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Sample records for broken femoral nails

  1. Stuffing the nail: A simple technique for the extraction of a broken femoral nail.

    Science.gov (United States)

    Lovell, Jane; Krishna, Damodaran; Gehr, Eugene

    2017-06-01

    The extraction of broken femoral nails can be a challenging procedure and surgeons should be familiar with many different techniques. This paper demonstrates a case study and new, simple and cost effective technique for the removal of broken cannulated femoral nails. Our technique uses two guide wires of variable diameter and had several key points of differentiation from previous methods. Firstly, stuffing the nail with guide wires of greater total diameter than the cannula; secondly, reversing the second guide wire and finally, bending the tips of the wires. These innovations allow the technique to be used for narrow cannulated nails, superior purchase along the length of the nail, easy wire insertion and limited soft tissue damage. Our technique for the removal of broken femoral nails is quick, effective, cheap and easy to replicate and can be used by any generalist orthopaedic surgeon with basic equipment.

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

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    Metikala, Sreenivasulu; Mohammed, Riazuddin

    2011-07-01

    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. 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. 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. We report a technique for successful extraction of the distal fragment of broken femoral intramedullary nails without additional surgical approaches.

  3. Current indications for open Kuntscher nailing of femoral shaft ...

    African Journals Online (AJOL)

    Current indications for open Kuntscher nailing of femoral shaft fractures. A S Bajwa FCS(SA)ORTH. E Schnaid FCS(SA)ORTH. M E B Sweet MD PhD(rned). University of Witwatersrand, Johannesburg, South Africa. Key Words: Kuntscher nail, intramedullary nail, femoral fracture. We retrospectively reviewed 32 patients with.

  4. Effectiveness of plate augmentation for femoral shaft nonunion after nailing

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    Chin-Jung Lin

    2012-08-01

    Conclusion: Plate augmentation with retention of the nail with autologous bone grafting may be an effective and reliable alternative in treating nonunion of the femoral shaft fracture after open reduction and internal fixation with intramedullary nail.

  5. Subtrochanteric femoral fracture during trochanteric nailing for the treatment of femoral shaft fracture.

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    Yun, Ho Hyun; Oh, Chi Hun; Yi, Ju Won

    2013-09-01

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

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

    OpenAIRE

    Yun, Ho Hyun; Oh, Chi Hun; Yi, Ju Won

    2013-01-01

    We report on three cases of subtrochanteric femoral fractures during trochanteric intramedullary nailing for the treatment of femoral shaft fractures. Trochanteric intramedullary nails, which have a proximal lateral bend, are specifically designed for trochanteric insertion. When combined with the modified insertion technique, trochanteric intramedullary nails reduce iatrogenic fracture comminution and varus malalignment. We herein describe technical aspects of trochanteric intramedullary nai...

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

    Science.gov (United States)

    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.

  8. COMPARATIVE STUDY OF KUNTSCHER’S NAIL VS. INTERLOCKING NAILING FOR FEMORAL ISTHMUS FRACTURES

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    Rajeev Kumar Roy

    2017-05-01

    Full Text Available BACKGROUND Interlocking intramedullary nailing is suitable for comminuted femoral isthmus fractures, but for non-comminuted fractures its benefit over unlocked nailing is debatable. This study was undertaken to compare outcomes of interlocking nailing versus k-nail in such fractures. MATERIALS AND METHODS 40 cases of noncomminuted femoral isthmus fractures treated with interlocking nailing and K-nail from April 1, 2015, to December 1, 2016, were reviewed. Radiological and clinical union rates, bony alignment, complication and knee function were investigated. RESULTS There was no statistical significant difference with regard to union rate, implant failure, infection and fracture alignment in both study groups. Open fixation with K-nail is technically less demanding and requires less operating time; additionally, there is no exposure to radiation and cost of the implant is cheaper. CONCLUSION We therefore conclude that unlocked nailing is still useful for the management of noncomminuted isthmus fractures of the femur.

  9. OUTCOME OF INTERTROCHANTERIC FRACTURES TREATED WITH SHORT FEMORAL NAIL

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    Yadkikar Shriniwas V, Yadkikar Vishnu S, Patel Mayank, Dhruvilkumar Gandhi, Kunkulol Rahul

    2015-07-01

    Full Text Available Aim: To study the functional and anatomical outcome of Inter trochanteric fractures of femur treated with Short femoral nail. Method: This was retrospective study carried out in which 60 patients (50 Male & 10 Female of 5th to 8th decade of life who underwent Short femoral nail fixation for both Stable & unstable Inter Trochanteric fractures. From the records each patient data was assessed for time required for mobilization, average fracture healing time, degree and grade of hip range of movements, complications, anatomical reduction achieved using Short femoral nail fixation. Results: 55 cases achieved Anatomical reduction. Good to Excellent Hip range of Motion was in 55 (90 % cases. Fracture union was seen in all cases. No evidence of Z Effect, AVN of femoral head, Implant failure, Fracture of femoral shaft below the Nail tip was seen in any case, However Reverse Z Effect was seen in 4 & shortening of less than 2 cm was seen in 2 cases, External rotation of 10 degree was seen in1 case. Average fracture Union time was 14 weeks. Conclusion: Short femoral nail appears to be better implant for fixation of both Stable & unstable Inter Trochanteric fractures as it fulfills the biomechanical demands being minimally invasive, less blood loss , it prevents excessive varus collapse at fracture site, produces less stress riser effect below the nail tip, Short operative time, Facilitates early mobilization & functional recovery of patients. But Anatomical fracture reduction & optimal implant placement are absolutely must for better results.

  10. Ender’s Nail fixation in paediatric femoral shaft fractures.

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    Rajeev Dwivedi

    2013-12-01

    Flynn criteria 34 had excellent and 6 had satisfactory results. No poor results were seen. Conclusion: Ender’s nail fixation can be preferred method of treatment for femoral shaft fractures in age group 5 -15 years as the results are excellent and satisfactory. It is technically simple and can be done in a closed manner. It spares the vascularity and growth plate.

  11. ediatric femoral shaft fractures treated by flexible intramedullary nailing.

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

    2015-01-01

    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. 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. 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. 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.

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

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

    2014-12-01

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

  13. Evaluation of the Superior Gluteal Nerve During Proximal Femoral Nailing

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    Mehmet Sonmez

    2017-05-01

    Full Text Available Aim: The superior gluteal nerve may be compromised during hip surgery. We retrospectively evaluated the patients who underwent proximal femoral nailing for unstable trochanteric fractures in order to investigate the presence of superior gluteal nerve injury and its clinical findings. Material and Method: Twenty five patients (14 women, 11 men were included in the study who had femoral nailing between January 2004 and March 2010 at Hamidiye Sisli Etfal Training and Research Hospital Department of Orthopaedics. Two different types of nails which have similar designs and surgical techniques were used for fracture fixation. Patients who had a history of cerebrovascular disease, electromyography findings of polyneuropathy, or degenerative vertebral disease were excluded from the study. Patients were evaluated clinically and radiologically. Findings related to acute denervation in the gluteus medius muscle and motor unit action potential changes were accepted as signs of superior gluteal nerve injury. Results: Eight patients were using support during walking and three of these patients had positive Trendelenburg sign, but only one patient had acute denervation signs of the superior gluteal nerve. Discussion: Based on the present study the incidence of iatrogenic nerve injury is a rare complication of proximal femoral nailing. Elderly patients, regardless of whether they have nerve injury, may limp and need to use a walking support.

  14. Treatment of unstable trochanteric fractures. Randomised comparison of the gamma nail and the proximal femoral nail.

    NARCIS (Netherlands)

    Schipper, I.B.; Steyerberg, E.W.; Castelein, R.M.; Heijden, F.H. van der; Hoed, P.T. den; Kerver, A.J.; Vugt, A.B. van

    2004-01-01

    The proximal femoral nail (PFN) is a recently introduced intramedullary system, designed to improve treatment of unstable trochanteric fractures of the hip. In a multicentre prospective clinical study, the intra-operative use, complications and outcome of treatment using the PFN (n = 211) were

  15. The treatment of nonisthmal femoral shaft nonunions with im nail exchange versus augmentation plating.

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    Park, Jin; Kim, Sul Gee; Yoon, Han Kook; Yang, Kyu Hyun

    2010-02-01

    The purpose of this study was to compare the results between exchange nailing (EN) and augmentation plating (AP) with a nail left in situ for nonisthmal femoral shaft nonunion after femoral nailing. : Retrospective data analysis, November 1996-March 2006. A level I trauma center. Eighteen patients with 18 nonisthmal femoral nonunions. Seven patients with 7 fractures treated for nonisthmal femoral shaft nonunions after femoral nailing with EN and 11 patients with 11 fractures treated for nonisthmal femoral shaft nonunions after nailing with AP combined with bone grafting. Union and complications. Five nonunions in the EN group failed to achieve union (72% failure rate), whereas all 11 pseudarthroses in the AP group obtained osseous union. Fisher exact test showed a higher nonunion rate of EN compared with AP for nonisthmal femoral shaft nonunion (odds ratio, 6.5; P = 0.002). AP with autogenous bone grafting may be a better option than EN for nonisthmal femoral nonunions.

  16. Flexible intramedullary nailing for femoral diaphyseal fractures in children

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    Rojan Tamrakar

    2017-12-01

    Full Text Available Background & Objectives: Although various treatment options are available for the treatment of femoral diaphyesal fractures in children, the titanium flexible nailing has gained popularity because it is safe, easy procedure with rapid recovery and high success rate. The aim of this study was to evaluate the outcome of titanium elastic nails in treating paediatric femoral diaphyesal fractures at Patan Hospital.Materials & Methods: There were 35 cases which were all fixed with titanium flexible intramedullary nail under image intensifier at the Patan hospital from January 2013 and December 2015. Patients were evaluated in follow-ups to observe the alignment of fracture, infection, delayed union, nonunion, limb length discrepancy, implant failure, range of movement of hip and knee joints, and time to unite the fracture. The final results were evaluated using criteria of titanium elastic nail (TEN outcome score described by Flynn et al.Results: The mean age of the patients was 8.51 years. Among 35 patients (22 boys and 13 girls, there were 19 mid-shaft fractures, nine proximal third fractures and seven distal third fractures. Fracture patterns were transverse (22, oblique (10, spiral (2, and comminuted (2. The mean time for fracture union was 8.17 weeks radiologically whereas 9.83 weeks clinically. According to TEN outcome score, excellent and good results were in 28 cases (80% and seven cases (20% respectively.Conclusion: Flexible titanium nailing is a safe and satisfactory treatment for diaphyseal femoral fractures in children, because it provides rapid recovery, short rehabilitation and immobilization as well as very high union rate with few complications.

  17. Incidence of Avascular Necrosis of the Femoral Head After Intramedullary Nailing of Femoral Shaft Fractures

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    Kim, Ji Wan; Oh, Jong-Keon; Byun, Young-Soo; Shon, Oog-Jin; Park, Jai Hyung; Oh, Hyoung Keun; Shon, Hyun Chul; Park, Ki Chul; Kim, Jung Jae; Lim, Seung-Jae

    2016-01-01

    Abstract The goal of this study was to determine the incidence of avascular necrosis of the femoral head (AVNFH) after intramedullary nailing of femoral shaft fractures and to identify risk factors for developing AVNFH. We retrospectively reviewed all patients with femoral shaft fractures treated with antegrade intramedullary nailing at 10 institutions. Among the 703 patients enrolled, 161 patients were excluded leaving 542 patients in the study. Average age was 42.1 years with average follow-up of 26.3 months. Patient characteristics and fracture patterns as well as entry point of femoral nails were identified and the incidence of AVNFH was investigated. Patients were divided into 2 groups according to open versus closed physis, open versus closed fractures, and age (<20 versus ≥20 years). Overall incidence of AVNFH was 0.2% (1 of 542): the patient was 15-year-old boy. Of 25 patients with open physis, the incidence of AVNFH was 4%, whereas none of 517 patients with closed physis developed AVNFH (P < 0.001). The incidence of AVNFH in patients aged < 20 versus ≥20 years was 1.1% (1 of 93) and 0.0% (0 of 449), respectively (P = 0.172), which meant that the incidence of AVNFH was 0% in adult with femur shaft fracture. Of 61 patients with open fractures, the incidence of AVNFH was 0%. The number of cases with entry point at the trochanteric fossa or tip of the greater trochanter (GT) was 324 and 218, respectively, and the incidence of AVNFH was 0.3% and 0.0%, respectively (P = 0.412). In patients aged ≥20 years with isolated femoral shaft fracture, there was no case of AVNFH following antegrade intramedullary nailing regardless of the entry point. Therefore, our findings suggest that the risk of AVNFH following antegrade femoral nailing is extremely low in adult patients. PMID:26844518

  18. 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.

  19. Long-term functional outcome following intramedullary nailing of femoral shaft fractures

    NARCIS (Netherlands)

    el Moumni, Mostafa; Voogd, Emma Heather; ten Duis, Henk Jan; Wendt, Klaus Wilhelm

    Background: The management of femoral shaft fractures using intramedullary nailing is a popular method. The purpose of this study was to evaluate the long-term functional outcome after antegrade or retrograde intramedullary nailing of traumatic femoral shaft fractures. We further determined

  20. Shielding of the patient's gonads during intramedullary interlocking femoral nailing.

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    Kwong, L M; Johanson, P H; Zinar, D M; Lenihan, M R; Herman, M W

    1990-12-01

    Levels of exposure to radiation were recorded at sixty sites in fifteen patients during intramedullary interlocking femoral nailing. Radiation film dosimeters were placed at four gonadal sites on each subject. A standard male-gonad cup or a pelvic drape of 0.5-millimeter-thick lead-equivalent was put in place to shield the gonads. A second set of four dosimeters was placed external to the shield to approximate unprotected exposure. The total duration of the fluoroscopy averaged five minutes (range, thirty seconds to fourteen minutes). The total exposure to radiation external to the shield was 35 +/- 34 millirems at the male gonadal sites and 17 +/- 11 millirems at the female gonadal sites. With use of the gonadal shield, exposure to radiation was not measurable in thirteen of the fifteen patients. The differences between the exposures of the shielded and unshielded sites to radiation were statistically significant (p less than 0.001). The highest level of gonadal exposure was found with the treatment of proximal femoral fractures and with the use of statically locked nails. Regardless of the conditions, and for all types of fractures and locations, our results demonstrated that gonadal shielding is justified.

  1. Shielding of the patient's gonads during intramedullary interlocking femoral nailing

    International Nuclear Information System (INIS)

    Kwong, L.M.; Johanson, P.H.; Zinar, D.M.; Lenihan, M.R.; Herman, M.W.

    1990-01-01

    Levels of exposure to radiation were recorded at sixty sites in fifteen patients during intramedullary interlocking femoral nailing. Radiation film dosimeters were placed at four gonadal sites on each subject. A standard male-gonad cup or a pelvic drape of 0.5-millimeter-thick lead-equivalent was put in place to shield the gonads. A second set of four dosimeters was placed external to the shield to approximate unprotected exposure. The total duration of the fluoroscopy averaged five minutes (range, thirty seconds to fourteen minutes). The total exposure to radiation external to the shield was 35 +/- 34 millirems at the male gonadal sites and 17 +/- 11 millirems at the female gonadal sites. With use of the gonadal shield, exposure to radiation was not measurable in thirteen of the fifteen patients. The differences between the exposures of the shielded and unshielded sites to radiation were statistically significant (p less than 0.001). The highest level of gonadal exposure was found with the treatment of proximal femoral fractures and with the use of statically locked nails. Regardless of the conditions, and for all types of fractures and locations, our results demonstrated that gonadal shielding is justified

  2. Fracture Union in Closed Interlocking Nail in Femoral Fracture

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    R L Sahu

    2010-09-01

    Full Text Available INTRODUCTION: Fractures shaft femur is a major cause of morbidity and mortality in patients with lower extremity injuries. The objective of this study was to find out the outcome of Interlocking nail in fracture femur. METHODS: This study was conducted in the Department of Orthopaedic surgery in M. M. Medical College from July 2006 to November 2008. Seventy eight patients were recruited from Emergency and out patient department having closed fracture of femoral shaft. All patients were operated under general or spinal anesthesia. All patients were followed for nine months. RESULTS: Out of seventy eight patients, sixty nine patients underwent union in 90 to 150 days with a mean of 110.68 days. Touch down weight bearing was started on 2nd post-operative day. Complications found in four patients who had non-union, and five patients had delayed union which was treated with dynamization and bone graft. The results were excellent in 88.46% and good in 6.41% patients. CONCLUSIONS: We concluded that this technique is advantageous because of early mobilization (early weight bearing, less complication with good results and is economical. Keywords: close reamed interlocking nail, dynamization, femoral shaft fractures, union

  3. 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.

  4. Augmentation of proximal femoral nail in unstable trochanteric fractures

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    Gadegone Wasudeo M.

    2017-01-01

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

  5. 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

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

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    Korkmaz, Mehmet Fatih; Erdem, Mehmet Nuri; Disli, Zeliha; Selcuk, Engin Burak; Karakaplan, Mustafa; Gogus, Abdullah

    2014-01-01

    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. 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. 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: 12-75 months). Postoperative radiographs showed a near-anatomical fracture reduction in 78% of patients. The Harris hip score was negatively correlated with the ASA score and patient age. No cases of implant failure were observed. Three patients died before discharge (one due to pulmonary embolism, two due to cardiac arrest), and five patients died due to unrelated medical conditions within the first 3 months of the follow-up. Our study showed that proximal femoral nail is a reliable fixation with good fracture union, and it is not associated with major complications in any type of trochanteric femoral fracture.

  7. Trochanteric entry femoral nails yield better femoral version and lower revision rates-A large cohort multivariate regression analysis.

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    Yoon, Richard S; Gage, Mark J; Galos, David K; Donegan, Derek J; Liporace, Frank A

    2017-06-01

    Intramedullary nailing (IMN) has become the standard of care for the treatment of most femoral shaft fractures. Different IMN options include trochanteric and piriformis entry as well as retrograde nails, which may result in varying degrees of femoral rotation. The objective of this study was to analyze postoperative femoral version between three types of nails and to delineate any significant differences in femoral version (DFV) and revision rates. Over a 10-year period, 417 patients underwent IMN of a diaphyseal femur fracture (AO/OTA 32A-C). Of these patients, 316 met inclusion criteria and obtained postoperative computed tomography (CT) scanograms to calculate femoral version and were thus included in the study. In this study, our main outcome measure was the difference in femoral version (DFV) between the uninjured limb and the injured limb. The effect of the following variables on DFV and revision rates were determined via univariate, multivariate, and ordinal regression analyses: gender, age, BMI, ethnicity, mechanism of injury, operative side, open fracture, and table type/position. Statistical significance was set at pregression analysis revealed that a lower BMI was significantly associated with a lower DFV (p=0.006). Controlling for possible covariables, multivariate analysis yielded a significantly lower DFV for trochanteric entry nails than piriformis or retrograde nails (7.9±6.10 vs. 9.5±7.4 vs. 9.4±7.8°, pregression analysis. However, this is not to state that the other nail types exhibited abnormal DFV. Translation to the clinical impact of a few degrees of DFV is also unknown. Future studies to more in-depth study the intricacies of femoral version may lead to improved technology in addition to potentially improved clinical outcomes. Copyright © 2017 Elsevier Ltd. All rights reserved.

  8. A STUDY OF UNSTABLE INTERTROCHANTERIC FEMORAL FRACTURES TREATED BY TROCHANTERIC FEMORAL NAIL

    Directory of Open Access Journals (Sweden)

    Sreenivasa Neikar

    2017-11-01

    Full Text Available BACKGROUND Intertrochanteric fracture is one of the most common fracture of the hip especially in the elderly. The incidence of intertrochanteric fracture is rising because of the increase in number of elderly population along with superadded osteoporosis. MATERIALS AND METHODS Study included cases of unstable intertrochanteric fractures (AO and OTA Classification 31-A2 and 31-A3 fracture patterns that were operated with the short trochanteric femoral nail, which fitted into the inclusion criteria done in medical college hospital, Vijayanagara Institute of Medical Sciences, Bellary, from February 2015 to September 2016. RESULTS The age distribution was from 40 to 80 years. The largest group of patients were from 61 to 70 years. The average age was 60.5 years. The number of male patients in our series was 20 (66.7% and female was 10 (33.3%. Right side was affected in 11 cases (36.7% and left side in 19 cases (63.3%. Good reduction was achieved in 23 patients (76.7%. Acceptable reduction was achieved in 7 (23.3% patients due to severe comminution. In our study, 25 patients (83.33% had no complications. We encountered one intraoperative complication in the form of greater trochanter splintering, while inserting the nail. In our study, we encountered following postoperative complications. We noticed one case of delayed union, one case of Z effect and 2 cases of varus malunion. CONCLUSION We conclude that short trochanteric femoral nail provides good fixation for unstable intertrochanteric fractures if proper preoperative planning, good reduction and surgical technique are followed leading to high rate of bone union and minimal soft tissue damage especially for Asian patients with relatively small femora.

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

    Science.gov (United States)

    Sugand, Kapil; Mawkin, Mala; Gupte, Chinmay

    2016-02-01

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

  10. 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.

  11. Prevention of excessive postoperative sliding of the short femoral nail in femoral trochanteric fractures.

    Science.gov (United States)

    Ito, Juji; Takakubo, Yuya; Sasaki, Kan; Sasaki, Junya; Owashi, Kazuya; Takagi, Michiaki

    2015-05-01

    Lag screw cut-out is one of the major postoperative complications on femoral trochanteric fractures. However, precise analyses of excessive sliding and lag screw cut-out were limited. The purpose of this study was to investigate the factors that induce this unfavorable event. From April 2010 to April 2013, 226 patients were operated in our institute using a short femoral nail. Among them, 177 patients (29 males and 148 females) with a mean age of 84 years (60-97 years), who were followed up >3 months, were included in this study. The postoperative sliding distance, fracture type (AO/OTA classification), tip-apex distance (TAD), reduction pattern in the postoperative X-ray (antero-posterior and lateral views), bone quality (canal flare and cortical indices), walking ability at the time of pre-injury and final follow-up, and complications were investigated retrospectively. The mean sliding distance was 3.7 mm, and one cut-out case (0.6 %) was observed. The sliding distance of the AO/OTA 31-A2 fractures was significantly longer than that of the A1 fractures (p fractures, an accurate reduction in the lateral view at surgery is important, particularly in unstable fractures.

  12. Complications and Functional Recovery in Treatment of Femoral Shaft Fractures with Unreamed Intramedullary Nailing

    OpenAIRE

    Sadic, Sahmir; Custovic, Svemir; Smajic, Nedim; Fazlic, Mirsad; Vujadinovic, Aleksandar; Hrustic, Asmir; Jasarevic, Mahir

    2014-01-01

    ABSTRACT Introduction: Fracture of the femoral shaft is a common fracture encountered in orthopedic practice. In the 1939, K?ntscher introduced the concept of intramedullary nailing for stabilization of long bone fractures. Intramedullary nailing has revolutionized the treatment of fractures. Material and methods: The study included 37 male patients and 13 female patients, averaged 39?20,5 years (range, 16 to 76 years). Results and discussion: There were 31 left femurs and 21 right femurs fra...

