    Ferrara, Sergio

    2016-01-01

    We derive the mass formulae for ${\\cal N}=1$, $D=4$ matter-coupled Supergravity for broken (and unbroken) Supersymmetry in curved space-time. These formulae are applicable to de Sitter configurations as is the case for inflation. For unbroken Supersymmetry in anti-de Sitter (AdS) one gets the mass relations modified by the AdS curvature. We compute the mass relations both for the potential and its derivative non-vanishing.