  13. An evaluation of flexible intramedullary nail fixation in femoral shaft fractures in paediatric age group.

    Science.gov (United States)

    Kumar, Sanjay; Roy, Sandip Kumar; Jha, Amrish Kumar; Chatterjee, Debdutta; Banerjee, Debabrata; Garg, Anant Kumar

    2011-06-01

    Sixty-two femoral shaft fractures in 60 patients treated by elastic intramedullary nailing with mean age of the patients being 9.2 years (range 5 years to 12 years) and average follow-up of 15 months (range 7 months to 60 months) are evaluated. Twenty-eight fractures were fixed with titanium elastic nail while 34 fractures were fixed with Enders nail. There were 40 midshaft fractures, 18 proximal femoral and 4 were fractures of distal third. Fracture patterns were transverse in 35, short oblique in 14 cases and 13 were spiral fractures. Mean age of union in this series was 17 weeks (range 12 weeks to 28 weeks). Ten cases had complications, 5 had nail tip irritation, 3 varus or valgus malalignment and 2 had delayed union. In this series, we did not have any non-union, refracture, limb length discrepancy or any major infection. The result demonstrates 100% union rate irrespective of the age, weight and height of the patient. Regardless of the site of fracture and their pattern, it united every time with elastic nail fixation. We did not find and mismatch in the results of fractures stabilised with titanium elastic nail with that of elastic stainless steel nail.

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

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    Tank Gyaneshwar

    2016-08-01

    Conclusion: Majority of paediatric femoral shaft fractures are now treated operatively by elastic stable intramedullary nails. Operative intervention results in a shorter hospital stay and has economic and social benefits over conservative treatment. The cost of stainless steel nail is one third the cost of titanium nail. However, the clinico-radiological results are not significantly different between titanium and stainless steel nails at one year follow-up as observed by our study.

  15. [Results of femoral lengthening over an intramedullary nail and external fixator].

    Science.gov (United States)

    Jasiewicz, Barbara; Kacki, Wojciech; Tesiorowski, Maciej; Potaczek, Tomasz

    2008-01-01

    Current techniques of operative limb lengthening usually are based on distraction osteogenesis. One of the techniques is limb lengthening over an intramedullary nail. The goal of this study is to evaluate the results of femoral lengthening over an intramedullary nail. Between 1999 and 200619 femoral "over nail" lengthenings were performed. There were 7 males and 12 females. Mean patients' age at surgery was 15.8 years, and mean initial femoral shortening was 5.1 cm. Operative technique consisted of one-stage implantation of intramedullary nail and external fixator. Ilizarov apparatus was used in 9 patients, monolateral fixator in 10 cases--ORTHOFIX in 9 patients, Wagner fixator--in 1 patient. Intramedullary nail was locked proximally with screws or Schanz pins from external fixator. After distraction phase, external fixator was removed and distal locking screws were applied. Evaluation criteria: obtained lengthening, time of external fixator, treatment time, healing index, external fixation index, range of motion in hip and knee joints and complications according to Paley. The mean lengthening was 4.6 cm, and mean distraction time was 66.6 days. Mean time of external fixation was 115.5 days, and external fixation index was 26.2 days for centimeter. Healing index was 36.9 days for centimeter. In cases with monolateral fixator, healing index did not differ with the whole group. During treatment 18 complications occurred, for a rate of 0.9 complication per segment. Lengthening over an intramedullary nail reduces the time of external fixator. Over nail femoral lengthening can prevent axis deviation following regenerate bending. Complication rate is similar to lengthenings with the classic Ilizarov technique. There are no differences in the treatment time in relation to the type of external fixator.

  16. Removal of a broken guide wire entrapped in a fractured femoral neck

    Directory of Open Access Journals (Sweden)

    ZHU Qing-hua

    2013-08-01

    Full Text Available 【Abstract】Guide wire plays an important role in the fixation of femoral neck fracture with dynamic hip screw (DHS. Breakage of a guide wire during operation is a very rare condition. We met such a dilemma in DHS fixation of a 54-year-old male patient who sustained Garden type IV frac-ture of the right femoral neck. The distal end of the guide wire broke and was entrapped in the fractured femoral neck. We tried to get the broken part out by a cannulated drill. Reaming was started with the cannulated drill slowly rotat-ing around the guide K-wire until the reamer fully contained the target under fluoroscope. A bone curette was used to get the broken wire out but failed, so we had to use the cannuated drill to dredge this bone tunnel. Finally the bro-ken wire end was taken out, mixed with blood and bone fragments. Through the existing drilling channel, DHS fixa-tion was easily finished. The patient had an uneventful re-covery without avascular necrosis of femoral head or non-union of the fracture at one year’s follow-up. A few methods can be adopted to deal with the broken guide wire. The way used in our case is less invasive but technically challenging. When the guide wire is properly positioned, this method is very practical and useful. Key words: Femoral neck fractures; Bones wires; Complications

  17. A biomechanical comparison of proximal femoral nails and locking proximal anatomic femoral plates in femoral fracture fixation A study on synthetic bones

    Directory of Open Access Journals (Sweden)

    Korhan Ozkan

    2015-01-01

    Conclusion: The proximal femoral intramedullary nail provides more stability and allows for earlier weight bearing than the locking plate when used for the treatment of unstable intertrochanteric fractures of the femur. Clinicians should be cautious for early weight bearing with locking plate for unstable intertrochanteric femur fractures.

  18. The impact of antegrade intramedullary nailing start site using the SIGN nail in proximal femoral fractures: A prospective cohort study.

    Science.gov (United States)

    Mustafa Diab, Mohamed; Wu, Hao-Hua; Eliezer, Edmund; Haonga, Billy; Morshed, Saam; Shearer, David W

    2018-02-01

    In many low and middle-income countries (LMICs) SIGN nail is commonly used for antegrade femoral intramedullary (IM) nailing, using a start site either at the tip of the greater trochanter or piriformis fossa. While a correct start site is considered an essential technical step; few studies have evaluated the impact of using an erroneous start site. This is particularly relevant in settings with limited access to fluoroscopy to aid in creating a nail entry point. The purpose of this study was to evaluate the impact of antegrade SIGN IM nailing start site on radiographic alignment and health-related quality of life. In this prospective cohort study, adult patients with proximal femur fractures (OTA 32, subtrochanteric zone) treated with antegrade IM SIGN nail at Muhimbili Orthopaedic Institute (MOI), Dar es Salaam, Tanzania were enrolled. Start site was determined on the immediate postoperative X-ray and was graded on a continuous scale based on distance of the IM nail center from the greater trochanteric tip. The primary outcome measurement was coronal alignment on the post-operative x-ray. The secondary outcomes were reoperation rates, RUST scores and EQ5D scores at one year follow-up. Seventy-nine patients were enrolled. 50 of them (63.3%) had complete data at 1year and were included in the final data analysis. Of the fifty patients, nine (18%) had IM nails placed laterally, 26 (52%) medially and 15 (30%) directly over the tip of the greater trochanter. Compared to a start site at the tip or medial to the greater trochanter, a lateral start site was 9 times more likely to result in a varus malalignment (95% CI: 1.42-57.70, p=0.021). Lateral start site was associated with varus malalignment. Although lateral start site was not significantly associated with reoperation, varus deformity was associated with higher reoperation rates. Surgeons should consider avoiding a start site lateral to the tip of the greater trochanter or allow the nail to rotate to avoid

  19. [Midterm follow-up results on Asian femoral intramedullary nail for the treatment of segmental and comminuted femoral fractures].

    Science.gov (United States)

    Li, Lang; Gao, Feng; Huang, Qi; Li, Qiang; Xie, Lin; Zhang, Bin

    2016-06-01

    To investigate midterm follow-up results on Asian femoral intramedullary nail in treating segmental and comminuted femoral fractures. Between June 2011 and October 2012,16 patients with segmental and comminuted femoral fractures were treated with minimally invasive reset and Asian femoral intramedullary nail under extension table. Among them, there were 10 males and 6 females aged from 21 to 49 years old with an average of 34.5 years old; the time from injury to operation ranged from 3 to 24 d with an average of 9.1 d. There were 6 cases were type C1,2 cases were type C2 and 8 cases were type C3 according to AO classification. X-ray of femoral segment at 3,6 and 12 months after operation were applied for evaluating fracture healing. Harris score of hip joint and HSS score of knee joint were used to evaluate postoperative function. All patients were followed up from 24 to 36 months with an average of 28.4 months. Operative time was from 88 to 112 min with an average of 90.7 min; blood loss ranged from 150 to 200 ml with an average of 188.75 ml; the time of fracture healing was from 5 to 9 months with an average of 5.4 months. All incision were healed at stage I. No loosening, breakage of internal fixation and displacement of fracture were occurred. There were no significant differences in Harris score of hip joint at 3, 6 and 12 months after operation (F = 0.07, P = 0.893 > 0.05), 10 cases obtained excellent results, 5 good and 1 moderate. There was no obvious meaning in HSS score of knee joint (F = 0.08,P = 0.876 > 0.05), 9 cases obtained excellent results, 6 good and 1 poor. Asian femoral intramedullary nail could treat segmental and comminuted femoral fractures by using variety of less invasive ways,which has advantages of less trauma, quick recovery of function and satisfied midterm following-up results. But long term following-up effects remains to be seen.

  20. Avascular necrosis associated with nailing of femoral neck fracture

    International Nuclear Information System (INIS)

    Stroemqvist, B.; Hansson, L.I.

    1983-01-01

    Two patients with femoral neck fractures, one displaced and one undisplaced, are presented. Preoperative intravital staining with tetracycline and Tc-MDP scintimetry both showed intact femoral head circulation while Tc-MDP-scintimetry 1 week after operation showed pronounced circulatory deficiency. SR 85 -scintimetry performed at the same time was inconclusive. Segmental collapse was observed radiographically, 8 and 12 months postoperatively. The major vascular injury resulting in avascularity most probably occured during the procedure of osteosynthesis, and Tc-MDP-scintimetry was found suitable for early postoperative recognition of avascular necrosis in both fractures. (author)

  1. Avascular necrosis associated with nailing of femoral neck fracture

    Energy Technology Data Exchange (ETDEWEB)

    Stroemqvist, B; Hansson, L I [Department of Orthopaedic Surgery, University Hospital in Lund, Sweden

    1983-01-01

    Two patients with femoral neck fractures, one displaced and one undisplaced, are presented. Preoperative intravital staining with tetracycline and Tc-MDP scintimetry both showed intact femoral head circulation while Tc-MDP-scintimetry 1 week after operation showed pronounced circulatory deficiency. Sr/sup 85/-scintimetry performed at the same time was inconclusive. Segmental collapse was observed radiographically, 8 and 12 months postoperatively. The major vascular injury resulting in avascularity most probably occured during the procedure of osteosynthesis, and Tc-MDP-scintimetry was found suitable for early postoperative recognition of avascular necrosis in both fractures.

  2. 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...... clinically after median 1.5 (1-3) years. Their median hospital stay was 6 (2-20) days. All fractures were radiographically united at a median of 7 (5-9) weeks. The nails were removed in 29 children after a median of 22 (6-38) weeks postoperatively. At follow-up, we found a leg-length discrepancy up to 1 cm...

  3. [Intramedullary nailing combined with cannulated screw in treating femoral condyles fractures].

    Science.gov (United States)

    Shen, Guo-Qing; Zhang, Hao; Long, Da-Fu; Li, Zheng-Wen; Tan, Ying-Dong

    2017-07-25

    To observe the clinical effects of retrograde intramedullary nailing and cannulated screws in the treatment of femoral condylar fracture. From June 2009 to June 2015, 13 patients with femoral condyles fracture were treated by retrograde intramedullary nailing and cannulated screws including 6 males and 7 females with an average age of 46.1 years old ranging from 16 to 76 years old. There were 10 cases of closed fractures, 3 cases of open fraetures. According to AO classification criteriam, 4 cases were type C1, 7 cases were type C2, 2 cases were type C3. Postoperative reduction of fracture and the knee joint function recovery were observed. All patients were followed up for 12 to 36 months with a mean of 24 months. X-ray examination showed that the union time of fracture was 18 to 24 weeks, 21 weeks on average. There were no cases of loosening, breakage of internal fixators and re-fracture. Hospital for Special Surgery(HSS) knee score was 90.07±4.99 at 1 year after the operation. The clinical efficacy for retrograde intramedullary nailing and cannulated screw for the treatment of femoral condyles fracture was excellent. It can improve the anatomical reattachment rate and reduce the complications and promote the knee functional recovery.

  4. 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

    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

  5. Femoral shaft fractures in children, treaties with elastic nails of titanium - TENs

    International Nuclear Information System (INIS)

    Solano Urrutia, Antonio Luis; Gallon, Luis Alfonso; Echandia, Carlos

    2003-01-01

    Femoral shaft fractures are a common and temporarily disabling injury in children. Recent advances in orthopedic traumatology have led us at the Hospital Universitario del Valle, in Cali, Colombia, to perform a case series observational study with the use of a more aggressive approach with the new endomedullar titanium nails (TENs) in children suffering femur shaft fractures, in a closed procedure performed under image intensification. The main purpose of this study was to evaluate the outcome of 30 children treated with these nails. Pediatric femoral shaft fractures are more common in males with approximately a 2.75:1 male to female ratio. The age distribution is bimodal, with peaks in the younger than 5 years and mid-teenage groups (10-14 years) because of the increased incidence of high-energy trauma in teenage children (mean age: 9 years). Overall, TENs allowed rapid mobilization with few complications. The results were excellent or satisfactory in our cases. No child lost rotational alignment in the postoperative period. Irritation of the soft tissue near the knee by the nail tip occurred in one patient. As indications, implantation technique, and aftercare are refined, TENs may prove to be the ideal implant to stabilize most pediatric femur shaft fractures, avoiding the prolonged immobilization and complications of traction and spica cast

  6. Should the tip-apex distance (TAD) rule be modified for the proximal femoral nail antirotation (PFNA)? A retrospective study.

    Science.gov (United States)

    Nikoloski, Andrej N; Osbrough, Anthony L; Yates, Piers J

    2013-10-17

    Unstable proximal femoral fractures are common and challenging for the orthopaedic surgeon. Often, these are treated with intramedullary nails. The most common mode of failure of any device to treat these fractures is cut-out. The Synthes proximal femoral nail antirotation (PFNA) is unique because it is the only proximal femoral intramedullary nail which employs a helical blade in lieu of a lag screw. The optimal tip-apex distance is 25 mm or less for a dynamic hip screw. The optimal blade tip placement is not known for the PFNA. The aim of this study is to determine if the traditional tip-apex distance rule (TAD) less than 20 mm. There was no cut-out in cases where the TAD was from 20-30 mm. There were three implant-related failures (nail fracture, missed nail and loose locking screw), four implant-related femoral fractures, two non-unions, two delayed unions and one loss of reduction. The PFNA is a suitable fixation device for the treatment of unstable proximal femoral fractures. There were still a relatively large number of cut-outs, and the tip-apex distance in the failures showed a bimodal distribution, not like previously demonstrated with dynamic hip screw. We propose that the helical blade behaves differently to a screw, and placement too close to the subchondral bone may lead to penetration through the head.

  7. Management of Femoral Shaft Fractures with Elastic Titanium Nails in Pediatric Patients

    Directory of Open Access Journals (Sweden)

    Yunus Güzel

    2016-06-01

    Full Text Available Objective: The aim of this study was to evaluate the func­tional and radiological results of the application of intra­medullary fixation with elastic titanium nails in unstable femoral fractures and to determine the factors affecting these results. Methods: A total of 32 patients aged 4-17 years treated with intramedullary elastic nails for a femoral diaphysis fracture between 2001 and 2014 were included. The frac­ture was left side in 12 cases, right side in 18 and bilateral in 2. The fracture pattern was determined as fragmented in 11 cases, short oblique in 11, transverse in 8 and spi­ral in 4. The same surgical technique and postoperative care was applied to all the patients. Sagittal and coronal angle measurements were made from postoperative and follow-up anterior-posterior and lateral radiographs. The mean follow-up period was 54 months (12-156 months. Positive union criteria were accepted as pain-free weight-bearing and callus bridging in at least 3 cortices seen on direct radiographs. Results: Union was achieved in all except one patient. They were able to return to previous activities with full knee and hip joint range of movement. Radiologically, the mean time to union was determined as 9 weeks (range, 6-16 weeks. Limb shortness was determined in 5 (14% patients. No significant association was detected be­tween shortness and fracture pattern. No varus or valgus angulation of >10˚ was determined in any patient. Conclusion: Application of titanium elastic nails in pe­diatric femoral diaphysis fractures is a comfortable, eco­nomic, and reliable method which is allows early weight-bearing.

  8. Modification of elastic stable intramedullary nailing with a 3rd nail in a femoral spiral fracture model - results of biomechanical testing and a prospective clinical study.

    Science.gov (United States)

    Kaiser, Martin M; Stratmann, Christine; Zachert, Gregor; Schulze-Hessing, Maaike; Gros, Nina; Eggert, Rebecca; Rapp, Marion

    2014-01-08

    Elastic stable intramedullary nailing (ESIN) is the standard treatment for displaced diaphyseal femoral fractures in children. However, high complication rates (10-50%) are reported in complex fractures. This biomechanical study compares the stiffness with a 3rd nail implanted to that in the classical 2C-shaped configuration and presents the application into clinical practice. For each of the 3 configurations of ESIN-osteosynthesis with titanium nails eight composite femoral grafts (Sawbones®) with an identical spiral fracture were used: 2C configuration (2C-shaped nails, 2 × 3.5 mm), 3CM configuration (3rd nail from medial) and 3CL configuration (3rd nail from lateral). Each group underwent biomechanical testing in 4-point bending, internal/external rotation and axial compression. 2C and 3CM configurations showed no significant differences in this spiroid type fracture model. 3CL had a significantly higher stiffness during anterior-posterior bending, internal rotation and 9° compression than 2C, and was stiffer in the lateral-medial direction than 3CM. The 3CL was less stable during p-a bending and external rotation than both the others. As biomechanical testing showed a higher stability for the 3CL configuration in two (a-p corresponding to recurvation and 9° compression to shortening) of three directions associated with the most important clinical problems, we added a 3rd nail in ESIN-osteosynthesis for femoral fractures. 11 boys and 6 girls (2.5-15 years) were treated with modified ESIN of whom 12 were '3CL'; due to the individual character of the fractures 4 patients were treated with '3CM' (third nail from medial) and as an exception 1 adolescent with 4 nails and one boy with plate osteosynthesis. No additional stabilizations or re-operations were necessary. All patients achieved full points in the Harris-Score at follow-up; no limb length discrepancy occurred. The 3CL configuration provided a significantly higher stiffness than 2C and 3CM configurations

  9. 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.

  10. Open grade III fractures of femoral shaft: Outcome after early reamed intramedullary nailing.

    Science.gov (United States)

    Singh, D; Garg, R; Bassi, J L; Tripathi, S K

    2011-09-01

    Open grade III fractures of femur are a challenging therapeutic problem as most of them are associated with multiple trauma. Method used for skeletal stabilization of these fractures should limit further soft tissue damage, bacterial spread and morbidity in addition to its ease of application, providing mechanical support and restoring normal alignment. Forty-six patients with open grade III fractures of femoral shaft were included in the study. There were 10 grade IIIA, 34 grade IIIB and two grade IIIC fractures that were treated with early reamed intramedullary nailing with adequate management of soft tissue. Patients were reviewed retrospectively. Mean time of union was 27 weeks. Infection rate was 4% and non-union rate was 9%. There were two cases (4%) with limb shortening. No case of angular or rotational deformity was noted. Early reamed intramedullary nailing for open grade III fractures of femoral shaft, after giving due respect to the soft tissue injury, gives satisfactory results with proper alignment, good range of motion, short rehabilitation period and low infection rate. Level IV. Retrospective therapeutic study. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

  11. Shielding of the patient's gonads during intramedullary interlocking femoral nailing

    Energy Technology Data Exchange (ETDEWEB)

    Kwong, L.M.; Johanson, P.H.; Zinar, D.M.; Lenihan, M.R.; Herman, M.W. (Harbor/Univ. of California, Los Angeles Medical Center, Torrance (USA))

    1990-12-01

    Levels of exposure to radiation were recorded at sixty sites in fifteen patients during intramedullary interlocking femoral nailing. Radiation film dosimeters were placed at four gonadal sites on each subject. A standard male-gonad cup or a pelvic drape of 0.5-millimeter-thick lead-equivalent was put in place to shield the gonads. A second set of four dosimeters was placed external to the shield to approximate unprotected exposure. The total duration of the fluoroscopy averaged five minutes (range, thirty seconds to fourteen minutes). The total exposure to radiation external to the shield was 35 +/- 34 millirems at the male gonadal sites and 17 +/- 11 millirems at the female gonadal sites. With use of the gonadal shield, exposure to radiation was not measurable in thirteen of the fifteen patients. The differences between the exposures of the shielded and unshielded sites to radiation were statistically significant (p less than 0.001). The highest level of gonadal exposure was found with the treatment of proximal femoral fractures and with the use of statically locked nails. Regardless of the conditions, and for all types of fractures and locations, our results demonstrated that gonadal shielding is justified.

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

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

    2016-08-01

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

  13. 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.

  14. Rotational malalignment after closed intramedullary nailing of femoral shaft fractures and its influence on daily life.

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    Karaman, Ozgur; Ayhan, Egemen; Kesmezacar, Hayrettin; Seker, Ali; Unlu, Mehmet Can; Aydingoz, Onder

    2014-10-01

    Any intraoperative rotational malalignment during intramedullary nailing (IMN) of femoral shaft fractures will become permanent. We hypothesized that rotational malalignment of the femur and its compensatory biomechanics may induce problems in the hip, knee, patellofemoral and ankle joints. We purposed to clarify the influence of a femoral rotational malalignment of ≥10° on daily activities. Twenty-four femoral shaft fracture patients treated with closed antegrade IMN were included. At last follow-up, to reveal any rotational malalignment, computerized tomography (CT) scans of both femurs (injured and uninjured sides) were examined. The patient groups with or without CT-detected true rotational malalignment ≥10° were compared with respect to the activity scores. Ten of the 24 patients (41.7%) had a CT-detected true rotational malalignment of ≥10° compared with the unaffected side. The AOFAS scores were 100.00 for all of the patients. LKS, WOMAC knee, and WOMAC hip scores were significantly decreased in the patients with rotational malalignment compared to those without. Patients without rotational malalignment tolerated climbing stairs significantly better than those with rotational malalignment. Patients who could not tolerate climbing stairs were consistently complaining of anterior knee pain. A femoral rotational malalignment of ≥10° is symptomatic for the patients, and the hip, knee, and patellofemoral joints were affected. Because of the possibly altered joint loadings and biomechanics, these could render patients prone to degenerative joint disease. In addition, due to the high rates of rotational malalignment after femoral shaft fracture and consequent malpractice claims, it is important for surgeons to be more aware of rotational alignment during surgery.

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

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    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. Copyright 2014, SLACK Incorporated.

  16. Intramedullary nailing for the treatment of aseptic femoral shaft non-unions after plating failure: effectiveness and timing.

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    Megas, Panagiotis; Syggelos, Spyros A; Kontakis, Georgios; Giannakopoulos, Andreas; Skouteris, Georgios; Lambiris, Elias; Panagiotopoulos, Elias

    2009-07-01

    This retrospective, multicentre study aimed to evaluate reamed intramedullary nailing (IMN) for the treatment of 30 cases of aseptic femoral shaft non-union after plating failure. Following nailing, 29 non-unions had healed by a mean 7.93 months. In one case a hypertrophic non-union required renailing after 8 months, using a nail of greater diameter, and united within five further months. Healing times were not related to whether the fracture was open or closed, the type non-union or the type of fracture. The delay from the initial plating to intramedullary nailing had a statistically significant effect on healing time and final outcome. This treatment is cost effective and should be implemented as soon as the non-union is diagnosed.

  17. Complications and functional recovery in treatment of femoral shaft fractures with unreamed intramedullary nailing.

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    Sadic, Sahmir; Custovic, Svemir; Smajic, Nedim; Fazlic, Mirsad; Vujadinovic, Aleksandar; Hrustic, Asmir; Jasarevic, Mahir

    2014-01-01

    Fracture of the femoral shaft is a common fracture encountered in orthopedic practice. In the 1939, Küntscher introduced the concept of intramedullary nailing for stabilization of long bone fractures. Intramedullary nailing has revolutionized the treatment of fractures. The study included 37 male patients and 13 female patients, averaged 39 +/- 20.5 years (range, 16 to 76 years). There were 31 left femurs and 21 right femurs fractured. 46 fractures were the result of blunt trauma. Low energy trauma was the cause of fractures in six patients, of which five in elderly females. 49 fractures were closed. Healing time given in weeks was 19.36 +/- 6.1. The overall healing rate was 93.6%. There were three (6.25%) major complications nonunion. There were one (2%) delayed union, one (2%) rotational malunion and no infection. The shortening of 1 cm were in two patients. Antercurvatum of 10 degrees was found in one patient. There was no statistically significant reduction of a motion in the hip and knee (p knee extensors) muscle weakness (p fractures.

  18. [Comparative study of proximal femoral shortening after the third generation of Gamma nail versus proximal femoral nail anti-rotation in treatment of intertrochanteric fracture].

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    Hou, Yu; Yao, Qi; Zhang, Gen'ai; Ding, Lixiang

    2018-03-01

    To explore the difference of the proximal femoral shortening (PFS) between the third generation of Gamma nail (TGN) and the proximal femoral nail anti-rotation (PFNA) in treating intertrochanteric fracture of femur. The clinical data of 158 patients with intertrochanteric fracture of femur who were treated with TGN internal fixation or PFNA internal fixation between January 2014 and December 2015 were retrospectively analysed. The patients were divided into TGN group (69 cases) and PFNA group (89 cases) according to surgical operation. There was no significant difference in gender, age, bone mineral density, causes of injury, AO/Association for the Study of Internal Fixation (AO/ASIF) classification, accompanied disease, and the time from injury to operation between 2 groups ( P >0.05). The result of fracture reduction was divided into 3 types: positive medial cortex support, neutral position cortex support, and negative medial cortex support according to the method of Chang et al . At 18 months postoperatively, bilateral hip anteroposterior X-ray films were taken to measure horizontal PFS values (marked as X), vertical PFS values (marked as Y), and calculate the total PFS values (marked as Z). The PFS values were divided into 4 grades according to the criteria (≤1.0 mm, 1.0-4.9 mm, 5.0-9.9 mm, and ≥10.0 mm), and the constituent ratio was calculated and compared between 2 groups. The X, Y, and Z values and the collodiaphyseal angles of 2 groups at 18 months postoperatively were compared. The X, Y, and Z values of 2 groups of patients with failed fixation and normal healing within 18 months after operation were recorded and compared. The X, Y, and Z values of 2 groups of the patients with different cortex support types were also compared. There were 34 cases of positive medial cortex support, 30 cases of neutral position cortex support, and 5 cases of negative medial cortex support in TGN group, and there were 45, 33, and 11 cases in PFNA group respectively

  19. 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

  20. 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.

  1. Static bending test after proximal femoral nail (PFN removal - in vitro analysis

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    Leonardo Morais Paiva

    Full Text Available Abstract Objective To evaluate, through biomechanical testing, the resistance to and energy required for the occurrence of proximal femoral fracture in synthetic bone after removal of a proximal femoral nail model (PFN, comparing the results obtained with a reinforcement technique using polymethylmethacrylate (PMMA. Methods Fifteen synthetic bones were used: five units for the control group (CG, five for the test group without reinforcement (TGNR, and five for the test group with reinforcement (TGR. The biomechanical analysis was performed simulating a fall on the trochanter using a servo-hydraulic machine. In the GC, the assay was performed with the PFN intact. In the TGNR and TGR groups, a model of PFN was introduced and the tests were performed in the TGNR, after simple removal of the synthesis material, and in the TGR, after removal of the same PFN model and filling of the cavity in the femoral neck with PMMA. Results All groups presented a basicervical fracture. The CG presented a mean of 1427.39 Newtons (N of maximum load and 10.14 Joules (J of energy for the occurrence of the fracture. The TGNR and TGR presented 892.14 N and 1477.80 N of maximum load, and 6.71 J and 11.99 J of energy, respectively. According to the Kruskal-Wallis ANOVA, there was a significant difference in the maximum load (p = 0.009 and energy (p = 0.007 between these groups. Conclusion The simple removal of a PFN in synthetic bone showed a significant reduction of the maximum load and energy for the occurrence of fracture, which were re-established with a reinforcement technique using PMMA.

  2. Presence of a nail in the medullary canal; is it enough to prevent femoral neck shortening in trochanteric fracture?

    Science.gov (United States)

    Song, Hyung Keun; Yoon, Han Kuk; Yang, Kyu Hyun

    2014-09-01

    Presence of a cephalomedullary nail (CMN) in the medullary canal has been thought as advantageous in the control of femoral neck shortening (FNS) and lag screw sliding in trochanteric fracture compared to extramedullary fixation system. However, researches on the factors that influence the degree of FNS after cephalomedullary nailing are lacking. We observed 95 patients (mean age, 75±2.8 years) with trochanteric fractures who were treated with a CMN, and evaluated the relationship between FNS and patient factors including age, gender, fracture type (AO/OTA), bone mineral density, medullary canal diameter, canal occupancy ratio (COR=nail size/canal diameter), and tip-apex distance using initial, immediate postoperative, and follow-up radiography. Univariate regression analyses revealed that the degree of FNS was significantly correlated with fracture type (A1 versus A3, pfracture type (pfracture.

  3. One-stage lengthening using a locked nailing technique for distal femoral shaft nonunions associated with shortening.

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    Wu, Chi-Chuan; Lee, Zhon-Liau

    2004-02-01

    To assess the effectiveness of a one-stage lengthening using a locked nail technique for the treatment of distal femoral shaft nonunions associated with shortening. Retrospective. University hospital. During a 6-year period, 36 distal femoral shaft nonunions associated with shortening (>1.5 cm) were treated by the one-stage lengthening technique. Indications for this technique were distal femoral shaft aseptic or quiescent infected nonunions, 1.5-5 cm shortening, and a fracture level suitable for the insertion of two distal locked screws. The surgical technique involved skeletal traction using the femoral condyle, local débridement, lengthening by lengthening was 2.5 cm (range 1.5-3.5 cm). One-stage lengthening using the locked nailing technique to treat distal femoral shaft nonunions associated with shortening can achieve a high success rate and low complication rate. The key to successful treatment is the patient's complete cooperation with strictly protected weight bearing until the fracture has healed.

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

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

    2016-06-01

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

  5. Outcomes following femoral lengthening: An initial comparison of the Precice intramedullary lengthening nail and the LRS external fixator monorail system.

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    Laubscher, M; Mitchell, C; Timms, A; Goodier, D; Calder, P

    2016-10-01

    Patients undergoing femoral lengthening by external fixation tolerate treatment less well when compared to tibial lengthening. Lengthening of the femur with an intramedullary device may have advantages. We reviewed all cases of simple femoral lengthening performed at our unit from 2009 to 2014. Cases of nonunions, concurrent deformities, congenital limb deficiencies and lengthening with an unstable hip were excluded, leaving 33 cases (in 22 patients; 11 patients had bilateral procedures) for review. Healing index, implant tolerance and complications were compared. In 20 cases (15 patients) the Precice lengthening nail was used and in 13 cases (seven patients) the LRS external fixator system. The desired length was achieved in all cases in the Precice group and in 12 of 13 cases in the LRS group. The mean healing index was 31.3 days/cm in the Precice and 47.1 days/cm in the LRS group (p < 0.001). This was associated with an earlier ability to bear full weight without aids in the Precice group. There were more complications with LRS lengthening, including pin site infections and regenerate deformity. Implant tolerance and the patients' perception of the cosmetic result were better with the Precice treatment. Femoral lengthening with the Precice femoral nail achieved excellent functional results with fewer complications and greater patient satisfaction when compared with the LRS system in our patients. Cite this article: Bone Joint J 2016;98-B:1382-8. ©2016 The British Editorial Society of Bone & Joint Surgery.

  6. Treatment options for unstable trochanteric fractures: Screw or helical proxima femoral nail.

    Science.gov (United States)

    Bajpai, Jeetendra; Maheshwari, Rajesh; Bajpai, Akansha; Saini, Sumit

    2015-01-01

    To compare treatment outcome of screw proximal femoral nail (PFN) system with that of a helical PFN. 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 inde- pendently 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. 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 buttrochanteric 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.

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

    Science.gov (United States)

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

    2015-12-01

    Reverse oblique intertrochanteric fractures have unique mechanical characteristics and are often treated with intramedullary implants. We compared the outcomes of the reconstruction trochanteric antegrade nail (TAN) with the proximal femoral nail antirotation (PFNA). Between July 2008 and February 2014, we reviewed all patients with reverse oblique intertrochanteric fractures treated at our hospital. Patients with pathological fractures and those who were treated with other than TAN and PFNA nailing systems were excluded. Preoperative assessment included the Abbreviated mental test score (AMT), the ASA grade, pre-injury mobility and place of residence. Postoperative outcome measures included the type of implant used, time to fracture union, failures of fixation and revision surgeries. Fifty-eight patients were included and divided into two groups based on the treatment: 22 patients treated with TAN and 36 patients treated with PFNA systems. The two groups were well matched with regards to demographics and fracture type. The overall union rate was similar in both groups but the time to union was shorter in the TAN group. There were 8 implant failures in the PFNA (22.2%) group compare to none in the TAN group. Implant failure was associated with the severity of fracture (AO 31.A3.3) but was not related to fracture malreduction or screw position (Tip-apex-distance). Our study suggests that the use of reconstruction system with two screws such as TAN may be more suitable implant for reverse oblique intertrochanteric hip fractures. Copyright © 2015 Elsevier Ltd. All rights reserved.

  8. Minimizing Leg Length Discrepancy After Intramedullary Nailing of Comminuted Femoral Shaft Fractures: A Quality Improvement Initiative Using the Scout Computed Tomography Scanogram.

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    Gheraibeh, Petra; Vaidya, Rahul; Hudson, Ian; Meehan, Robert; Tonnos, Frederick; Sethi, Anil

    2018-05-01

    To prevent leg length discrepancy (LLD) after locked femoral nailing in patients with comminuted femoral shaft fractures. Prospective consecutive case series aimed at quality improvement. Level 1 Trauma Center PATIENTS:: Ninety-eight consecutive patients with a comminuted femoral shaft fracture underwent statically locked intramedullary nailing, with a focused attempt at minimizing LLD during surgery. A computed tomography scanogram of both legs was performed on postoperative day 1 to assess for residual LLD. Patients were offered the option to have LLD >1.5 cm corrected before discharge. LLD >1.5 cm. Twenty-one patients (21.4%) were found to have an LLD >1.5 cm. An LLD >1.5 cm occurred in 10/55 (18%) antegrade nail patients and 11/43 (26%) retrograde nail patients (P = 0.27). No difference was noted based on the mechanism of injury, surgeon training and OTA/AO type B versus C injury. Ninety of 98 patients left with 1.5 cm after locked intramedullary nailing for a comminuted femoral shaft fracture without being informed and the option of early correction. We recommend using a full-length computed tomography scanogram after IM nailing of comminuted femur fractures to prevent iatrogenic LLD. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

  9. Subtrochanteric femoral fractures treated with the Long Gamma3® nail: A historical control case study versus Long trochanteric Gamma nail®.

    Science.gov (United States)

    Georgiannos, D; Lampridis, V; Bisbinas, I

    2015-10-01

    Gamma nail was developed for the treatment of subtrochanteric hip fractures. Despite its advantages over extramedullary devices, gamma nail has been historically related to significant complications (implant breakage, femoral fractures at the tip of the nail). There is limited data to determine if the rate of these complications was minimized by using a new design of the gamma nail. Therefore we performed a case control study between the long gamma3 nail (LG3N) and the long trochanteric gamma nail (LTGN) to assess if: (1) the complication rate in the treatment of subtrochanteric fractures using the LG3N was lower than the one using the LTGN; (2) the reoperation rate was lower after using the LG3N. The complication rate after fixation of subtrochanteric fracture of the femur is lower with LG3N than with the LTGN. This study prospectively recorded the intra- and postoperative complications of 75 patients with subtrochanteric fractures treated with the LG3N and compared them with those of a historical cohort of 83 patients treated with the LTGN. The two groups were matched regarding age, gender and fracture type. Patients with open, pathological, or impending fractures were excluded. Intraoperative complications in the LG3N group were lower (4 cases, 5.3%) compared with those in the LTGN group (9 cases, 10.8%; P=0.04). The major intraoperative complication encountered with the use of LTGN was fracture of the femur in 3 cases. We encountered in total 9 postoperative complications in LG3N (12%) and 20 in group LTGN (24%). The most frequent complication in both groups was the cut out of the lag screw (3 cases in LG3N and 7 cases in LTGN group). The overall reoperation rate was higher in LTGN group (20.4% vs 10.6%; P=0.03). As a result of the improvement of its mechanical characteristics, LG3N has proved a safe and efficient implant for the treatment of subtochanteric fractures. The new design seems superior to previous generation, giving promising outcomes, reduced

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

    Science.gov (United States)

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

    2017-05-18

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

  11. Femoral intertrochanteric nail (fitn): a new short version design with an anterior curvature and a geometric match study using post-operative radiographs.

    Science.gov (United States)

    Chang, Shi-Min; Hu, Sun-Jun; Ma, Zhuo; Du, Shou-Chao; Zhang, Ying-Qi

    2018-02-01

    Femoral intertrochanteric fractures are usually fixed with short, straight cephalomedullary nails. However, mismatches between the nail and the femur frequently occur, such as tip impingement and tail protrusion. The authors designed a new type of short femoral intertrochanteric nail (fitn) with an anterior curvature (length=19.5cm, r=120cm) and herein report the geometric match study for the first of 50 cases. A prospective case series of 50 geriatric patients suffering from unstable intertrochanteric fractures (AO/OTA 31 A2/3) were treated. There were 15 males and 35 females, with an average age of 82.3 years. Post-operatively, the nail entry point position in the sagittal greater trochanter (in three categories, anterior, central and posterior), the nail-tip position in the medullary canal (in 5-grade scale) and the nail-tail level to the greater trochanter (in 3-grade scale) were measured using X-ray films. For the nail entry point measurement, 5 cases were anterior (10%), 38 cases were central (76%), and 7 cases were posterior (14%). For the distal nail-tip position, 32 cases (64%) were located along the central canal axis, 13 cases (26%) were located anteriorly but did not contact the anterior inner cortex, 2 cases (4%) showed less than one-third anterior cortex thickness contact, and 3 cases (6%) were located posteriorly with no contact. For the proximal nail-tail level, there were no protrusions over the greater trochanter in 15 cases (30%), protrusion of less than 5mm in 29 cases (58%), and protrusion of more than 5mm in 6 cases (12%). The fitness was very high, as 96% cases showed no tip-cortex contact, and 88% cases showed less than 5mm proximal tail protrusion. The newly designed femoral intertrochanteric nail has a good geometric match with the femur medullary canal and the proximal length in the Chinese population. Copyright © 2017 Elsevier Ltd. All rights reserved.

  12. A study on management of extracapsular trochanteric fractures by proximal femoral nail

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    K Ramaprathap Reddy

    2016-01-01

    Full Text Available Background: Trochanteric fractures of femur like intertrochanteric and subtrochanteric fractures are a leading cause of hospital admissions in elderly people. Conservative methods of treatment results in malunion with shortening and limitation of hip movement as well as complications of prolonged immobilizations such as bed sores, deep vein thrombosis, and respiratory infections. This study is done to analyze the surgical management of trochanteric fractures of the femur using a proximal femoral nail (PFN. Methodology: This is a prospective study of 40 cases of trochanteric and subtrochanteric fractures admitted to Government General Hospital, Vijayawada, Andhra Pradesh. Cases were taken according to inclusion and exclusion criteria, i.e., patients with trochanteric fractures femur above the age of 20 years. Medically unsuitable, open fractures and patients not willing for surgery were excluded from the study. Results: Forty percentage of cases were admitted due to slip and fall and with a slight predominance of the right side. Out of 40 cases, 26 were trochanteric, and 14 were subtrochanteric. In trochanteric class, 37.5% were body and griffin Type 2, in subtrochanteric class 12.5% were sinsheimer Type 3a and 10% were 2b. Out of 30 remaining cases, 25 were trochanteric, and 05 were subtrochanteric. Good to excellent results are seen in 100% cases of trochanteric fractures and 90% cases in subtrochanteric fractures. Conclusion: From this sample study, we consider that PFN is an excellent implant for the treatment of pertrochanteric fractures. The terms of successful outcome include a good understanding of fracture biomechanics, proper patient selection, good preoperative planning, accurate instrumentation, good image intensifier, and exactly performed osteosynthesis.

  13. Type II Intertrochanteric Fractures: Proximal Femoral Nailing (PFN Versus Dynamic Hip Screw(DHS

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    Cyril Jonnes

    2016-01-01

    Full Text Available Background: Intertrochanteric fracture is one of the most common fractures of the hip especially in the elderly with osteoporotic bones, usually due to low-energy trauma like simple falls. Dynamic Hip Screw (DHS is still considered the gold standard for treating intertrochanteric fractures by many. Not many studies compare the DHS with Proximal femoral nail (PFN, in Type II intertrochanteric fractures (Boyd and Griffin classification. This study was done to compare the functional and radiological outcome of PFN with DHS in treatment of Type II intertrochanteric fractures.   Methods: From October 2012 to March 2015, a prospective comparative study was done where 30 alternative cases of type II intertrochanteric fractures of hip were operated using PFN or DHS. Intraoperative complications were noted. Functional outcome was assessed using Harris Hip Score and radiological findings were compared at 3, 6, and 12 months postoperatively. Results: The average age of the patients was 60 years. In our series we found that patients with DHS had increased intraoperative blood loss (159ml, longer duration of surgery (105min, and required longer time for mobilization while patients who underwent PFN had lower intraoperative blood loss (73ml, shorter duration of surgery (91min, and allowed early mobilization. The average limb shortening in DHS group was 9.33 mm as compared with PFN group which was only 4.72 mm. The patients treated with PFN started early ambulation as they had better Harris Hip Score in the early post-op period. At the end of 12th month, there was not much difference in the functional outcome between the two groups. Conclusion: PFN is better than DHS in type II inter-trochanteric fractures in terms of decreased blood loss, reduced duration of surgery, early weight bearing and mobilization, reduced hospital stay, decreased risk of infection and decreased complications.

  14. Strategies for Proximal Femoral Nailing of Unstable Intertrochanteric Fractures: Lateral Decubitus Position or Traction Table.

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    Sonmez, Mesut Mehmet; Camur, Savas; Erturer, Erden; Ugurlar, Meric; Kara, Adnan; Ozturk, Irfan

    2017-03-01

    The aim of this prospective randomized study was to compare the traction table and lateral decubitus position techniques in the management of unstable intertrochanteric fractures. Eighty-two patients with unstable intertrochanteric fractures between 2011 and 2013 were included in this study. All patients were treated surgically with the Proximal Femoral Nail Antirotation implant (DePuy Synthes). Patients were randomized to undergo the procedure in the lateral decubitus position (42 patients) or with the use of a traction table (40 patients). Patients whose procedure was not performed entirely with a semi-invasive method or who required the use of additional fixation materials, such as cables, were excluded from the study. The groups were compared on the basis of the setup time, surgical time, fluoroscopic exposure time, tip-to-apex distance, collodiaphyseal angle, and modified Baumgaertner criteria for radiologic reduction. The setup time, surgical time, and fluoroscopic exposure time were lower and the differences were statistically significant in the lateral decubitus group compared with the traction table group. The collodiaphyseal angles were significantly different between the groups in favor of the lateral decubitus method. The tip-to-apex distance and the classification of reduction according to the modified Baumgaertner criteria did not demonstrate a statistically significant difference between the groups. The lateral decubitus position is used for most open procedures of the hip. We found that this position facilitates exposure for the surgical treatment of unstable intertrochanteric fractures and has advantages over the traction table in terms of set up time, surgical time and fluoroscopic exposure time.

  15. 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

  16. Evaluation of malrotation following intramedullary nailing in a femoral shaft fracture model: Can a 3D c-arm improve accuracy?

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    Ramme, Austin J; Egol, Jonathan; Chang, Gregory; Davidovitch, Roy I; Konda, Sanjit

    2017-07-01

    Difficulty determining anatomic rotation following intramedullary (IM) nailing of the femur continues to be problematic for surgeons. Clinical exam and fluoroscopic imaging of the hip and knee have been used to estimate femoral version, but are inaccurate. We hypothesize that 3D c-arm imaging can be used to accurately measure femoral version following IM nailing of femur fractures to prevent rotational malreduction. A midshaft osteotomy was created in a femur Sawbone to simulate a transverse diaphyseal fracture. An intramedullary (IM) nail was inserted into the Sawbone femur without locking screws or cephalomedullary fixation. A goniometer was used to simulate four femoral version situations after IM nailing: 20° retroversion, 0° version, 15° anteversion, and 30° anteversion. In each simulated position, 3D c-arm imaging and, for comparison purposes, perfect lateral radiographs of the knee and hip were performed. The femoral version of each simulated 3D and fluoroscopic case was measured and the results were tabulated. The measured version from the 3D c-arm images was 22.25° retroversion, 0.66° anteversion, 19.53° anteversion, and 25.15° anteversion for the simulated cases of 20° retroversion, 0° version, 15° anteversion, and 30° anteversion, respectively. The lateral fluoroscopic views were measured to be 9.66° retroversion, 12.12° anteversion, 20.91° anteversion, and 18.77° anteversion for the simulated cases, respectively. This study demonstrates the utility of a novel intraoperative method to evaluate femur rotational malreduction following IM nailing. The use of 3D c-arm imaging to measure femoral version offers accuracy and reproducibility. Copyright © 2017 Elsevier Ltd. All rights reserved.

  17. Breakage of cephalomedullary nailing in operative treatment of trochanteric and subtrochanteric femoral fractures.

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    von Rüden, Christian; Hungerer, Sven; Augat, Peter; Trapp, Oliver; Bühren, Volker; Hierholzer, Christian

    2015-02-01

    Mechanical breakage of cephalomedullary nail osteosynthesis is a rare complication attributed to delayed fracture union or nonunion. This study presents a series of cases of breakage and secondary lag screw dislocation after cephalomedullary nailing. The aim of this study was to identify factors that contribute to cephalomedullary nail breakage. In a retrospective case series review between 02/2005 and 12/2013, we analyzed 453 patients with trochanteric and subtrochanteric fracture who had been treated by cephalomedullary nailing. Fractures were classified according to AO/OTA classification. 13 patients with cephalomedullary nail breakage were included (failure rate 2.9 %). Seven patients were women, and six men with a mean age of 72 years (range 35-94). Implant breakage occurred 6 months postoperatively (range 1-19 months). In ten cases, breakage was secondary to delayed or nonunion, which was thought to be mainly due to insufficient reduction of the fracture, and in two cases due to loss of the lag screw because of missing set screw. In one case, breakage was apparent during elective metal removal following complete fracture healing. Short-term outcome was evaluated 6 months after operative revision using Harris hip score in 11 out of 13 patients showing a mean score of 84 %. Complete radiological fracture healing has been found in 11 patients available for follow-up within 6 months after revision surgery. Breakage of cephalomedullary nail osteosynthesis of trochanteric fractures is a severe complication. The results of our study demonstrate that revision surgery provides good clinical and radiological short-term results. Predominately, failures of trochanteric fractures are related to lack of surgeon performance. Therefore, application of the implant requires accurate preoperative planning, advanced surgical experience to evaluate the patient and the fracture classification, and precise surgical technique including attention to detail and anatomical

  18. 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

  19. Pseudoaneurysm of the deep femoral artery caused by a guide wire following femur intertrochanteric fracture with a hip nail: A case report

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    Ji Wan Kim

    2017-05-01

    Full Text Available An 85-year-old woman developed severe swelling and pain in the proximal thigh after internal fixation of an intertrochanteric fracture of the femur with a hip nail. In order to identify the causes and determine the effective treatment, angiography was performed. The results of the angiography revealed a pseudoaneurysm of a branch of deep femoral artery. Endovascular embolization was used to treat the pseudoaneurysm. After reviewing all possible causes, we found a mistake in insertion of a guide wire for hip nail. Using intraoperative fluoroscopic images, we found the mal-positioned guide wire located posterior to trochanter on lateral view of hip. This case study reminds us that pseudoaneurysm can occur in a guide wire during hip nailing. Surgeons can avoid this complication with confirmation of lateral and anteroposterior view of hip.

  20. Ipsilateral Femoral Fracture Non-Union and Delayed Union Treated By Hybrid Plate Nail Fixation and Vascularized Fibula Bone Grafting: A Case Report

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    CK Chan

    2013-07-01

    Full Text Available Non-union is a well recognized complication of femoral neck fractures. The decision whether to attempt fracture fixation or to resort to hip replacement is particularly difficult in patients in the borderline age group in whom complex attempts at gaining union may fail and later present a difficult revision. On the other hand the patient may be young enough that arthroplasty best be avoided . Besides, presence of ipsilateral femoral shaft fracture with delayed union in addition to the femoral neck non-union will pose major problems at operation. We share our experience in treating a femoral neck fracture non-union with ipsilateral femoral shaft delayed union in the shaft and in the distal femur in a fifty years old patient. The fracture was treated with an angle blade plate and supracondylar nail supplemented with a free vascularised fibular bone grafting and autologous cancellous graft. There was radiological union at fourth month. At sixth months, the patient was free of pain and able to walk without support. Thus, we would like to suggest that vascularised fibula bone grafting with supracondylar nailing is a viable option for this pattern of fracture.

  1. Mating of a PROSTALAC spacer with an intramedullary nail for reconstruction of an infected interprosthetic femoral shaft fracture: a case report.

    Science.gov (United States)

    Kamath, Atul F; Austin, Daniel; Lee, Gwo-Chin

    2012-08-01

    Reconstruction for concurrent infection of an ipsilateral total hip arthroplasty (THA) and total knee arthroplasty (TKA) is a challenge. We report a 2-stage reconstruction of a THA for chronic infection of both the THA and TKA with severe femoral bone loss secondary to interprosthetic fractures. The reconstruction involved using a custom-made, temporary, antibiotic-impregnated PROSTALAC spacer mated with an intramedullary nail. The acetabulum was then exposed and the necrotic cartilage was removed and curetted. The acetabulum was reamed to accept a PROSTALAC acetabular shell. The shell was cemented into the acetabulum with antibiotic cement. The custom-made spacer was then inserted distally first into the tibia. The distal end of the intramedullary nail was interlocked with a bicortical bolt to minimise nail rotation. Antibiotic-impregnated cement was moulded around the nail and spacer. The proximal end of the spacer was then reduced into the acetabular socket, and the joint was irrigated and the wound closed. A customised abduction brace was fitted, and partial weight bearing was allowed. Sufficient leg length, soft-tissue tension, and range of hip motion were restored, and a total femur and constrained liner was re-implanted 4 months later. Mating of an intramedullary nail with a PROSTALAC spacer is a viable reconstructive option.

  2. Early Complications in Proximal Femoral Nailing Done for Treatment of Subtrochanteric Fractures

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    B Kanthimathi

    2012-03-01

    Full Text Available AIM: To analyse the early complications following the use of PFN in subtrochanteric fractures. Background: Osteosynthesis with PFN in subtrochanteric fracture features the advantages of high rotational stability of the head–neck fragment, an unreamed implantation technique and the possibility of static or dynamic distal locking. However, the use of the nail requires technical expertise and is accompanied by some risks of error which can lead to osteosynthesis failure. METHODS: Between May 2009 and May 2011, 50 consecutive patients with PFN fixations for subtrochanteric fractures were observed for intraoperative and postoperative complications. RESULTS: We identified intraoperative technical difficulties in four patients and six patients showed postoperative complications. CONCLUSION: When subtrochanteric fractures are to be stabilised with a PFN, the precise and expert technical performance of implantation is the basic surgical requirement. Good reduction with minimal dissection and the use of an appropriate implant is necessary to avoid treatment failure.

  3. A Prospective Study to Evaluate the Management of Sub-trochanteric Femur Fractures with Long Proximal Femoral Nail.

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    Kumar, M; Akshat, V; Kanwariya, A; Gandhi, M

    2017-11-01

    Introduction: Sub-trochanteric fractures of the femur remains one of the most challenging fractures faced by orthopaedic surgeons. This study was done to analyse the management and complications of sub-trochanteric fractures using long proximal femoral nail (PFN). Materials and Methods: This was a prospective study of 50 patients with sub-trochanteric fractures of femur who were treated with long PFN at a tertiary care center from July 2012 to June 2016. The fractures were classified according to Seinsheimer classification. All patients were assessed functionally by Harris Hip Score. Results: Average duration of union was 17.08 weeks (range 13 to 32 weeks), union was achieved in 92% cases. Closed reduction was achieved in 68% cases and open reduction was required in 32% cases. Various intraoperative complications were seen in 12% and delayed complications in 26% of cases. Good anatomical results were achieved in 86% of cases and 14% were fair. As per Harris Hip score, excellent results were noted in 28% cases, good in 56% cases and fair in 16% cases. Conclusion: The long PFN is a reliable implant for subtrochanteric femur fractures, with high rate of bone union and minimal soft tissue damage. Intramedullary fixation has biological and biomechanical advantages, but the surgery is technically demanding.

  4. A Prospective Study to Evaluate the Management of Sub-trochanteric Femur Fractures with Long Proximal Femoral Nail

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    Kumar M

    2017-11-01

    Full Text Available INTRODUCTION: Sub-trochanteric fractures of the femur remains one of the most challenging fractures faced by orthopaedic surgeons. This study was done to analyse the management and complications of sub-trochanteric fractures using long proximal femoral nail (PFN. MATERIALS AND METHODS: This was a prospective study of 50 patients with sub-trochanteric fractures of femur who were treated with long PFN at a tertiary care center from July 2012 to June 2016. The fractures were classified according to Seinsheimer classification. All patients were assessed functionally by Harris Hip Score. RESULTS: Average duration of union was 17.08 weeks (range 13 to 32 weeks, union was achieved in 92% cases. Closed reduction was achieved in 68% cases and open reduction was required in 32% cases. Various intraoperative complications were seen in 12% and delayed complications in 26% of cases. Good anatomical results were achieved in 86% of cases and 14% were fair. As per Harris Hip score, excellent results were noted in 28% cases, good in 56% cases and fair in 16% cases. CONCLUSION: The long PFN is a reliable implant for sub-trochanteric femur fractures, with high rate of bone union and minimal soft tissue damage. Intramedullary fixation has biological and biomechanical advantages, but the surgery is technically demanding.

  5. A Study of Inflammatory/Necrosis Biomarkers in the Fracture of the Femur Treated with Proximal Femoral Nail Antirotation

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    Mariapaola Marino

    2015-01-01

    Full Text Available Pertrochanteric fractures are common injuries in adults and source of morbidity and mortality among the elderly. Different surgical techniques were recommended for their treatment but undoubtedly they add an additional inflammatory trauma along the fracture itself. Many attempts to quantify the degree of approach-related trauma are carried out through measurements of systemic inflammatory parameters. In this study we prospectively analyzed laboratory data of 20 patients over eighty with pertrochanteric fracture of the femur treated with proximal femoral nail antirotation (PFNA. This is an excellent device for osteosynthesis because it can be easily and quickly inserted by a mini-incision providing stable fixation and early full mobilization. Serum tumor necrosis factor-alpha (TNF-α, interleukin-6 (IL-6, C-reactive protein (CRP, and plasma creatin kinase (CK were evaluated 1 hour preoperatively and 24 hours postoperatively. Our results show that PFNA did not induce significant increments in serum levels of inflammatory cytokines TNF-α and IL-6; CRP was elevated preoperatively in correlation with waiting time for surgery; CRP and CK showed a significant increment in the first postoperatory day; CK increment was correlated with surgical time length. We conclude that, for the markers we analyzed, PFNA shows a low biomechanical-inflammatory profile that represents an advantage over other techniques.

  6. 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

  7. Effects of third fragment size and displacement on non-union of femoral shaft fractures after locking for intramedullary nailing.

    Science.gov (United States)

    Lee, J R; Kim, H-J; Lee, K-B

    2016-04-01

    femoral shaft fractures with fragments 8cm or longer or when the displacement in the proximal area is 20mm or greater and 10mm or greater in the distal area during the intramedullary nailing procedure. Regarding union rate, the degree of displacement has more influence than the third fragment size in femoral shaft fractures. IV, retrospective cohort study. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  8. Femoral Medialization, Fixation Failures, and Functional Outcome in Trochanteric Hip Fractures Treated With Either a Sliding Hip Screw or an Intramedullary Nail From Within a Randomized Trial.

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    Bretherton, Christopher P; Parker, Martyn J

    2016-12-01

    The aim of this study was to determine if femoral medialization influences residual pain and mobility and to determine if fixation method or fracture pattern influences the tendency to medialize. This study used data from within a randomized controlled trial. Peterborough City Hospital, UK. Eight hundred forty-four patients presenting with a trochanteric hip fracture were randomized. Five hundred thirty-eight were available for 1-year follow-up. Fractures were classified according to OTA/AO classification as 31 A1, A2, and A3. Randomized to fixation with a Targon proximal femoral nail or sliding hip screw (SHS). Femoral medialization was calculated from follow-up x-rays at a minimum of 28 days post-fixation. Pain and mobility scores were assessed at 1 year by an independent blinded observer. Fixation failure and revision procedures were assessed at a minimum of 1 year from injury. Patients with >50% medialization had worse pain (P = 0.012) and mobility scores (P = 0.013) at 1 year. They also had more fracture healing complications (P = 0.021) and required more revision procedures (P = 0.014). Fractures treated with SHS were more likely to medialize >50% compared with intramedullary nail (P fractures were more likely to medialize, and A3 fractures were more likely to undergo >50% medialization (P fractures treated with SHS to undergo femoral medialization and correlates this with worse functional outcomes. It supports the use of intramedullary nails for A3 fractures, which have a significant tendency to medialize. Prognostic level II. See Instructions for Authors for a complete description of levels of evidence.

  9. 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

  10. [Treatment of multi-segment fracture of complex femoral shaft with instrument-assisted reduction combined with intramedullary interlocking nail fixation].

    Science.gov (United States)

    Fan, Ke-Jie; Chen, Ke; Ma, Wen-Long; Tian, Ke-Wei; Ye, Ye; Chen, Hong-Gan; Tang, Yan-Feng; Cai, Hong-Min

    2018-05-25

    To investigate the effect of minimally invasive mini-incision and instrumented reduction combined with interlocking intramedullary nailing in the treatment of patients with multi-segment fracture of complex femoral shaft. From January 2013 to January 2016, 32 patients with multiple fractures segments of femoral shaft were treated with instrumentation-assisted reduction combined with interlocking intramedullary nailing, including 22 males and 10 females with an average age of 45 years old ranging 17 to 68 years old. The time from injured to operation was 5 to 10 days with an average of 7 days. After admission, routine tibial tubercle or supracondylar bone traction was performed. The patient's general condition was evaluated, the operation time and intraoperative blood loss were recorded. According to Thorsen femoral fracture morphology evaluation criteria and Hohl knee function evaluation of postoperative efficacy, postoperative fracture healing, complications and postoperative recovery of limb function were observed. All patients were followed up for 6 to 24 months with an average of 12 months. The operative time ranged from 48 to 76 minutes with an average of 67 min. The intraoperative blood loss was 150 to 400 ml with an average of 220 ml. The surgical incisions all achieved grade A healing. The fractures reached the clinical standard of healing. The fracture healing time ranged from 4.2 to 10.8 months with an average of 5.7 months. There were no nonunion, incision infection and internal fixation fracture, failure and other complications. According to Thorsen femoral fracture morphology evaluation criteria, the result was excellent in 28 cases, good in 3 cases, fair in 1 case. According to Hohl knee function evaluation criteria, the result was excellent in 30 cases, good in 2 cases. Instrument-assisted reduction combined with interlocking intramedullary nail fixation is a safe and effective method for the treatment of complex femoral shaft fractures. It has

  11. Staged protocol for the treatment of chronic femoral shaft osteomyelitis with Ilizarov's technique followed by the use of intramedullary locked nail.

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    Chou, Po-Hsin; Lin, Hsi-Hsien; Su, Yu-Pin; Chiang, Chao-Ching; Chang, Ming-Chau; Chen, Chuan-Mu

    2017-06-01

    Infected nonunion of the femoral shaft is uncommon, and usually presents with challenging therapeutic and reconstructive problems. There are still controversies over treating infected nonunion of the femoral shaft. The purposes of this retrospective study were to review the treatment outcomes and describe a staged protocol for spontaneous wound healing. Six patients with chronic femoral shaft infected-nonunion from October 2002 to September 2010 were included in this retrospective study. Serial plain films and triple films of lower legs were performed to evaluate the alignment of the treated femoral shaft and bony union following our staged protocol of Ilizarov distraction osteogenesis and intramedullary nailing. An average bone defect of 7 cm was noted after staged osteotomy. Mean follow-up was 87.5 (range, 38-133) months. Union was achieved in all six patients, with an average external fixation time of 6.8 (range, 5-11) months. There was no reinfection. One complication of a 4-cm leg discrepancy was noted, with an initial shortening of 15 cm. The mean knee ranges of motion (ROM) before staged protocols and at final follow-up were 64.2±8.6 (range, 60-75)° and 53.3±9.3 (range, 40-65)°, respectively. The ROM at the knee joint statistically decreased following staged protocols. In the treatment of chronic femur osteomyelitis, the staged protocol of Ilizarov distraction osteogenesis followed by intramedullary nailing was safe and successful, and allowed for union, realignment, reorientation, and leg-length restoration. With regard to the soft tissue, this technique provides a unique type of reconstructive closure for infected wounds. It is suggested that the staged protocol is reliable in providing successful simultaneous reconstruction for bone and soft tissue defects without flap coverage. Copyright © 2017. Published by Elsevier Taiwan LLC.

  12. A COMPARATIVE STUDY OF PROXIMAL FEMUR LOCKING COMPRESSION PLATE VERSUS PROXIMAL FEMORAL NAILING IN THE MANAGEMENT OF COMMINUTED TROCHANTERIC AND SUBTROCHANTERIC FRACTURE

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    Satish Koti

    2016-11-01

    Full Text Available BACKGROUND Fractures of proximal femur and hip are relatively common injuries in elderly individuals constituting 11.6% of total fractures. The latest implant for management of intertrochanteric fracture is Proximal Femoral Locking Compression Plate (PF-LCP. In this study, we compare the clinical outcome of fractures treated by proximal femoral nail with that of proximal femur locking compression plate. MATERIALS AND METHODS The present study consists of 24 elderly patients of peritrochanteric factures of femur satisfying the inclusion criteria who were treated with PF-LCP or PFN in Department of Orthopaedics, S.V.R.R.G.G.H, Tirupati, during a period between December 2013 to October 2015. RESULTS 24 cases were treated with PF-LCP or PFN in a randomised pattern who satisfied inclusion criteria. Intraoperative complication were found to be more with PF-LCP in contrast to PFN. Postoperative rehabilitation was easier with PFN though not statistically significant functional and anatomical outcomes were found to be better with PFN. CONCLUSION Both PFN and PF-LCP have good effectiveness in the treatment of intertrochanteric fractures with the lateral unsubstantial femoral wall in the elderly patients. Each has its own advantages and disadvantages. Further studies with large number of patients and long-term follow up is needed to determine the optimal implant for the internal fixation of comminuted pertrochanteric femoral fractures.

  13. 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

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

    Science.gov (United States)

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

    2014-08-01

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

  15. Treatment for Trochanteric Fracture of the Femur with Short Femoral Nail: A Comparison between the Asian Intramedullary Hip Screw (IMHS) and the Conventional IMHS.

    Science.gov (United States)

    Kawaji, Hidemi; Uematsu, Takuya; Oba, Ryosuke; Satake, Yoshihiko; Hoshikawa, Naoya; Takai, Shinro

    2016-01-01

    We usually use short femoral nails for the treatment of trochanteric fracture of the femur. In this retrospective study, we investigated and compared the clinical results of the conventional intramedullary hip screw (IMHS) and the Asian IMHS, which is a redesigned version of the former. The subjects were 42 patients; 21 treated with the Asian IMHS and 21 were treated with the conventional IMHS. From the clinical records, we retrospectively investigated the patients' age, sex, in-hospital waiting period for operation, operating time, intraoperative blood loss, walking ability before fracture and at discharge, and complication pertaining to the operation. The 21 patients (4 men and 17 women) receiving the Asian IMHS and the 21 patients (5 men and 16 women) receiving the conventional IMHS did not differ significantly in mean age, sex ratio, preoperative waiting period, mean postoperative hospital stay, mean operation time, or mean intraoperative blood loss. Among patients receiving the Asian IMHS, the complications of intraoperative fractures of the femur developed in 3 patients and breakage of the implant occurred in 1 patient. No complications occurred in patients receiving the conventional IMHS. Compared with the conventional IMHS, the Asian IMHS is smaller, has increased variations in the shaft/neck angle of the lag screw, and has a titanium-alloy construction, allowing magnetic resonance imaging. The intraoperative fracture may have occurred because of the configuration of the distal interlocking screw in the Asian IMHS. Breakage of the implant likely occurred because the nail was too small in diameter, and too short in length for the unstable AO 31-A3 fracture. If careful attention is paid to the configuration of its distal interlocking screw intraoperatively and a nail of appropriate size is selected, the Asian IMHS is better suited than the conventional IMHS for treating Japanese patients, who generally have a small physique, because of its many variations in

  16. [Curative effect analysis on proximal frmoral nail antirotation for the treatment of femoral intertrochanteric fracture and integrity of lateral trochanteric wall].

    Science.gov (United States)

    Wei, Jie; Qin, De-an; Guo, Xiu-sheng

    2015-06-01

    To explore clinical efficacy and key matters for the treatment of femoral intertrochanteric fracture and integrity of lateral trochanteric wall by proximal frmoral nail antirotation (PFNA). From June 2010 to December 2012,210 femoral intertrochanteric fracture patients treated with PFNA were retrospectively analyzed, including 76 males and 134 females aged from 46 to 96 years old with an average of 71 years old. All fracture were caused by injury and classified to type I (5 cases) type II (16 cases), type III (73 cases) and type IV (116 cases) according to Evans classification. The time of getting out of bed, postoperative complications and displacement of screw blade and fracture healing were observed, Baumgaertner criteria were used to evaluate quality of fracture reduction, Harris criteria were used to evaulate hip joint function. All incisions were healed at stage I, no complications occurred except incomplete of lateral trochanteric wall patients without reconstruction, other patients could get out of bed with crutches at one week and all patients discharged from hospital at 10 days after operation. One hundred and seventy-eight patients were followed up from 3 to 17 months with an average of 10 months. One case occurred unhealed fracture displacement caused by screw blade cutting, 2 cases occurred screw blade transfomed to proximal and out femoral head, other patients obtained fracture healing at 12 to 16 weeks after operation. According to Baumgaertner criteria, 130 cases obtained good results, 45 cases acceptable, and 3 poor; while 107 cases obtained excellent results, 65 good, 3 good and 3 poor according to Harris score. PFNA with mechanical advantage of intramedullary fixation has advantsges of stable fixation, shorter operation time, minimally invasive. Satisfied clinical effects could obtained by grasping fixation principle, dealing with negative factors in operation. Intraoperative reconstruction for integrity of lateral trochanteric wall could assure

  17. 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

  18. Which factor is most important for occurrence of cutout complications in patients treated with proximal femoral nail antirotation? Retrospective analysis of 298 patients.

    Science.gov (United States)

    Turgut, Ali; Kalenderer, Önder; Karapınar, Levent; Kumbaracı, Mert; Akkan, Hasan Ali; Ağuş, Haluk

    2016-05-01

    Mechanical complications, such as cut-out of the head-neck fixation device, are the most common causes of morbidity after trochanteric femur fracture treatment. The causes of cut-out complications are well defined in patients who are treated with sliding hip screws and biaxial cephalomedullary nails but there are few reports about the patients who are treated with proximal femoral nail antirotation. The purpose of this study was to evaluate the most important factor about occurance of cutout complication and also to evaluate the risks of the combination of each possible factors. Overally 298 patients were enrolled in the study. Medical records were reviewed for patients' age, fracture type, gender, anesthesia type and occurance of cut-out complication. Postoperatively taken radiographs were reviewed for tip-apex distance, obtained collo-diaphyseal angle, the quadrant of the helical blade and Ikuta reduction subgroup. The most important factor (s) and also predicted probability of cut-out complication was calculated for each combination of factors. Cut-out complication was observed in 14 patients (4.7 %). The most important factor about occurrence of the cut-out complication was found as varus reduction (p: 0.01), the second important factor was found as implantation of the helical blade in the improper quadrant (p: 0.02). Tip-apex distance was found as third important factor (p: 0.10). The predicted probability of cut-out complication was calculated as 45.6 % when whole of the four surgeon dependent factors were improperly obtained. Althought obtaining proper tip-apex distance is important to prevent cutout complication in these fractures, if the fracture is not reduced in varus position and helical blade is inserted in the proper quadrant, possibility of cut-out complication is very low even in the patients with high tip-apex distance.

  19. Intramedullary stabilization and over-nail lengthening as two-stage treatment of femoral nonunion with shortening. Case study.

    Science.gov (United States)

    Kącki, Wojciech; Jasiewicz, Barbara; Radło, Paweł

    2014-01-01

    Nonunion is one of the most serious complications of long bone fractures. It may be accompanied by a shortening of the segment. The authors describe the case of a 21-year-old woman with a post-traumatic nonunion with shortening of the femur. Treatment was divided into two stages: first, a previously placed nail was removed and new intramedullary stabilization was carried out while bone defects were filled with a bone graft substitute and platelet rich plasma was administered. After the nonunion had healed, the femur was lengthened over an external fixator and an intramedullary nail, resulting in equality of limb length. After eight years of follow-up, the lower limbs remain equal with a properly aligned long axis of the lower limb operated on and a full range of motion in the joints. The treatment strategy described in our article may be an alternative to one-stage surgery if the patient does not consent to it or in the presence of contraindications, but it is associated with a longer treatment time and necessity of additional surgeries.

  20. 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

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    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

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

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    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.

  2. Nail cosmetics

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    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.

  3. Nail cosmetics.

    Science.gov (United States)

    Madnani, Nina A; Khan, Kaleem J

    2012-01-01

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

  4. Rotationally Stable Screw-Anchor With Locked Trochanteric Stabilizing Plate Versus Proximal Femoral Nail Antirotation in the Treatment of AO/OTA 31A2.2 Fracture: A Biomechanical Evaluation.

    Science.gov (United States)

    Knobe, Matthias; Nagel, Philipp; Maier, Klaus-Jürgen; Gradl, Gertraud; Buecking, Benjamin; Sönmez, Tolga T; Modabber, Ali; Prescher, Andreas; Pape, Hans-Christoph

    2016-01-01

    Third-generation cephalomedullary nails currently represent the gold standard in the treatment of unstable trochanteric femur fractures. Recently, an extramedullary rotationally stable screw-anchor system (RoSA) has been developed. It was designed to combine the benefits of screw and blade and to improve stability using a locked trochanteric stabilizing plate (TSP). The purpose of this study was to compare the biomechanical behavior of RoSA/TSP and the proximal femoral nail antirotation (PFNA). Standardized AO/OTA 31A2.2 fractures were induced by an oscillating saw in 10 paired human specimens (n = 20; mean age = 85 years; range: 71-96 years). The fractures were stabilized by either the RoSA/TSP (Koenigsee Implants, Allendorf, Germany) or the PFNA (DePuy Synthes, Zuchwil, Switzerland). Femurs were positioned in 25 degrees of adduction and 10 degrees of posterior flexion and were cyclically loaded with axial sinusoidal pattern at 0.5 Hz, starting at 300 N, with stepwise increase by 300 N every 500 cycles until bone-implant failure occurred. After every load step, the samples were measured visually and radiographically. Femoral head migration was assessed. The stiffness at the load up to the clinically relevant load step of 1800 N (639 ± 378 N/mm (RoSA/TSP) vs. 673 ± 227 N/mm (PFNA); P = 0.542) was comparable, as was the failure load (3000 ± 787 N vs. 3780 ± 874 N; P = 0.059). Up to 1800 N, no femoral head rotation, head migration, or femoral neck shortening were observed either for RoSA/TSP or PFNA. Whereas failure of the PFNA subsumed fractures of the greater trochanter and the lateral wall, a posterior femoral neck fracture with a significantly increased femoral neck shortening (1.7 mm vs. 0 mm; P = 0.012) was the cause of failure with RoSA/TSP. This specific kind of failure was induced by a femoral neck weakening caused by the posterior TSP stabilizing screw. There was no significant difference in biomechanical properties between the RoSA/TSP and the PFNA for

  5. frequency of ipsilateral femoral neck fractures in patients

    African Journals Online (AJOL)

    Background: Ipsilateral associated femoral neck and shaft fractures are reported to occur in 2.5-6% of all femoral shaft ... nailing of the shaft fracture, which makes treatment of the neck ... chest, spine), while the other had maxillofacial injuries.

  6. Staged protocol for the treatment of chronic femoral shaft osteomyelitis with Ilizarov's technique followed by the use of intramedullary locked nail

    Directory of Open Access Journals (Sweden)

    Po-Hsin Chou

    2017-06-01

    Conclusion: In the treatment of chronic femur osteomyelitis, the staged protocol of Ilizarov distraction osteogenesis followed by intramedullary nailing was safe and successful, and allowed for union, realignment, reorientation, and leg-length restoration. With regard to the soft tissue, this technique provides a unique type of reconstructive closure for infected wounds. It is suggested that the staged protocol is reliable in providing successful simultaneous reconstruction for bone and soft tissue defects without flap coverage.

  7. Broken bone

    Science.gov (United States)

    ... Drugs & Supplements Videos & Tools Español You Are Here: Home → Medical Encyclopedia → Broken bone URL of this page: //medlineplus.gov/ency/ ... following steps to reduce your risk of a broken bone: Wear protective ... pads. Create a safe home for young children. Place a gate at stairways ...

  8. Removal torque of nail interlocking screws is related to screw proximity to the fracture and screw breakage.

    Science.gov (United States)

    White, Alexander A; Kubacki, Meghan R; Samona, Jason; Telehowski, Paul; Atkinson, Patrick J

    2016-06-01

    Studies have shown that titanium implants can be challenging to explant due to the material's excellent biocompatibility and resulting osseointegration. Clinically, titanium alloy nail interlocking screws may require removal to dynamize a construct or revise the nail due to nonunion, infection, pain, or periprosthetic fracture. This study was designed to determine what variables influence the removal torque for titanium alloy interlocking screws. An intramedullary nail with four interlocking screws was used to stabilize a 1-cm segmental femoral defect in a canine model for 16 weeks. The animals were observed to be active following a several-day recovery after surgery. In six animals, the femora and implanted nail/screws were first tested to failure in torsion to simulate periprosthetic fracture of an implant after which the screws were then removed. In four additional animals, the screws were removed without mechanical testing. Both intraoperative insertional and extraction torques were recorded for all screws. Mechanical testing to failure broke 10/24 screws. On average, the intact screws required 70% of the insertional torque during removal while broken screws only required 16% of the insertional torque (p torque than the outboard distal screw (p torque was ∼80°. The peak axial load did not significantly correlate with the torque required to remove the screws. On average, the removal torque was lower than at the time of insertion, and less torque was required to remove broken screws and screws remote to the fracture. However, broken screws will require additional time to retrieve the remaining screw fragment. This study suggests that broken screws and screws in prematurely active patients will require less torque to remove. © IMechE 2016.

  9. Haste bloqueada "Faculdade de Medicina de Ribeirão Preto": experiência clínica no tratamento das fraturas femorais Ribeirão Preto school of medicine locking nail: clinical experience in the femoral fractures treatment

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    Fernando Mendes Paschoal

    2000-12-01

    Full Text Available Uma série de 103 casos de fraturas diafisárias complexas do fêmur foram tratadas com a haste intramedular bloqueada FMRP, no período de maio de 1987 a dezembro 1995. Das 103 fraturas, 67 eram cominutivas, 12 bifocais (segmentar, 4 espirais, 13 proximais e 21 distais, instáveis, rotacionalmente, da diáfise femoral. Do total dos casos, constatou-se 97 bloqueios estáticos e 6 dinâmicos. Dessas 97 estáticas, 7 foram dinamizadas durante a evolução. Clínica e radiográficamente a consolidação ocorreu em 97,09% dos casos, com média de 16,72 semanas e em 3 casos não houve consolidação. Houve 4 casos de infecção suspeita e 3 estabelecidas que foram debeladas e evoluíram para consolidação. Houve 81 casos de encurtamentos que variaram entre 0,5 a 4 cm com média de 1 cm. O encurtamento menor ou igual a 2 cm ocorreu em 73 casos. Desvio de alinhamento em qualquer plano acima de 10 º e igual a 15º foi observado em 8 pacientes. Houve 10 casos de deformidades rotacionais, porém nenhum caso acima de 10º. A incidência de infecção foi baixa e a de consolidação alta. A estabilização dessas fraturas complexas permitiu imediata mobilização do paciente, reabilitação precoce do membro e diminuição da permanência hospitalar, excetuando os politraumatizados. A haste FMRP permitiu o tratamento dessas fraturas sem o uso de intensificador de imagens e de fresas flexíveis com baixo custo operacional. Os resultados foram semelhantes aos obtidos com as hastes intramedulares bloqueadas que necessitam de aparelhagem técnica mais sofisticada, porém com vantagens para o paciente e a equipe cirúrgica.A series of 103 cases of complex femoral fracture were treated with FMRP (Faculdade de Medicina de Ribeirão Preto nail. These fractures were treated from May 1987 until December 1995. From the 103 fractures, 67 were cominutive, 12 bifocal (segmental, 4 spiral, 13 proximal e 21 distal and unstable rotationaly. From the total of cases, 97

  10. Broken Arm

    Science.gov (United States)

    ... of falling — including football, soccer, gymnastics, skiing and skateboarding — also increases the risk of a broken arm. ... for high-risk activities, such as in-line skating, snowboarding, rugby and football. Don't smoke. Smoking ...

  11. Green Nail Syndrome

    Science.gov (United States)

    ... nail is detached from the nail bed, the waterproof seal formed by the skin on the nail ... should also be noted that wearing tight-fitting shoes for a prolonged time, especially while exercising, is ...

  12. Onychomycosis nailed

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    Leelavathi Muthupalaniappen

    2014-04-01

    Full Text Available Fungal infection of the nail is a common condition that causes much concern because of its disfiguring appearance. Although specific treatment is available for this condition, treatment outcome is variable and persistent nail dystrophy post-treatment may cause distress to both the patient and the physician. This article describes the current available treatment options for onychomycosis, management approach and the expected treatment outcome to enhance primary care physicians’ confidence in managing this condition. Oral antifungal agents such as terbinafine and itraconazole are good treatment options for onychomycosis. Combination therapy using oral antifungal agents with topical lacquer preparations may provide added benefits. Evaluation of patient’s expectations, providing information on treatment outcome, clinical cure and recurrence rates are essential in the management of onychomycosis. This article is intended to guide primary care physicians to achieve realistic treatment goals and for a satisfactory experience in the overall management of this challenging condition.

  13. Update on nail cosmetics.

    Science.gov (United States)

    Jefferson, Julie; Rich, Phoebe

    2012-01-01

    Nail cosmetics are used by millions of people worldwide who desire smooth, lustrous nails. The nail cosmetic industry continues to expand to meet increasing consumer demand. In 2011 alone, consumers spent $6.6 billion on nail salon services. Although nail cosmetics are relatively safe, poor application techniques can promote disease, deformity, and allergic and irritant contact dermatitis. The foundation for managing nail cosmetic problems is prevention through education. Familiarity with the procedures and materials used in the nail cosmetic industry is necessary in order to recommend safe nail care strategies. © 2012 Wiley Periodicals, Inc.

  14. Short-term outcome of patients with closed comminuted femoral ...

    African Journals Online (AJOL)

    Short-term outcome of patients with closed comminuted femoral shaft fracture treated with locking intramedullary sign nail at Muhimbili Orthopaedic Institute in Tanzania. Billy T. Haonga, Felix S. Mrita, Edmundo E. Ndalama, Jackline E. Makupa ...

  15. Interventions for nail psoriasis

    NARCIS (Netherlands)

    de Vries, Anna Christa Q.; Bogaards, Nathalie A.; Hooft, Lotty; Velema, Marieke; Pasch, Marcel; Lebwohl, Mark; Spuls, Phyllis I.

    2013-01-01

    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 to therapy.

  16. Interventions for nail psoriasis

    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

  17. Broken Bones (For Parents)

    Science.gov (United States)

    ... Safe Videos for Educators Search English Español Broken Bones KidsHealth / For Parents / Broken Bones What's in this ... bone fragments in place. When Will a Broken Bone Heal? Fractures heal at different rates, depending upon ...

  18. 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.

  19. 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.

  20. [Trochanteric femoral fractures].

    Science.gov (United States)

    Douša, P; Čech, O; Weissinger, M; Džupa, V

    2013-01-01

    At the present time proximal femoral fractures account for 30% of all fractures referred to hospitals for treatment. Our population is ageing, the proportion of patients with post-menopausal or senile osteoporosis is increasing and therefore the number of proximal femoral fractures requiring urgent treatment is growing too. In the age category of 50 years and older, the incidence of these fractures has increased exponentially. Our department serves as a trauma centre for half of Prague and part of the Central Bohemia Region with a population of 1 150 000. Prague in particular has a high number of elderly citizens. Our experience is based on extensive clinical data obtained from the Register of Proximal Femoral Fractures established in 1997. During 14 years, 4280 patients, 3112 women and 1168 men, were admitted to our department for treatment of proximal femoral fractures. All patients were followed up until healing or development of complications. In the group under study, 82% were patients older than 70 years; 72% of those requiring surgery were in their seventies and eighties. Men were significantly younger than women (pfractures were 2.3-times more frequent in women than in men. In the category under 60 years, men significantly outnumbered women (pfractures were, on the average, eight years older than the patients with intertrochanteric fractures, which is a significant difference (pTrochanteric fractures accounted for 54.7% and femoral neck fractures for 45.3% of all fractures. The inter-annual increase was 5.9%, with more trochanteric than femoral neck fractures. There was a non-significant decrease in intertrochanteric (AO 31-A3) fractures. On the other hand, the number of pertrochanteric (AO 31-A1+2) fractures increased significantly (pfractures were treated with a proximal femoral nail; a short nail was used in 1260 and a long nail in 134 of them. A dynamic hip screw (DHS) was employed to treat 947 fractures. Distinguishing between pertrochanteric (21-A1

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

    Science.gov (United States)

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

    2014-01-01

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

  2. Preoperative virtual reduction reduces femoral malrotation in the treatment of bilateral femoral shaft fractures.

    Science.gov (United States)

    Omar, Mohamed; Suero, Eduardo M; Hawi, Nael; Decker, Sebastian; Krettek, Christian; Citak, Musa

    2015-10-01

    In bilateral femoral shaft fractures, significant malrotation (>15°) occurs in about 40 % of cases after intramedullary nailing. Most of the methods that provide rotational control during surgery are based on a comparison to the intact femur and, thus, not applicable for bilateral fractures. In this study, we evaluated if preoperative virtual reduction can help improving rotational alignment in patients with bilateral femoral shaft fractures. Seven patients with bilateral femoral shaft fractures were initially treated with external fixation of both femurs. After obtaining a CT scan of both legs, the fractures were reduced virtually using the software program VoXim®, and the amount and direction of rotational correction were calculated. Subsequently, the patients were treated by antegrade femoral nailing and rotation was corrected to the preoperatively calculated amount. After external fixation, the mean rotational difference between both legs was 15.0° ± 10.2°. Four out of seven patients had a significant malrotation over 15°. Following virtual reduction, the mean rotational difference between both legs was 2.1° ± 1.2°. After intramedullary nailing, no case of malrotation occurred and the mean rotational difference was 6.1° ± 2.8°. Preoperative virtual reduction allows determining the pretraumatic femoral antetorsion and provided useful information for the definitive treatment of bilateral femoral shaft fractures. We believe that this procedure is worth being implemented in the clinical workflow to avoid malrotation after intramedullary nailing.

  3. How to Stop Biting Your Nails

    Medline Plus

    Full Text Available ... Hair care / hair loss Injured skin Nail care Artificial nails Healthy nails Child nail care Manicure safety Nail biting Nail changes a dermatologist should examine Anti-aging skin care Kids’ zone Video library Find a ...

  4. How to Stop Biting Your Nails

    Medline Plus

    Full Text Available ... hair, and nail care Skin care Hair care / hair loss Injured skin Nail care Anti-aging skin care ... hair, and nail care Skin care Hair care / hair loss Injured skin Nail care Artificial nails Healthy nails ...

  5. How to Stop Biting Your Nails

    Medline Plus

    Full Text Available ... hair loss Injured skin Nail care Artificial nails Healthy nails Child nail care Manicure safety Nail biting Nail changes a dermatologist should examine Anti-aging skin care Kids’ zone Video library Find a ...

  6. How to Stop Biting Your Nails

    Medline Plus

    Full Text Available ... Injured skin Nail care Artificial nails Healthy nails Child nail care Manicure safety Nail biting Nail changes ... c Explore the Academy Member resources Practice Tools Education Meetings & events Advocacy Public & patients Academy resources for: ...

  7. Facts about Broken Bones

    Science.gov (United States)

    ... Safe Videos for Educators Search English Español Broken Bones KidsHealth / For Kids / Broken Bones What's in this ... sticking through the skin . What Happens When a Bone Breaks? It hurts to break a bone! It's ...

  8. Clinical Outcomes after Open Locked Intramedullary Nailing of ...

    African Journals Online (AJOL)

    2017-12-05

    Dec 5, 2017 ... joint stiffness due to prolonged immobilization.[8,9] Open reduction and internal fixation have reduced some of these complications by enabling early mobilization of the patient after surgery. The gold standard for treating closed femoral shaft fractures currently is closed locked intramedullary nailing.[10-13] ...

  9. How to Stop Biting Your Nails

    Medline Plus

    Full Text Available ... biting your nails Nail biting typically begins in childhood and can continue through adulthood, and the side ... set of nails, such as your thumb nails, first. When that’s successful, eliminate your pinky nails, pointer ...

  10. Outcomes in closed reamed interlocking nail in fractures of shaft of femur

    International Nuclear Information System (INIS)

    Mohammad, T.; Sawati, A.; Ahmed, A.

    2015-01-01

    Femoral shaft fracture is one of the common fractures seen in accident and emergency department of our hospital. Violent forces are required to break this and strongest of human bones. There are various treatment modalities for femoral shaft fractures in adults like traction, brace, platting, intramedullary nail (IMN), external fixators and inter locking nails. The study was done with an objective to evaluate the results of closed reamed interlocking nail in fractures of shaft of femur. Methods: A prospective study of 114 cases of femoral shaft fractures was carried out at orthopaedic unit of Ayub Teaching Hospital Abbottabad during 1 year. All these cases were treated with statically locked nails under spinal or general anaesthesia. These cases were followed up for up to one year and Results of the interlocking nail were observed in terms of union and complications. Results: Out of 114 patients, 95 underwent union in 90-150 days with a mean of 110.68 days. Ten patients had dynamization within six weeks because of obvious fracture gap in radiograph. There were 3 patients who had non-union, and 6 patients had delayed union which was treated with dynamization. Conclusion: Close reamed interlocking intramedullary nail in femoral shaft fractures is the treatment of choice. Patient rehabilitation is early, hospitalization is short, and fracture healing response is good. (author)

  11. Ipsilateral proximal femur and shaft fractures treated with hip screws and a reamed retrograde intramedullary nail.

    Science.gov (United States)

    Ostrum, Robert F; Tornetta, Paul; Watson, J Tracy; Christiano, Anthony; Vafek, Emily

    2014-09-01

    Although not common, proximal femoral fractures associated with ipsilateral shaft fractures present a difficult management problem. A variety of surgical options have been employed with varying results. We investigated the use of hip screws and a reamed retrograde intramedullary (IM) nail for the treatment of this combined fracture pattern in terms of postoperative alignment (malunion), nonunion, and complications. Between May 2002 and October 2011, a total of 95 proximal femoral fractures with associated shaft fractures were treated at three participating Level 1 trauma centers; all were treated with hip screw fixation (cannulated screws or sliding hip screws) and retrograde reamed IM nails. The medical records of these patients were reviewed retrospectively for alignment, malunion, nonunion, and complications. Followup was available on 92 of 95 (97%) of the patients treated with hip screws and a retrograde nail. Forty were treated with a sliding hip screw, and 52 were treated with cannulated screws. There were five proximal malunions in this series (5%). The union rate was 98% (90 of 92) for the femoral neck fractures and 91.3% (84 of 92) for the femoral shaft fractures after the initial surgery. There were two nonunions of comminuted femoral neck fractures after cannulated screw fixation. There was no difference in femoral neck union or alignment when comparing cannulated screws to a sliding hip screw. Four open comminuted femoral shaft fractures went on to nonunion and required secondary surgery to obtain union, and one patient developed symptomatic avascular necrosis. The treatment of ipsilateral proximal femoral neck and shaft fractures with hip screw fixation and a reamed retrograde nail demonstrated a high likelihood of union for the femoral neck fractures and a low risk of malunion. Comminution and initial displacement of the proximal femoral fracture may still lead to a small incidence of malunion or nonunion, and open comminuted femoral shaft fractures

  12. An in vivo evaluation of surface polishing of TAN intermedullary nails for ease of removal

    Directory of Open Access Journals (Sweden)

    JS Hayes

    2009-09-01

    Full Text Available Fractures of the tibia and femoral diaphysis are commonly repaired by intra-medullary (IM nailing. Currently IM nails are available in either electropolished stainless steel (SS or in Titanium-Aluminium-Niobium (TAN. After healing, removal of the nails still is common but removal of TAN IM nails often has complications whereas SS IM nails of the same design are less often associated with problems. We believe the differences in removal are due to the ability of TAN to promote strong bone on-growth. We have previously shown in vivo that polishing cortical screws reduces removal torque and the percentage of bone-implant contact. Therefore, we postulate that bony on-growth onto IM nails can be reduced by means of surface polishing, for ease of removal. Here we aim to compare the pull-out forces for removal of standard TAN (TAN-S compared to experimental paste polished TAN (TAN-PP IM nails from a bilateral non-fracture sheep tibia model after 12 months implantation. Histological analysis was also performed to assess tissue on-growth to the nails. We show that polishing significantly reduces (p=0.05 the extraction force required for TAN IM nail removal. This effect in part is attributable to the distinct tissue-material reaction produced. For TAN-S nails direct bone contact was observed while for TAN-PP nails a fibrous tissue interface was noted. Since TAN is preferred over SS for IM nailing due to superior biocompatibility and mechanical properties, we believe these findings could be used to recommend changes to current surface technologies of intramedullary nails to reduce complications seen with nail removal especially in rapidly growing bone in children.

  13. Advanced nail surgery

    Directory of Open Access Journals (Sweden)

    Eckart Haneke

    2011-01-01

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

  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. Skin, Hair, and Nails

    Science.gov (United States)

    ... Safe Videos for Educators Search English Español Skin, Hair, and Nails KidsHealth / For Parents / Skin, Hair, and ... piel, el cabello y las uñas About Skin, Hair and Nails Skin is our largest organ. If ...

  16. 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.

  17. Outcome of intramedullary interlocking SIGN nail in tibial diaphyseal fracture

    International Nuclear Information System (INIS)

    Khan, I.; Javed, S.; Khan, G.N.; Aziz, A.

    2013-01-01

    Objective: To determine the outcome of intramedullary interlocking surgical implant generation network (SIGN) nail in diaphyseal tibial fractures in terms of union and failure of implant (breakage of nail or interlocking screws). Study Design: Case series. Place and Duration of Study: Orthopaedics and Spinal Surgery, Ghurki Trust Teaching Hospital, Lahore Medical and Dental College, Lahore, from September 2008 to August 2009. Methodology: Fifty patients aged 14 - 60 years, of either gender were included, who had closed and Gustilo type I and II open fractures reported in 2 weeks, whose closed reduction was not possible or was unsatisfactory and fracture was located 7 cm below knee joint to 7 cm above ankle joint. Fractures previously treated with external fixator, infected fractures and unfit patients were excluded. All fractures were fixed with intramedullary interlocking SIGN nail and were followed clinically and radiographically for union and for any implant failure. Results: Forty one (88%) patients had united fracture within 6 months, 5 (10%) patients had delayed union while 4 (8%) patients had non-union. Mean duration for achieving union was 163 + 30.6 days. Interlocking screws were broken in 2 patients while no nail was broken in any patient. Conclusion: Intramedullary interlocking nailing is an effective measure in treating closed and grade I and II open tibial fractures. It provides a high rate of union less complications and early return to function. (author)

  18. Outcome of intramedullary interlocking SIGN nail in tibial diaphyseal fracture.

    Science.gov (United States)

    Khan, Irfanullah; Javed, Shahzad; Khan, Gauhar Nawaz; Aziz, Amer

    2013-03-01

    To determine the outcome of intramedullary interlocking surgical implant generation network (SIGN) nail in diaphyseal tibial fractures in terms of union and failure of implant (breakage of nail or interlocking screws). Case series. Orthopaedics and Spinal Surgery, Ghurki Trust Teaching Hospital, Lahore Medical and Dental College, Lahore, from September 2008 to August 2009. Fifty patients aged 14 - 60 years, of either gender were included, who had closed and Gustilo type I and II open fractures reported in 2 weeks, whose closed reduction was not possible or was unsatisfactory and fracture was located 7 cm below knee joint to 7 cm above ankle joint. Fractures previously treated with external fixator, infected fractures and unfit patients were excluded. All fractures were fixed with intramedullary interlocking SIGN nail and were followed clinically and radiographically for union and for any implant failure. Forty one (88%) patients had united fracture within 6 months, 5 (10%) patients had delayed union while 4 (8%) patients had non-union. Mean duration for achieving union was 163 + 30.6 days. Interlocking screws were broken in 2 patients while no nail was broken in any patient. Intramedullary interlocking nailing is an effective measure in treating closed and grade I and II open tibial fractures. It provides a high rate of union less complications and early return to function.

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

    International Nuclear Information System (INIS)

    Zimel, Melissa N.; Hwang, Sinchun; Riedel, Elyn R.; Healey, John H.

    2015-01-01

    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.)

  20. 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.)

  1. Occurrence of secondary fracture around intramedullary nails used for trochanteric hip fractures: a systematic review of 13,568 patients.

    Science.gov (United States)

    Norris, Rory; Bhattacharjee, Dhritiman; Parker, Martyn J

    2012-06-01

    A sliding hip screw (SHS) is currently the treatment of choice for trochanteric hip fractures, largely due to the low incidence of complications. An alternative treatment is the use of intramedullary proximal femoral nails. Unfortunately these implants have been associated with a risk of later fracture around the implant. The aim of this study was to see if any improvements have been made to the current intramedullary nails, to reduce the incidence of secondary fracture around the distal tip of the nail. We analysed data related to 13,568 patients from 89 studies, focusing on the incidence of post operative secondary femoral shaft fracture following the use of intramedullary nails in the fixation of trochanteric hip fractures. The overall reported incidence of secondary fracture around the nail was 1.7%. The incidence of fracture has reduced in the 3rd generation Gamma nails when compared to the older Gamma nail (1.7% versus 2.6%, p value 0.03). However, the incidence of secondary fracture in the 3rd generation Gamma nails is still significantly higher than the other brands of short nail (1.7% versus 0.7%, p value 0.0005). Long nails had a slight tendency towards a lower risk of fracture although the difference was not statistically significant (1.1% versus 1.7%, p value 0.28). There was a significantly lower risk of fracture for those nails with a biaxial fixation as opposed to uniaxial fixation (0.6% versus 1.9%, p value fracture around a proximal femoral nail is one of the most significant of fracture healing complications, and this study suggests that continuing design changes to this method of fixation has reduced the risk of this complication occurring. Copyright © 2011 Elsevier Ltd. All rights reserved.

  2. Closed External Fixation for Failing or Failed Femoral Shaft Plating in a Developing Country.

    Science.gov (United States)

    Aliakbar, Adil; Witwit, Ibrahim; Al-Algawy, Alaa A Hussein

    2017-08-01

    Femoral shaft fractures are one of the common injuries that is treated by open reduction, with internal fixation by plate and screws or intramedullary nailing, which can achieve a high union rate. To evaluate the outcome of using closed external fixation to augment a failing plate; with signs of screw loosening and increasing bone/plate gap; a failed plate; broken plate; screws completely out of bone with redisplacement of fracture. A retrospective study on 18 patients, aged between 17-42 years, who presented between 6-18 weeks after initial surgical fixation, with pain, difficulty in limb function, deformity and abnormal movement at fracture site, was done. X-Rays showed plating failure with acceptable amount of callus, which unfortunately had refractured. Cases associated with infection and no radiological evidence of callus formation were excluded from this study. Closed reduction was done by manipulation, then fracture fixation by AO external fixator. The patients were encouraged for full weight bearing as early as possible with dynamization later on. Of the 18 patients who underwent external fixation after close reduction, 15 cases showed bone healing in a period between 11-18 weeks (mean of 14.27 weeks) with good alignment (Radiologically). Removal of external fixator was done followed by physical therapy thereafter. Closed external fixation for treatment of failing or failed femoral plating, achieves good success rate and has less complications, is a short time procedure, especially in a hospital with limited resources.

  3. Femoral head vitality after intracapsular hip fracture

    International Nuclear Information System (INIS)

    Stroemqvist, B.

    1983-01-01

    Femoral head vitality before, during and at various intervals from the operation was determined by tetracycline labeling and/or 99 sp (m)Tc-MDP scintimetry. In a three-year follow-up, healing prognosis could be determined by scintimetry 3 weeks from operation; deficient femoral head vitality predicting healing complications and retained vitality predicting uncomplicated healing. A comparison between pre- and postoperative scintimetry indicated that further impairment of the femoral head vitality could be caused by the operative procedure, and as tetracycline labeling prior to and after fracture reduction in 370 fractures proved equivalent, it was concluded that the procedure of osteosynthesis probably was responsible for capsular vessel injury, using a four-flanged nail. The four-flanged nail was compared with a low-traumatic method of osteosynthesis, two hook-pins, in a prospective randomized 14 month study, and the postoperative femoral head vitality was significantly better in the hook-pin group. This was also clearly demonstrated in a one-year follow-up for the fractures included in the study. Parallel to these investigations, the reliability of the methods of vitality determination was found satisfactory in methodologic studies. For clinical purpose, primary atraumatic osteosynthesis, postoperative prognostic scintimetry and early secondary arthroplasty when indicated, was concluded to be the appropriate approach to femoral neck fracture treatment. (Author)

  4. Broken or dislocated jaw

    Science.gov (United States)

    ... broken or dislocated jaw requires prompt medical attention. Emergency symptoms include difficulty breathing or heavy bleeding. ... safety equipment, such as a helmet when playing football, or using ... can prevent or minimize some injuries to the face or jaw.

  5. Greater rate of cephalic screw mobilisation following proximal femoral nailing in hip fractures with a tip-apex distance (TAD) and a calcar referenced TAD greater than 25 mm.

    Science.gov (United States)

    Aicale, Rocco; Maffulli, Nicola

    2018-05-02

    To ascertain whether the tip-apex distance (TAD), calcar referenced TAD (CalTAD), and the sum of both (TADcalTAD) are predictive measurements of mobilisation of the cephalic screw in patients with trochanteric hip fractures. Between 2014 and 2015, 68 patients (mean age 86 years, 45 females, 23 males) with a trochanteric hip fracture underwent intramedullary nailing. The TAD and CalTAD were measured, and for each parameter, we calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). There is evidence of a statistically significant association between a TAD and CalTAD greater than 25 mm and a TADcalTAD greater than 50 mm and mobilisation of the cephalic screw. All measurements have similar sensitivity, but the TAD presents the highest specificity (p TAD and CalTAD less than 25 mm and a TADcalTAD less than 50 mm when using intramedullary fixation.

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

    Science.gov (United States)

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

    2008-10-01

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

  7. Nail Problems (Toenails)

    Science.gov (United States)

    ... may include prescribing topical or oral medication, and debridement (removal of diseased nail matter and debris) of ... treated by your podiatrist, who susceptible to all types of infection, can diagnose the ailment, and then ...

  8. 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, ...

  9. Diagnostic applications of nail clippings.

    Science.gov (United States)

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

    2015-04-01

    "Nail clipping is a simple technique for diagnosis of several nail unit dermatoses. This article summarizes the practical approach, utility, and histologic findings of a nail clipping in evaluation of onychomycosis, nail unit psoriasis, onychomatricoma, subungual hematoma, melanonychia, and nail cosmetics, and the forensic applications of this easily obtained specimen. It reviews important considerations in optimizing specimen collection, processing methods, and efficacy of special stains in several clinical contexts. Readers will develop a greater understanding and ease of application of this indispensable procedure in assessing nail unit dermatoses." Copyright © 2015 Elsevier Inc. All rights reserved.

  10. 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.

  11. Nail involvement in psoriatic arthritis

    Directory of Open Access Journals (Sweden)

    Piotr Sobolewski

    2017-07-01

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

  12. Femoral fractures : indications an[d] biomechanics of external fixation

    NARCIS (Netherlands)

    A.H. Broekhuizen (Tom); B. van Linge

    1988-01-01

    textabstractInternal fixation can be carried out in various ways. For femoral shaft fractures, an (interlocking) nail is becoming increasingly popular, instead of open realignment of the fracture. External fixation, which has become a generally accepted method of treating fractures of the lower

  13. Laterally Loaded Nail-Plates

    DEFF Research Database (Denmark)

    Nielsen, Jacob; Rathkjen, Arne

    Load-displacement curves from about 200 short-term and laterally loaded nail-plate joints are analysed. The nail-plates are from Gang-Nail Systems, type GNA 20 S. The test specimens and the measuring systems are described. The tests are divided into 32 different series. The influence of the number...

  14. Trauma to the nail complex

    Directory of Open Access Journals (Sweden)

    Jefferson Braga Silva

    2014-04-01

    Full Text Available OBJECTIVE: to analyze the results from surgical intervention to treat trauma of the nail complex.METHODS: we retrospectively reviewed a series of 94 consecutive patients with trauma of the nail complex who were treated between 2000 and 2009. In 42 patients, nail bed suturing was performed. In 27 patients, nail bed suturing was performed subsequent to osteosynthesis of the distal phalanx. In 15, immediate grafting was performed, and in 10, late-stage grafting of the nail bed. The growth, size and shape of the nail were evaluated in comparison with the contralateral finger. The results were obtained by summing scores and classifying them as good, fair or poor.RESULTS: the results were considered to be good particularly in the patients who underwent nail bed suturing or nail bed suturing with osteosynthesis of the distal phalanx. Patients who underwent immediate or late-stage nail grafting had poor results.CONCLUSION: trauma of the nail complex without loss of substance presented better results than did deferred treatment for reconstruction of the nail complex.

  15. Nail biopsy: A user's manual

    Directory of Open Access Journals (Sweden)

    Chander Grover

    2018-01-01

    Full Text Available Nail biopsy is a procedure not routinely resorted to; but when indicated, it is often the only clue left for diagnosis. At such times, it pays to be conversant with it. It is an investigation that not only provides etiologic, diagnostic, and prognostic information but also aids in understanding the pathogenesis of nail diseases. It can be of therapeutic value, especially with respect to nail tumors. This article compiles the procedural techniques for nail biopsy of various types and attempts to summarize the evidence available in the literature. The objective of nail biopsy is to clinch a precise diagnosis of nail pathology with a simple and safe surgical procedure, avoiding pain or permanent nail damage. Patient selection is of utmost importance, wherein, the patient does not have typical skin lesions, yields inadequate information on routine nail investigations, and has no peripheral vascular compromise. The patient needs to be explained about the risks associated, the expected functional handicap, the time required for regrowth, a possibility of permanent nail dystrophy, and a possibility of not achieving a diagnosis even after the biopsy. Techniques and types of various nail biopsies are being discussed in this article. The specimen could be collected as an excision biopsy, punch biopsy, shave biopsy, or longitudinal biopsy. The trick lies in choosing the appropriate area for biopsy. Various biopsy types discussed in this article include nail plate biopsy (easiest and least scarring; nail bed biopsy (elliptical excision or punch; nail matrix biopsy (elliptical excision, punch excision (≤3 mm or tangential/shave excision; and nail fold biopsy. Complications reported along with means to minimize them are also discussed.

  16. Case report: AVN of the femoral head five year follow-up of the combination of ipsilateral femoral neck and sub-trochanteric fracture.

    Science.gov (United States)

    Zhang, Wei; Zhu, Feng; Dong, Hanqing; Xu, Yaozeng

    2016-04-01

    To our knowledge, the type of combination of ipsilateral femoral neck and sub-trochanteric fracture is rare. And the long term follow-up is seldom been reported. A 60 year old woman suffered from a traffic accident. We gave her the intramedullary nail treatment for the combination of ipsilateral femoral neck and sub-trochanteric fracture, and the fracture indeed cured after one year and there is no clue of necrosis of the femoral head, but after 5 years, there is an evidence of necrosis of the femoral head. Combination of ipsilateral femoral neck and sub-trochanteric fracture should be kept in mind. Patients with this unusual fracture should be kept under surveillance for longer than might be thought currently to be necessary for there is a possibility of necrosis of the femoral head, even a nondisplaced femoral neck fracture.

  17. Fractures (Broken Bones): First Aid

    Science.gov (United States)

    First aid Fractures (broken bones) Fractures (broken bones): First aid By Mayo Clinic Staff A fracture is a ... 10, 2018 Original article: http://www.mayoclinic.org/first-aid/first-aid-fractures/basics/ART-20056641 . Mayo Clinic ...

  18. Nail Bed Injuries

    Science.gov (United States)

    ... All Topics A-Z Videos Infographics Symptom Picker Anatomy Bones Joints Muscles Nerves Vessels Tendons About Hand Surgery What is a Hand Surgeon? What is a Hand Therapist? Media Find a Hand Surgeon Home Anatomy Nail Bed Injuries Email to a friend * required ...

  19. 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.

  20. 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

  1. Metallographic examination of a failed Jewett nail-plate from a human femur

    International Nuclear Information System (INIS)

    Gray, R.J.; Zirkel, L.G. Jr.

    1976-01-01

    A type 316L wrought stainless steel Jewett nail-plate is one of several implant designs for bridging fractures in the proximal end of the femur. A soldier received a high velocity projectile in the trochanteric region of the femur. He was treated for a subtrochanteric fracture and greater trochanteric bone loss. After 9 months, hip varus angulation was progressively increasing. A Jewett nail-plate was inserted after valgus osteotomy and bone grafting of the unhealed fracture. The nail-plate fractured three weeks after surgery. Optical and scanning electron microscopy related the origin of failure to an impactor failure and subsequent microscopic scoring of the nail-plate during insertion into the abnormally hard femoral head. Photomicrographs showing the implant failure and evidences of corrosion after the short time in the body are presented. 12 figs

  2. 3066 consecutive Gamma Nails. 12 years experience at a single centre

    Directory of Open Access Journals (Sweden)

    Ekholm Carl

    2010-06-01

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

  3. Spontaneously broken mass

    International Nuclear Information System (INIS)

    Endlich, Solomon; Nicolis, Alberto; Penco, Riccardo

    2015-01-01

    The Galilei group involves mass as a central charge. We show that the associated superselection rule is incompatible with the observed phenomenology of superfluid helium 4: this is recovered only under the assumption that mass is spontaneously broken. This remark is somewhat immaterial for the real world, where the correct space-time symmetries are encoded by the Poincaré group, which has no central charge. Yet it provides an explicit example of how superselection rules can be experimentally tested. We elaborate on what conditions must be met for our ideas to be generalizable to the relativistic case of the integer/half-integer angular momentum superselection rule.

  4. How to Stop Biting Your Nails

    Medline Plus

    Full Text Available ... nails, or even an entire hand. The goal is to get to the point where you no longer bite any of your nails. For some people, nail biting may be a sign of a more serious psychological ...

  5. How to Stop Biting Your Nails

    Medline Plus

    Full Text Available ... Part 1: Structure Part 2: Origin Part 3: Function Textbook Study notes Image library 3-D animated ... hair, and nail care Nail care Nail biting "); (function () { var a = "", b = [ "adid=aad-aad-1", "site= ...

  6. How to Stop Biting Your Nails

    Medline Plus

    Full Text Available ... Center Coding and reimbursement Coding MACRA Fee schedule Managing a practice Prior authorization assistance Evaluating practice models ... Child nail care Manicure safety Nail biting Nail changes a dermatologist should examine Anti-aging skin care ...

  7. How to Stop Biting Your Nails

    Medline Plus

    Full Text Available ... skin, hair, and nails Skin dictionary Camp Discovery Good Skin Knowledge lesson plans and activities Video library ... biting. Replace the nail-biting habit with a good habit: When you feel like biting your nails, ...

  8. How to Stop Biting Your Nails

    Medline Plus

    Full Text Available ... this safe, but awful-tasting formula discourages many people from biting their nails. Get regular manicures: Spending ... longer bite any of your nails. For some people, nail biting may be a sign of a ...

  9. How to Stop Biting Your Nails

    Medline Plus

    Full Text Available ... Hair care / hair loss Injured skin Nail care Anti-aging skin care Kids’ zone About skin: Your ... Nail biting Nail changes a dermatologist should examine Anti-aging skin care Kids’ zone Video library Find ...

  10. Femoral nerve damage (image)

    Science.gov (United States)

    The femoral nerve is located in the leg and supplies the muscles that assist help straighten the leg. It supplies sensation ... leg. One risk of damage to the femoral nerve is pelvic fracture. Symptoms of femoral nerve damage ...

  11. Topics in broken supersymmetry

    International Nuclear Information System (INIS)

    Lee, I.H.

    1984-01-01

    Studies on two topics in the framework of broken supersymmetry are presented. Chapter I is a brief introduction in which the motivation and the background of this work are discussed. In Chapter II, the author studies the decay K + → π + γγ in models with spontaneous supersymmetry breaking and find that it is generally suppressed relative to the decay K + → π + anti nu nu of the conventional model, except possibly for a class of models where the scalar quark masses are generated by radiative corrections from a much larger supersymmetry breaking scale. For a small range of scalar quark and photino mass parameters, the cascade decay process K + → π + π 0 → π + γγ will become dominant over the anti nu nu mode. The author also comments on the possibility of probing the neutrino mass through the K + → π + π 0 → π + anti nu nu cascade decay. Chapter III is concerned with the implications of explicit lepton number violating soft operators in a general low energy effective theory with softly broken supersymmetry

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

    Science.gov (United States)

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

    2014-07-21

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

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

    Directory of Open Access Journals (Sweden)

    Takashi Iwakura

    2013-01-01

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

  14. Comparision of the Expandable Nail with Locked Nail in the ...

    African Journals Online (AJOL)

    2017-09-14

    Sep 14, 2017 ... [5-7] The axial and rotational stability of locked nails depends .... weight bearing was defined as no or minimal pain .... of the nail is changed to load bearing. In delayed .... fractures. J Bone Joint Surg Br 1988;70:206-10. 4.

  15. Ipsilateral Femoral Neck fracture During Closed Intraedullary Nailing ...

    African Journals Online (AJOL)

    23. Full Text: EMAIL FULL TEXT EMAIL FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · http://dx.doi.org/10.4314/njotra.v7i1.29317 · AJOL African Journals Online. HOW TO USE AJOL... for Researchers · for Librarians ...

  16. A broken symmetry ontology: Quantum mechanics as a broken symmetry

    International Nuclear Information System (INIS)

    Buschmann, J.E.

    1988-01-01

    The author proposes a new broken symmetry ontology to be used to analyze the quantum domain. This ontology is motivated and grounded in a critical epistemological analysis, and an analysis of the basic role of symmetry in physics. Concurrently, he is led to consider nonheterogeneous systems, whose logical state space contains equivalence relations not associated with the causal relation. This allows him to find a generalized principle of symmetry and a generalized symmetry-conservation formalisms. In particular, he clarifies the role of Noether's theorem in field theory. He shows how a broken symmetry ontology already operates in a description of the weak interactions. Finally, by showing how a broken symmetry ontology operates in the quantum domain, he accounts for the interpretational problem and the essential incompleteness of quantum mechanics. He proposes that the broken symmetry underlying this ontological domain is broken dilation invariance

  17. Humeral Shaft Fracture: Intramedullary Nailing.

    Science.gov (United States)

    Konda, Sanjit R; Saleh, Hesham; Fisher, Nina; Egol, Kenneth A

    2017-08-01

    This video demonstrates the technique of intramedullary nailing for a humeral shaft fracture. The patient is a 30-year-old man who sustained a gunshot wound to his right arm. The patient was indicated for humeral nailing given the comminuted nature of the diaphysis and to allow for minimal skin incisions. Other relative indications include soft-tissue compromise about the arm precluding a large surgical exposure. This video presents a case of a comminuted humeral shaft fracture treated with an intramedullary nail. Anatomic reduction and stable fixation was obtained with this technique. This case demonstrates a soft-tissue sparing technique of humeral shaft fixation using a humeral intramedullary nail. The technique is easy to perform and has significant benefits in minimizing surgical exposure, decreasing operative time, and decreasing blood loss. In the correct clinical setting, humeral nailing provides an expeditious form of fixation that restores length, alignment, and rotation of the fracture humeral diaphysis.

  18. The efficacy of single-stage open intramedullary nailing of neglected femur fractures.

    Science.gov (United States)

    Boopalan, P R J V C; Sait, Azad; Jepegnanam, Thilak Samuel; Matthai, Thomas; Varghese, Viju Daniel

    2014-02-01

    Neglected femur fractures are not rare in the developing world. Treatment options include single-stage open reduction and intramedullary nailing, or open release, skeletal traction, and then second-stage open intramedullary nailing, with bone grafting. Single-stage procedures have the potential advantage of avoiding neurovascular complications secondary to acute lengthening, but they require a second operation, with potentially increased resource use and infection risk. We sought to determine the (1) likelihood of union, (2) complications and reoperations, and (3) functional results with single-stage open intramedullary nailing without bone grafting in patients with neglected femur fractures. Between January 2003 and December 2007, 17 consecutive patients presented to our practice with neglected femoral shaft fractures. All were treated with single-stage nailing without bone grafting. There were 15 men and two women with a median age of 27 years. The average time from fracture to treatment was 13 weeks (range, 4-44 weeks). Eleven patients underwent open nailing with interlocked nails and six were treated with cloverleaf Kuntscher nails. Patients were followed for a minimum of 6 months (mean, 33 months; range, 6-72 months). The mean preoperative ROM of the knee was 28° (range, 10°-150°) and femoral length discrepancy was 3.1 cm (range, 1-5 cm). All fractures united and the mean time to union was 16 weeks (range, 7-32 weeks). There were no neurologic complications secondary to acute lengthening. The mean postoperative ROM of the knee was 130° (range, 60°-150°). All patients were able to return to preinjury work. Sixteen patients regained their original femoral length. One-stage open intramedullary nailing of neglected femoral diaphyseal fractures without bone grafting was safe and effective, and obviated the need for a two-stage approach. Although the findings need to be replicated in larger numbers of patients, we believe this technique may be useful in

  19. Risk of septic knee following retrograde intramedullary nailing of open and closed femur fractures

    Directory of Open Access Journals (Sweden)

    Halvorson Jason J

    2012-02-01

    Full Text Available Abstract Background One potential complication of retrograde femoral nailing in the treatment of femur fractures is the risk of septic knee. This risk theoretically increases in open fractures as a contaminated fracture site has the potential to seed the instrumentation being passed in and out of the sterile intraarticular starting point. There are few studies examining this potential complication in a relatively commonly practiced technique. Methods All patients who received a retrograde femoral nail for femur fracture between September 1996 and November 2006 at a Level 1 trauma center were retrospectively reviewed. This yielded 143 closed fractures, 38 open fractures and 4 closed fractures with an ipsilateral traumatic knee arthrotomy. Patient follow-up records were reviewed for documentation of septic knee via operative notes, wound culture or knee aspirate data, or the administration of antibiotics for suspected septic knee. Results No evidence of septic knee was found in the 185 fractures examined in the dataset. Utilizing the Wilson confidence interval, the rate of septic knee based on our population was no greater than 2%, with that of the open fracture group alone being 9%. Conclusions Based on these results and review of the literature, the risk of septic knee in retrograde femoral nailing of both open and closed femoral shaft fractures appears low but potentially not insignificant. Funding There was no outside source of funding from either industry or other organization for this study.

  20. 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.

  1. Gamma nail in the treatment of closed trochanteric fractures. Results and indications of 121 cases.

    Science.gov (United States)

    Kempf, I; Grosse, A; Taglang, G; Favreul, E

    2014-02-01

    The Gamma Nail is the latest advance in the treatment of trochanteric fractures based on intramedullary nailing principles during closed procedures. Its design is based on Küntscher's Y-nail and locking intramedullary (IM) nails. This paper reports the results from the first-ever series of 121 patients operated between 1988 and 1990. They were followed until bone union was achieved. The mean patient age was 75 years. Most patients were in poor general health and had unstable fractures. Anatomical preoperative reduction was achieved in 72% of cases. Fixation was good in 66% of cases and acceptable in 27% of cases. Intra-operative complications consisted of nine fractures without consequences. Of the treated patients, 83.4% resumed weight-bearing during the first week. There was one case of deep infection that resolved with treatment. The mortality rate was 12.3% at three months. We noted 7 alunions in varus, 3 in valgus, 2 in external rotation and 1 in internal rotation. There were no cases of non-union. In six cases, the screw had cut out of the femoral head. The drawbacks associated with surgical treatment methods for trochanteric fractures also apply to the Gamma nail. Nevertheless, one of its primary advantages is the possibility of using a closed procedure. When compared to Ender nailing, knee pain is absent and weight-bearing can be achieved in all patients, no matter the fracture type. Copyright © 2014. Published by Elsevier Masson SAS.

  2. Comparison of accuracy of lag screw placement in cephalocondylic nails and sliding hip screw plate fixation for extracapsular fractures of the neck of femur

    OpenAIRE

    Shyam Kumar, A. J.; Parmar, V.; Bankart, J.; Williams, S. C.; Harper, W. M.

    2006-01-01

    This study compared the accuracy of lag screw placement between extracapsular femoral fractures fixed with sliding hip screw plate systems and those fixed with cephalocondylic nails. It involved 75 retrospective radiographs of fractures fixed with either a cephalocondylic nail (32) or a sliding hip screw plate system (43). Postoperative anteroposterior and lateral radiographs of the hip were scanned using a digital X-ray scanner and measured using computer software. Measurements were conducte...

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

    Directory of Open Access Journals (Sweden)

    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.

  4. 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...

  5. Atrophic femoral nonunion with bone loss: treatment with monorail transport: a case report.

    Science.gov (United States)

    Gay, David M; Voss, Frank R

    2004-08-01

    Nonunions are an uncommon outcome of femoral fractures. Atrophic nonunions with a leg length discrepancy secondary to bone loss are often the most difficult to treat, and the treatment options are limited. We present a case that uses concomitant monolateral external fixation and intramedullary nailing to heal a nonunion and perform a simultaneous 7-cm lengthening procedure in a 33-year-old female.

  6. 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.

  7. 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 ...

  8. What is Broken Heart Syndrome

    Science.gov (United States)

    ... pumping action and blood flow, go to the Health Topics How the Heart Works article.) Researchers are trying to identify the precise way in which the stress hormones affect the heart. Broken heart syndrome may result from ...

  9. 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)....

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

    Science.gov (United States)

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

    2010-01-01

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

  11. Surgery for pathological proximal femoral fractures, excluding femoral head and neck fractures: resection vs. stabilisation.

    Science.gov (United States)

    Zacherl, Max; Gruber, Gerald; Glehr, Mathias; Ofner-Kopeinig, Petra; Radl, Roman; Greitbauer, Manfred; Vecsei, Vilmos; Windhager, Reinhard

    2011-10-01

    Pathological femoral head and neck fractures are commonly treated by arthroplasty. Treatment options for the trochanteric region or below are not clearly defined. The purpose of this retrospective, comparative, double-centre study was to analyse survival and influences on outcome according to the surgical technique used to treat pathological proximal femoral fractures, excluding fractures of the femoral head and neck. Fifty-nine patients with 64 fractures were operated up on between 1998 and 2004 in two tertiary referral centres and divided into two groups. One group (S, n = 33) consisted of patients who underwent intramedullary nailing alone, and the other group (R, n = 31) consisted of patients treated by metastatic tissue resection and reconstruction by means of different implants. Median survival was 12.6 months with no difference between groups. Surgical complications were higher in the R group (n = 7) vs. the S group (n = 3), with no statistically significant difference. Patients with surgery-related complications had a higher survival rate (p = 0.049), as did patients with mechanical implant failure (p = 0.01). Survival scoring systems did not correlate with actual survival. Resection of metastases in patients with pathological fractures of the proximal femur, excluding femoral head and neck fractures, has no influence on survival. Patients with long postoperative survival prognosis are at risk of implant-related complications.

  12. How to Stop Biting Your Nails

    Medline Plus

    Full Text Available ... your fingers and from your nails to your face and mouth. To help you stop biting your ... re inclined to bite may help solve the problem. Try to gradually stop biting your nails: Some ...

  13. How to Stop Biting Your Nails

    Medline Plus

    Full Text Available ... figure out how to avoid these situations and develop a plan to stop. Just knowing when you’ ... a doctor. If you bite your nails and develop a skin or nail infection, consult a board- ...

  14. How to Stop Biting Your Nails

    Medline Plus

    Full Text Available ... your nails to your face and mouth. To help you stop biting your nails, dermatologists recommend the ... stress ball or silly putty instead. This will help keep your hands busy and away from your ...

  15. How to Stop Biting Your Nails

    Medline Plus

    Full Text Available ... and nails Skin dictionary Camp Discovery Good Skin Knowledge lesson plans and activities Video library Find a ... counter, this safe, but awful-tasting formula discourages many people from biting their nails. Get regular manicures: ...

  16. How to Stop Biting Your Nails

    Medline Plus

    Full Text Available ... Resident International Grant Resident Scholarship to Legislative Conference Skin Care for Developing Countries Grant State Advocacy Grant Strauss ... A-Z index Skin, hair, and nail care Skin care Hair care / hair loss Injured skin Nail care ...

  17. How to Stop Biting Your Nails

    Medline Plus

    Full Text Available ... your head About nails: More important than you think Questions lots of kids ask about their skin, ... habit with a good habit: When you feel like biting your nails, try playing with a stress ...

  18. How to Stop Biting Your Nails

    Medline Plus

    Full Text Available ... care / hair loss Injured skin Nail care Anti-aging skin care Kids’ zone About skin: Your body's ... biting Nail changes a dermatologist should examine Anti-aging skin care Kids’ zone Video library Find a ...

  19. How to Stop Biting Your Nails

    Medline Plus

    Full Text Available ... biting can make the skin around your nails feel sore, and it can damage the tissue that ... biting habit with a good habit: When you feel like biting your nails, try playing with a ...

  20. How to Stop Biting Your Nails

    Medline Plus

    Full Text Available ... and Lectureship Clarence S. Livingood Award and Lectureship Marion B. Sulzberger Award and Lectureship Master Dermatologist Award Members ... care Nail care Nail biting "); (function () { var a = "", b = [ "adid=aad-aad-1", "site=ehs.con.aad. ...

  1. How to Stop Biting Your Nails

    Medline Plus

    Full Text Available ... Injured skin Nail care Anti-aging skin care Kids’ zone About skin: Your body's largest organ About ... More important than you think Questions lots of kids ask about their skin, hair, and nails. Amazing ...

  2. Traumatic subchondral fracture of the femoral head in a healed trochanteric fracture.

    Science.gov (United States)

    Lee, Sang Yang; Niikura, Takahiro; Iwakura, Takashi; Kurosaka, Masahiro

    2014-07-11

    An 82-year-old woman sustained a trochanteric fracture of the left femur after a fall. Fracture fixation was performed using proximal femoral nail antirotation (PFNA) II, and she was able to walk with a T-cane after 3 months. Eleven months following the operation, the patient presented with left hip pain after a fall. Radiographs showed a subchondral collapse of the femoral head located above the blade tip. The authors removed the PFNA-II and subsequently performed cemented bipolar hemiarthroplasty. Histological evaluation of the femoral head showed osteoporosis with no evidence of osteonecrosis. Repair tissue, granulation tissue and callus formation were seen at the collapsed subchondral area. Based on these findings, a traumatic subchondral fracture of the femoral head in a healed trochanteric fracture was diagnosed. A traumatic subchondral fracture of the femoral head may need to be considered as a possible diagnosis after internal fixation of the trochanteric fracture. 2014 BMJ Publishing Group Ltd.

  3. The effect of lower limb rehabilitation gymnastics on postoperative rehabilitation in elderly patients with femoral shaft fracture

    OpenAIRE

    Yang, Si-Dong; Ning, Sheng-Hua; Zhang, Li-Hong; Zhang, Ying-Ze; Ding, Wen-Yuan; Yang, Da-Long

    2016-01-01

    Abstract The purpose of this study was to explore the effect of lower limb rehabilitation gymnastics on postoperative rehabilitation in elderly patients with femoral shaft fracture after undergoing intramedullary nail fixation surgery. We collected medical records of elderly patients aged???60 years with femoral shaft fracture between 03/2010 and 03/2015 in Longyao County Hospital. Totally, 160 patients were identified and divided into the intervention group (n = 80) and the control group (n ...

  4. EPR spectroscopic investigation of psoriatic finger nails.

    Science.gov (United States)

    Nakagawa, Kouichi; Minakawa, Satoko; Sawamura, Daisuke

    2013-11-01

    Nail lesions are common features of psoriasis and found in almost half of the patients. However, there is no feasible spectroscopic method evaluating changes and severity of nail psoriasis. EPR (electron paramagnetic resonance) might be feasible for evaluating nail conditions in the patients of psoriasis. Finger nails of five cases with nail psoriasis, (three females and two males) were examined. Nail samples were subjected to the EPR assay. The small piece of the finger nail (1.5 × 5 mm(2)) was incubated in ~50 μM 5-DSA (5-doxylstearic acid) aqueous solutions for about 60 min at 37°C. After rinsing and wiping off the excess 5-DSA solution, the nail samples were measured by EPR. EPR spectra were analyzed using the intensity ratio (Fast/Slow) of the two motions at the peaks of the lower magnetic field. We observed two distinguishable sites on the basis of the EPR results. In addition, the modern EPR calculation was performed to analyze the spectra obtained. The nail psoriasis-related region is 2~3 times higher than that of the control. The present EPR results show that there are two distinguishable sites in the nail. In the case of nail psoriasis, the fragile components are 2~3 times more than those of the control. Thus, the EPR method is thought to be a novel and reliable method of evaluating the nail psoriasis. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  5. How to Stop Biting Your Nails

    Medline Plus

    Full Text Available ... gloves to prevent biting. Replace the nail-biting habit with a good habit: When you feel like biting your nails, try ... recommend taking a gradual approach to break the habit. Try to stop biting one set of nails, ...

  6. Nail toxicity induced by cancer chemotherapy.

    Science.gov (United States)

    Gilbar, Peter; Hain, Alice; Peereboom, Veta-Marie

    2009-09-01

    To provide a comprehensive literature review of chemotherapy-induced nail toxicity, including clinical presentation, implicated drugs and approaches for prevention and management. A search of MEDLINE and EMBASE (1966-2008) databases was conducted using the terms (and variations of the terms) antineoplastic agents, nails, nail toxicity, onycholysis, and paronychia. Bibliographies from selected articles were reviewed for appropriate references. The retrieved literature was reviewed to include all articles relevant to the clinical presentation, diagnosis, incidence, prevention, and treatment of chemotherapy-induced nail toxicity. Nail toxicity is a relatively uncommon adverse effect linked to a number of chemotherapeutic agents. Clinical presentation varies, depending on which nail structure is affected and the severity of the insult. Nail changes may involve all or some nails. Toxicity may be asymptomatic and limited to cosmetic concerns, however, more severe effects, involving pain and discomfort can occur. Taxanes and anthracyclines are the antineoplastic drug groups most commonly implicated. It is suggested that the administration schedule may influence the incidence of nail abnormalities, for example reported cases linked to the weekly administration of paclitaxel.Before instituting chemotherapy, patients should be educated regarding potential nail toxicities and strategies for prevention implemented. Management includes appropriate nail cutting, avoiding potential irritants, topical, or oral antimicrobials, and possibly cessation or dose reduction of the offending agent. Cryotherapy, through the application of frozen gloves or socks, has been beneficial in reducing docetaxel-induced nail toxicity and may be effective for other drugs.

  7. How to Stop Biting Your Nails

    Medline Plus

    Full Text Available ... Mohs AUC MyDermPath+ Psoriasis Patient education resources Practice Management Center Coding and reimbursement Coding MACRA Fee schedule ... Child nail care Manicure safety Nail biting Nail changes a dermatologist should examine Anti-aging skin care ...

  8. How to Stop Biting Your Nails

    Medline Plus

    Full Text Available ... and nail care Nail care Nail biting "); (function () { var a = "", b = [ "adid=aad-aad-1", "site=ehs. ... t", "hpos=l", "zone=public", "mcat1=de12", ]; for (var c = 0; c "); (function () { var a = "", b = [ "adid= ...

  9. Yellow nail syndrome and bronchiectasis | Adegboye | Nigerian ...

    African Journals Online (AJOL)

    The Yellow Nail Syndrome includes slow growing, opaque yellow nails with exaggerated lateral curvature, associated with lymphoedema and chronic respiratory disorders. The nail changes may precede the lymphoedema by a number of years. Bronchiectasis may be the only chronic respiratory disorder; others include ...

  10. How to Stop Biting Your Nails

    Medline Plus

    Full Text Available ... Private payer Medicare physician payment MACRA implementation Alternative payment models Fee schedule State policy State policy and action ... a dermatologist Why see a board-certified dermatologist? Home Public and patients Skin, hair, and nail care Nail care Nail biting "); (function () { var a = "", b = [ " ...

  11. Broken Homes: Impact on Adolescents.

    Science.gov (United States)

    Koziey, Paul W.; Davies, Leigh

    1982-01-01

    Tends to support assertion that children from homes broken by separation, divorce, or death are less well-adjusted in terms of California Personality Inventory scales of self-control, socialization, femininity, and good impression, than children from intact homes. Age and sex were not found to be linked to the degree of maladjustment. (AH)

  12. Interventions for treating femoral shaft fractures in children and adolescents.

    Science.gov (United States)

    Madhuri, Vrisha; Dutt, Vivek; Gahukamble, Abhay D; Tharyan, Prathap

    2014-12-01

    intramedullary nailing may reduce recovery time. There is insufficient evidence from comparisons of different methods of conservative treatment or of different methods of surgical treatment to draw conclusions on the relative effects of the treatments compared in the included trials. Different methods of treating fractures of the shaft of the thigh bone in children and adolescents Although uncommon, fractures of the femoral shaft (thigh bone) in children may require prolonged treatment in hospital and sometimes surgery. This can cause significant discomfort and can disrupt the lives of the children and their familles. This review compared different methods of treating these fractures. Surgical treatment comprises different methods of fixing the broken bones, such as internally-placed nails, or pins incorporated into an external frame (external fixation). Non-surgical or conservative treatment usually involves different types of plaster casts with or without traction (where a pulling force is applied to the leg). We searched for studies in the medical literature until August 2013. The review includes 10 randomised or quasi-randomised controlled trials that recruited 527 children. Four trials compared different surgical versus non-surgical treatments; three compared different methods of non-surgical treatment and three compared different methods of surgical treatment. Generally we are unsure about the results of these trials because some were at risk of bias, some results were contradictory and usually there was too little evidence to rule out chance findings. Most trials failed to report on self-assessed function or when children resumed their usual activities. Comparing surgical versus non-surgical treatment. Low quality evidence (one trial, 101 children) showed children had similar function at two years after having surgery, involving external fixation, compared with those treated with a plaster cast. The other three trials did not report this outcome. There was moderate

  13. Avascular necrosis of the femoral head at 2 years after pertrochanteric fracture surgery: Case report.

    Science.gov (United States)

    Deleanu, Bogdan; Prejbeanu, Radu; Vermesan, Dinu; Honcea, Lucian; Mioc, Mihail Lazar; Tsiridis, Eleftherios; Predescu, Vlad

    2016-02-01

    The avascular necrosis of the femoral head represents the death of bone tissue due to the lack of blood supply. The disease has a progressive evolution and left untreated leads to femoral head collapse and severe arthritis. We present a case of a pertrochanteric fracture which has been successfully operated with a dynamic interlocking trochanteric gamma nail on the right hip. At 2 years after surgery the patient developed an incipient avascular necrosis of the femoral head. Despite the good positioning of the implant, we considered that the source of the pain was an intolerance of the implant, and thus we removed it. After implant removal, the patient was kept under observation and conservative treatment, to prevent further damage to the right hip and allow the healing to occur. At 6 months after the gamma nail was removed the X-rays revealed advanced avascular necrosis of the femoral head and secondary osteoarthritis on the right hip. The patient underwent surgery with an uncemented total hip arthroplasty. There are a few discussions regarding the avascular necrosis of the femoral head. These discussions may include the predisposing risk factors, the treatment of choice and the postoperative complications. The avascular necrosis of the femoral head is a complication of pertrochanteric fractures that can not be foreseen or avoided. The optimal treatment in these cases is uncemented total hip arthroplasty.

  14. The effects of intraoperative positioning on patients undergoing early definitive care for femoral shaft fractures.

    Science.gov (United States)

    Apostle, K L; Lefaivre, K A; Guy, P; Broekhuyse, H M; Blachut, P A; O'Brien, P J; Meek, R N

    2009-10-01

    To determine if there is a difference in morbidity and mortality in orthopaedic trauma patients with femoral shaft fractures undergoing early definitive care with intramedullary (IM) nails in the supine versus the lateral position. Retrospective cohort study, single centered. One level 1 trauma center. Nine hundred eighty-eight patients representing 1027 femoral shaft fractures treated with IM nails were identified through a prospectively gathered database between 1987 and 2006. Antegrade IM nail insertion with reaming of the femoral canal in either the supine or lateral position. Mortality was the primary outcome. Admission to intensive care unit (ICU) was the secondary outcome measure and a surrogate measure of morbidity. Literature review was performed to identify factors shown to contribute to morbidity and mortality in orthopaedic trauma patients. Intraoperative position in either the supine or lateral position was added to this list. Logistic regression analysis was performed to determine the magnitude and effect of the independent variables on each of the study end points. To determine if a more significant trend toward less favorable outcomes was observed with increasing severity of injury, particularly injuries of the chest and thorax, subgroup analysis was performed for all those with a femur fracture and an Injury Severity Score > or =18 and all those with a femur fracture and an Abbreviated Injury Score chest > or =3. Intraoperative position in either the supine or lateral position was not a significant predictor of mortality or ICU admission for the original cohort or the subgroup of Injury Severity Score > or =18. However, for the subgroup of Abbreviated Injury Score chest > or =3, intraoperative positioning in the lateral position had a statistically significant protective effect against ICU admission (P = 0.044). For polytrauma patients with femoral shaft fractures, surgical stabilization using IM nails inserted with reaming of the femoral canal in

  15. Broken supersymmetries and shifted superpropagators

    International Nuclear Information System (INIS)

    Helayel-Neto, J.A.; Rabelo de Carvalho, F.A.B.; Smith, A.W.

    1985-06-01

    Superfield Feynman rules are derived for a general case where global supersymmetry is spontaneously broken by F-terms. The complete superspace dependence of the superpropagators is factored out and they are employed to discuss the corrections to the effective action and the non-renormalization theorems. Their coupling to external gauge superfields is also contemplated and finite matter contributions to the gaugino mass and the Fayet-Iliopoulos term are considered. (author)

  16. Broken color symmetry and weak currents

    International Nuclear Information System (INIS)

    Stech, B.

    1976-01-01

    Broken colour symmetry predicts a very rich spectrum of new particles. If broken colour is relevant at all, charged psi-particles should be found in particular at the 4 GeV region. For the weak hadronic currents no completely satisfactory suggestion exists. Broken colour symmetry describes qualitatively several of the new effects observed recently. (BJ) [de

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

    Science.gov (United States)

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

    2011-07-01

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

  18. Cerebral damage caused by nail gun injury

    DEFF Research Database (Denmark)

    Andersen, Chris

    2016-01-01

    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....... 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...... criminal act. They found bloodstains on the back of the machine. When awake, the man explained, that by accident, he had hit his head against a nail gun and as a result of this, the nail gun delivered a nail into his skull. Conclusion Sometimes, the circumstances of a case are not clear...

  19. [Onychomatricoma, a rare lesion of the nail].

    Science.gov (United States)

    Pommepuy, Isabelle; Roblet, Denis; Blaise, Sophie; Delage-Corre, Manuela; Bonnetblanc, Jean-Marie; Fayol, Jacqueline; Labrousse, François

    2004-09-01

    Onychomatricoma is a rare fibroepithelial lesion of the nail matrix with peculiar clinical and histological features. Clinically, it is characterized by a longitudinal band of yellow thickening of the nail plate with transverse overcurvature and splinter hemorrhages. Nail avulsion exposes a villous tumor of the matrix with filamentous digitations extending into multiple holes of the nail plate. Histologically, a thick keratogenous zone forms a thickened nail plate. The lesion in its proximal portion is characterized by deep epithelial invaginations and by a stroma organized in two layers. The distal zone corresponds to multiple fibroepithelial projections extending into the nail plate. The diagnosis can be difficult in the presence of misleading clinical features or when the specimen is incomplete or examined with an improper orientation. Surgical resection is the recommended treatment.

  20. [Fingertip replantation with anastomosis of palm vein and retaining the nail].

    Science.gov (United States)

    Wang, Xiang; Zhang, Wei-Kai; Yin, Shao-Meng; Wang, Hai-Bing; He, Tao; Gong, Yong-Qing; Zhu, Guo-Ming; Mao, Gen-Lian; Hu, Ming-Xing; Li, Jian

    2013-08-01

    To study the replantation methods and clinical results of amputated fingertip. From October 2007 to June 2011, 18 fingers of 13 cases were replanted with anastomosis of palm vein and retaining the nail, including 9 males and 4 females,with an average age of 26 years old ranging from 17 to 45 years old. The time from injury to therapy was from 30 min to 5 h, time of broken finger ischemia was from 1.5 to 7 h. All broken fingers were preservation under normal temperature. All fingers were survived, no vascular crisis happened. All cases were followed up from 3 to 24 months with an average of 14 months. The length and shape of replanted fingers were similar to that of the healthy side. The new nails were smooth, the function was perfect,the sense of pain and touched sensation had been recovered. Their two-piont discriminations ranged from 3 to 6 mm with an average of 5 mm. According to the assessment standard of Chinese Medical Association of Hand Surgery, the results were excellent in 14 cases, good in 3 cases, poor in 1 case. Fingertip replantation with anastomosis of palm vein and retaining the nail is regained satisfactory appearance and function of the digits with a high survival rate.

  1. Bilateral simultaneous femoral neck and shafts fractures - a case report.

    Science.gov (United States)

    Sadeghifar, Amirreza; Saied, Alireza

    2014-10-01

    Simultaneous fractures of the femoral neck and shaft are not common injuries, though they cannot be considered rare. Herein, we report our experience with a patient with bilateral occurance of this injury. Up to the best of our knowkedge this is the first case reported in literature in which correct diagnosis was made initially. Both femurs were fixed using broad 4.5 mm dynamic compression plate and both necks were fixed using 6.5 mm cannulated screws. Femur fixation on one side was converted to retrograde nailing because of plate failure. Both neck fractures healed uneventfully. In spite of rarity of concomitant fractures of femoral neck and shaft, this injury must be approached carefully demanding especial attention and careful device selection.

  2. Femoral head avascular necrosis

    International Nuclear Information System (INIS)

    Chrysikopoulos, H.; Sartoris, D.J.; Resnick, D.L.; Ashburn, W.; Pretorius, T.

    1988-01-01

    MR imaging has been shown to be more sensitive and specific than planar scintigraphy for avascular necrosis (AVN) of the femoral head. However, experience with single photon emission CT (SPECT) is limited. The authors retrospectively compared 1.5-T MR imaging with SPECT in 14 patients with suspected femoral head AVN. Agreement between MR imaging and SPECT was present in 24 femurs, 14 normal and ten with AVN. MR imaging showed changes of AVN in the remaining four femoral heads. Of these, one was normal and the other three inconclusive for AVN by SPECT. The authors conclude that MR imaging is superior to SPECT for the evaluation of AVN of the hip

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

    Science.gov (United States)

    Singal, Archana; Daulatabad, Deepashree

    2017-01-01

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

  4. Dual head screw hip nailing for trochanteric fractures

    Science.gov (United States)

    Mavrogenis, Andreas F.; Igoumenou, Vasilios G.; Megaloikonomos, Panayiotis D.; Panagopoulos, George N.; Galanopoulos, Ioannis P.; Vottis, Christos Th.; Karamanis, Eirinaios; Koulouvaris, Panayiotis; Papagelopoulos, Panayiotis J.

    2017-01-01

    Introduction: There are limited information and inconclusive results for dual head screw intramedullary hip nails for trochanteric fractures. Therefore, we performed a prospective study to evaluate the healing of fractures, and survival, function, and complications of patients operated with this implant. Methods: We prospectively studied 79 patients (61 women and 18 men; mean age: 84.7 years; range: 65–96 years) with a low-energy trochanteric fracture, treated with a dual head screw intramedullary hip nail from 2013 to 2016. The mean follow-up was 2.1 years (range: 1–3 years); seven patients were lost to follow up. This left 72 patients for further analysis. We evaluated the healing of fractures, and survival, function, and complications of patients. Results: Fracture healing was evident in 70 patients (97.2%) at 2–3 months postoperatively. One patient experienced cut-out and z-effect phenomenon of the head screws. Another patient experienced a periprosthetic femoral diaphysis fracture at the distal tip of the nail. A third patient experienced an acute postoperative superficial skin infection that was treated successfully with wound dressing changes and a course of antibiotics. Sixteen patients (22.2%) deceased within 12 months postoperatively. In the remaining patients, the Harris Hip Score (HHS) at 12 months postoperatively was excellent in 16 (28.6%), good in 23 (41.1%), fair in 10 (17.8%), and poor in 7 patients (12.5%). The function declined after the patients’ fracture. Fair and poor results were related to age > 85 years, poor pre-fracture level of function, and AO/OTA-31-A3 fracture types. Conclusion: The dual head screw intramedullary hip nail is associated with high healing and low complication rates for intertrochanteric fractures. The function of the patients is good or excellent in most cases; however, it declines, especially for those patients with age > 85 years, poor pre-fracture level of function, and AO/OTA-31-A3 fracture types

  5. Dual head screw hip nailing for trochanteric fractures

    Directory of Open Access Journals (Sweden)

    Mavrogenis Andreas F.

    2017-01-01

    Full Text Available Introduction: There are limited information and inconclusive results for dual head screw intramedullary hip nails for trochanteric fractures. Therefore, we performed a prospective study to evaluate the healing of fractures, and survival, function, and complications of patients operated with this implant. Methods: We prospectively studied 79 patients (61 women and 18 men; mean age: 84.7 years; range: 65–96 years with a low-energy trochanteric fracture, treated with a dual head screw intramedullary hip nail from 2013 to 2016. The mean follow-up was 2.1 years (range: 1–3 years; seven patients were lost to follow up. This left 72 patients for further analysis. We evaluated the healing of fractures, and survival, function, and complications of patients. Results: Fracture healing was evident in 70 patients (97.2% at 2–3 months postoperatively. One patient experienced cut-out and z-effect phenomenon of the head screws. Another patient experienced a periprosthetic femoral diaphysis fracture at the distal tip of the nail. A third patient experienced an acute postoperative superficial skin infection that was treated successfully with wound dressing changes and a course of antibiotics. Sixteen patients (22.2% deceased within 12 months postoperatively. In the remaining patients, the Harris Hip Score (HHS at 12 months postoperatively was excellent in 16 (28.6%, good in 23 (41.1%, fair in 10 (17.8%, and poor in 7 patients (12.5%. The function declined after the patients’ fracture. Fair and poor results were related to age > 85 years, poor pre-fracture level of function, and AO/OTA-31-A3 fracture types. Conclusion: The dual head screw intramedullary hip nail is associated with high healing and low complication rates for intertrochanteric fractures. The function of the patients is good or excellent in most cases; however, it declines, especially for those patients with age > 85 years, poor pre-fracture level of function, and AO/OTA-31-A3

  6. Fatigue failure of the cephalomedullary nail: revision options, outcomes and review of the literature.

    Science.gov (United States)

    Tucker, Adam; Warnock, Michael; McDonald, Sinead; Cusick, Laurence; Foster, Andrew P

    2018-04-01

    Cephalomedullary nail (CMN) failure is a rare entity following hip fracture treatment. However, it poses significant challenges for revision surgery, both mechanically and biologically. Nail failure rates have been reported at failure, compared to "adequate" and "good" (p = 0.027). Tip-Apex Distance (TAD) mean was 23.2 ± 8.3 mm, and an adequate TAD with three-point fixation was seen in only 35% of cases. Mean time to failure was 401.0 ± 237.2 days, with mean age at failure of 74.0 ± 14.8 years. Options after failure included revision CMN nail, proximal femoral locking plate (PFLP), long-stem or restoration arthroplasty, or femoral endoprosthesis. Barthel Functional Index scores showed no significant difference at 3 and 12 months post-operatively, nor any difference between treatment groups. Mean 12-month mortality was 30%, akin to a primary hip fracture mortality risk according to NICE guidelines. Mortality rates were lowest in revision nails. Subsequent revision rates were higher in the PFLP group. There is no reported evidence on the best surgical technique for managing the failed CMN, with no clear functional benefit in the options above. Good surgical technique at the time of primary CMN surgery is critical in minimising fatigue failure. After revision, overall mortality rates were equivalent to reported primary hip fracture mortality rates. Further multicentre evaluations are required to assess which technique convey the best functional outcomes without compromising 12-month mortality rates.

  7. [Dehydration due to "mouth broken"].

    Science.gov (United States)

    Meijler, D P M; van Mossevelde, P W J; van Beek, R H T

    2012-09-01

    Two children were admitted to a medical centre due to dehydration after an oral injury and the extraction of a tooth. One child complained of "mouth broken". Dehydration is the most common water-electrolyte imbalance in children. Babies and young children are prone to dehydration due to their relatively large body surface area, the high percentage extracellular fluid, and the limited ability of the kidneys to conserve water. After the removal ofa tooth, after an oral trauma or in case of oral discomfort, a child is at greater risk of dehydration by reduced fluid and food intake due to oral pain and/or discomfort and anxiety to drink. In those cases, extra attention needs to be devoted to the intake of fluids.

  8. 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

  9. 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.

  10. 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

  11. 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…

  12. 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.

  13. One-stage lengthening and derotational osteotomy of the femur stabilised with a gamma nail.

    Science.gov (United States)

    van Doorn, R; Leemans, R; Stapert, J W

    1999-12-01

    To study the results of a one-stage lengthening and derotational osteotomy stabilised with a Gamma nail. Retrospective study. 2 hospitals, The Netherlands. 5 patients after failed osteosynthesis of femoral fractures. Mean lengthening of 3 cm and derotation of 30 degrees. Complications and functional results, after a mean follow-up of 43 months (range 30-57). Two patients required dynamisation and a cancellous bone graft to achieve union, which resulted in 1 and 1.5 cm loss of length. One patient had a temporary peroneal neurapraxy. No infections were observed. Our method is not an ultimate solution, but is suitable for one-stage lengthening and derotation osteotomies.

  14. Complications of close interlock nailing in the management of close tibial fracture

    International Nuclear Information System (INIS)

    Saeed, M.; Inam, M.; Khan, I.; Satar, A.; Arif, M.

    2015-01-01

    Objective: The objective of this study is to find out the frequency of complications of locally made interlock nailing in tibia after nine months of surgery. Material and Method:. This case series study was done from March 2004 to February 14 in the Department of Orthopedic and Trauma Postgraduate Medical Institute Hayatabad Medical Complex Peshawar. A total of 58 adults ( after the closure of epiphysis) patients were randomly selected provided that they have; Close diaphysial fracture of tibia which is located 7 cm below the knee joint and 4 cm above the ankle joint and fracture less than one week old. Results: Total numbers of patients were 58. Anterior Knee pain was observed in 14(24.1%), delayed union in 10(17.2%), external of 100 rotation in 4(6.9%) and internal rotation of 50 in 1(1.7%), non union in 4(6.9%), intramedullay infection in 3(5.2%), shortening of 1 centimeter (cm) in 2(3.4), 2 cm in 1(1.7%) and 1.5 cm in 3(5.2%) cases, distal screw broken in 2(3.4%), proximal screw broken in 1(1.7%), Nail broken in 2(3.4), infection at proximal screw in 2(3.4%) and at distal screw was 2(3.4%), Restriction of knee flexion in 1(1.7%), Restricted ankle movements in 1(1.7%), varus angulation of 100 in 1(1.7%), valgus angulation of 100 in 1(1.7%), Ankle pain in 1(1.7%) and deep vein thrombosis in 1(1.7%). Conclusion: interlocking nail is considered to be the gold standard for management of tibial fracture but it is not free of complication especially knee pain and angular rotation. (author)

  15. Management of long bone fractures using SIGN nail: experience ...

    African Journals Online (AJOL)

    Background: Intramedullary nailing with interlocking nails has become the treatment of choice for closed diaphyseal fractures of femur and tibia. When possible locked nailing should be performed as a closed procedure. Fractures fixed by interlocking nailing have comparatively less complications in fracture healing.

  16. Microbiological flora and nail polish: a brief report.

    Science.gov (United States)

    Rayan, G M; Flournoy, D J; Schlageter, P

    1994-11-01

    Removing nail polish and prosthetic nails from operating room (OR) personnel prior to scrubbing and from patients prior to hand surgery is recommended but not practiced in many hospitals. There is concern that nail polish can act as a vehicle for the transfer of infectious agents. This study was designed to determine the incidence of microbiological flora of nail polish in a clinical setting.

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

    International Nuclear Information System (INIS)

    Bakhru, Prashant; Park, Brian; Umans, Hilary; DiFelice, Gregory S.; Tobin, Keith

    2011-01-01

    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.)

  18. 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.)

  19. Self Derogation and Childhood Broken Home

    Science.gov (United States)

    Kaplan, Howard B; Pokorny, Alex D.

    1971-01-01

    The data from this study makes clear that it is not the fact of broken homes per se that is related to self derogation but rather the particular characteristics of the broken home situation. Prediction of self derogation is also contingent upon such subject characteristics as race, sex and social class. (Author/CG)

  20. "Broken Expectations" from a Global Business Perspective

    NARCIS (Netherlands)

    Koca, A.; Karapanos, E.; Brombacher, A.C.

    2009-01-01

    Especially in the past few years, there has been an increase in the rejection rate of interactive consumer electronics products in the field, not due to broken hardware or software, but due to ‘broken expectations’ of users. However, operational methods to capture triggering contextual reasons are

  1. Flexible Intramedullary Nailing for Paediatric Shaft of Femur Fractures – Does the Number of Nails Alter the Outcome?

    Directory of Open Access Journals (Sweden)

    B Kanthimathi

    2011-07-01

    Full Text Available BACKGROUND: The use of flexible intramedullary nailing, allowing micro movement at the fracture site, results in excellent outcomes regardless of the number of nails used. We undertook analysis of the outcomes of flexible nailing with reference to the number of nails used. METHODS: Twenty patients with diaphyseal femur fracture aged 5-15 years were treated with retrograde flexible intramedullary nailing. The number of nails varied from single to multiple. The results were analysed with regard to the number of nails used. RESULTS: The mean patient age was 7.9 years; patients were followed up for a mean duration of 13.2 months. Those with two and three nails had similar results. CONCLUSION: A minimum of two flexible nails is needed for optimal fixation in paediatric femur shaft fractures. Also, limiting the number of implants to two is cost effective, decreases operative time, reduces radiation exposure and offers equal results to that of three nails.

  2. Femoral shaft fractures

    International Nuclear Information System (INIS)

    Bender, C.E.; Campbell, D.C. II

    1985-01-01

    The femur is the longest, largest, and strongest bone in the body. Because of its length, width, and role as primary weight-bearing bone, it must tolerate the extremes of axial loading and angulatory stresses. Massive musculature envelopes the femur. This masculature provides abundant blood supply to the bone, which also allows great potential for healing. Thus, the most significant problem relating to femoral shaft fractures is not healing, but restoration of bone length and alignment so that the femoral shaft will tolerate the functional stresses demanded of it

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

    International Nuclear Information System (INIS)

    Fleming, David E.B.; Ware, Chris S.

    2017-01-01

    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 180 s (real time) duration were first performed on six whole nail phantoms having chromium concentrations of 0, 2, 5, 10, 15, and 20 µg/g. Using nail clippers, these phantoms were then converted to nail clippings, and assembled into different mass groups of 20, 40, 60, 80, and 100 mg 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±0.03 µg/g. For the clipping phantoms, the MDL ranged from 1.2 to 3.3 µg/g, depending on the mass group analyzed. For the 40 mg clipping group, the MDL was 1.2±0.1 µg/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. - Highlights: • Portable x-ray fluorescence (XRF) was explored as a technique to assess levels of chromium in human nails or nail clippings. • Results were found to depend on the mass of clipping sample provided. • Minimum detection limits for chromium were similar to concentration levels found in previous studies of human nail clippings.

  4. Despite the hair failing, nails thrive…

    Directory of Open Access Journals (Sweden)

    Samipa Samir Mukherjee

    2017-01-01

    Full Text Available Ectodermal dysplasias are defined as a group of congenital, nonprogressive, developmental syndromes with primary disorders in at least two ectoderm-derived structures namely eccrine glands, hair, nail and teeth. Pure hair and nail affecting ectodemal dysplasias are exceedingly rare in occurance and have been known to be associated with multiple abnormalities, such as keratoderma or ichthyosis, skeletal and hematological abnormalities, cardiac irregularities, mental or psychomotor retardation and cataracts. We herein report a case of hypotrichosis with trichorrhexis nodosa and twenty nail dystrophy- a hypohidrotic ectodermal dysplasia variant.

  5. NAIL SAMPLING TECHNIQUE AND ITS INTERPRETATION

    Directory of Open Access Journals (Sweden)

    TZAR MN

    2011-01-01

    Full Text Available The clinical suspicion of onychomyosis based on appearance of the nails, requires culture for confirmation. This is because treatment requires prolonged use of systemic agents which may cause side effects. One of the common problems encountered is improper nail sampling technique which results in loss of essential information. The unfamiliar terminologies used in reporting culture results may intimidate physicians resulting in misinterpretation and hamper treatment decision. This article provides a simple guide on nail sampling technique and the interpretation of culture results.

  6. Complications during removal of stainless steel versus titanium nails used for intramedullary nailing of diaphyseal fractures of the tibia

    OpenAIRE

    Mustafa Seyhan; Olcay Guler; Mahir Mahirogullari; Ferdi Donmez; Arel Gereli; Serhat Mutlu

    2018-01-01

    Objectives: Intramedullary nailing is the treatment of choice for fractures of the tibial shaft, which might necessitate the nail removal due to complications in the long-term. Although considered as a low-risk procedure, intramedullary nail removal is also associated with certain complications. Here, we compared the most commonly used stainless steel and titanium nails with respect to the complications during removal and clinical outcome for intramedullary nailing of diaphyseal fractures of ...

  7. Complications during removal of stainless steel versus titanium nails used for intramedullary nailing of diaphyseal fractures of the tibia

    OpenAIRE

    Seyhan, Mustafa; Guler, Olcay; Mahirogullari, Mahir; Donmez, Ferdi; Gereli, Arel; Mutlu, Serhat

    2018-01-01

    Objectives Intramedullary nailing is the treatment of choice for fractures of the tibial shaft, which might necessitate the nail removal due to complications in the long-term. Although considered as a low-risk procedure, intramedullary nail removal is also associated with certain complications. Here, we compared the most commonly used stainless steel and titanium nails with respect to the complications during removal and clinical outcome for intramedullary nailing of diaphyseal fractures of t...

  8. 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...

  9. Nails

    Science.gov (United States)

    ... Registration General information Housing & travel Education Exhibit hall Mobile app 2019 Annual Meeting Derm Exam Prep Course ... SkinPAC State societies Scope of practice Truth in advertising NP/PA laws Action center Public and patients ...

  10. 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.

  11. How to Stop Biting Your Nails

    Medline Plus

    Full Text Available ... like biting your nails, try playing with a stress ball or silly putty instead. This will help ... of hangnails, or other triggers, such as boredom, stress, or anxiety. By figuring out what causes you ...

  12. How to Stop Biting Your Nails

    Medline Plus

    Full Text Available ... and away from your mouth. Identify your triggers: These could be physical triggers, such as the presence ... nails, you can figure out how to avoid these situations and develop a plan to stop. Just ...

  13. How to Stop Biting Your Nails

    Medline Plus

    Full Text Available ... Action center Public and patients SPOT Skin Cancer™ Community programs & events Learn about skin cancer Get involved ... Diseases: A-Z index Skin, hair, and nail care Skin care Hair care / hair loss Injured skin ...

  14. How to Stop Biting Your Nails

    Medline Plus

    Full Text Available ... Mohs AUC MyDermPath+ Psoriasis Patient education resources Practice Management Center Coding and reimbursement Coding MACRA Fee schedule ... as boredom, stress, or anxiety. By figuring out what causes you to bite your nails, you can ...

  15. How to Stop Biting Your Nails

    Medline Plus

    Full Text Available ... Rotation PICMED Grant Professionalism Award Resident-Fellow QI Project Award Resident International Grant Resident Scholarship to Legislative ... continue through adulthood, and the side effects can be more than cosmetic. Repeated nail biting can make ...

  16. How to Stop Biting Your Nails

    Medline Plus

    Full Text Available ... Learning Center MOC Recognized Credit Basic Derm Curriculum Teaching and learning guides Suggested order of modules Basement ... Injured skin Nail care Anti-aging skin care Kids’ zone About skin: Your body's largest organ About ...

  17. How to Stop Biting Your Nails

    Medline Plus

    Full Text Available ... Scholarship to Legislative Conference Skin Care for Developing Countries Grant State Advocacy Grant Strauss and Katz Scholarship ... like biting your nails, try playing with a stress ball or silly putty instead. This will help ...

  18. How to Stop Biting Your Nails

    Medline Plus

    Full Text Available ... pointer nails, or even an entire hand. The goal is to get to the point where you ... c Explore the Academy Member resources Practice Tools Education Meetings & events Advocacy Public & patients Academy resources for: ...

  19. How to Stop Biting Your Nails

    Medline Plus

    Full Text Available ... Center Meetings and events Make a difference Career planning AAD apps Academy meeting Chronic urticaria—for members ... as boredom, stress, or anxiety. By figuring out what causes you to bite your nails, you can ...

  20. How to Stop Biting Your Nails

    Medline Plus

    Full Text Available ... diseases Cosmetic treatments Dry / sweaty skin Eczema / dermatitis Hair and scalp problems Itchy skin Painful skin / joints ... dermatologist? Other conditions Diseases: A-Z index Skin, hair, and nail care Skin care Hair care / hair ...

  1. How to Stop Biting Your Nails

    Medline Plus

    Full Text Available ... Part 2: Origin Part 3: Function Textbook Study notes Image library 3-D animated image library Board ... gradually stop biting your nails: Some doctors recommend taking a gradual approach to break the habit. Try ...

  2. How to Stop Biting Your Nails

    Medline Plus

    Full Text Available ... Mohs AUC MyDermPath+ Psoriasis Patient education resources ... Try to gradually stop biting your nails: Some doctors recommend taking a gradual approach to break the habit. Try to stop biting ...

  3. How to Stop Biting Your Nails

    Medline Plus

    Full Text Available ... Mohs AUC MyDermPath+ Psoriasis Patient education resources Practice Management Center Coding and reimbursement Coding MACRA Fee schedule ... your nails: Some doctors recommend taking a gradual approach to break the habit. Try to stop biting ...

  4. How to Stop Biting Your Nails

    Medline Plus

    Full Text Available ... facts about your skin, hair, and nails Skin dictionary Camp Discovery Good Skin Knowledge lesson plans and activities Video library Find a dermatologist Why see a board-certified dermatologist? Home ...

  5. NAIL SAMPLING TECHNIQUE AND ITS INTERPRETATION

    OpenAIRE

    TZAR MN; LEELAVATHI M

    2011-01-01

    The clinical suspicion of onychomyosis based on appearance of the nails, requires culture for confirmation. This is because treatment requires prolonged use of systemic agents which may cause side effects. One of the common problems encountered is improper nail sampling technique which results in loss of essential information. The unfamiliar terminologies used in reporting culture results may intimidate physicians resulting in misinterpretation and hamper treatment decision. This article prov...

  6. 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.

  7. Trace element analysis of nail polishes

    International Nuclear Information System (INIS)

    Misra, G.; Mittal, V.K.; Sahota, H.S.

    1999-01-01

    Instrumental neutron activation analysis (INAA) technique was used to measure the concentrations of various trace elements in nail polishes of popular Indian and foreign brands. The aim of the present experiment was to see whether trace elements could distinguish nail polishes of different Indian and foreign brands from forensic point of view. It was found that cesium can act as a marker to differentiate foreign and Indian brands. (author)

  8. Utility of gel nails in improving the appearance of cosmetically disfigured nails: Experience with 25 cases

    Directory of Open Access Journals (Sweden)

    Soni Nanda

    2014-01-01

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

  9. Nail Psoriasis: A Review of Treatment Options.

    Science.gov (United States)

    Pasch, Marcel C

    2016-04-01

    Nail involvement affects 80-90 % of patients with plaque psoriasis, and is even more prevalent in patients with psoriatic arthritis. This review is the result of a systemic approach to the literature and covers topical, intralesional, conventional systemic, and biologic systemic treatments, as well as non-pharmacological treatment options for nail psoriasis. The available evidence suggests that all anti-tumor necrosis factor-α, anti-interleukin (IL)-17, and anti-IL-12/23 antibodies which are available for plaque psoriasis and psoriatic arthritis are highly effective treatments for nail psoriasis. Conventional systemic treatments, including methotrexate, cyclosporine, acitretin, and apremilast, as well as intralesional corticosteroids, can also be effective treatments for nail psoriasis. Topical treatments, including corticosteroids, calcipotriol, tacrolimus, and tazarotene, have also been shown to have a position in the treatment of nail psoriasis, particularly in mild cases. Finally, non-pharmacological treatment options, including phototherapy, photodynamic therapy, laser therapy, and several radiotherapeutic options, are also reviewed but cannot be advised as first-line treatment options. Another conclusion of this review is that the lack of a reliable core set of outcomes measures for trials in nail psoriasis hinders the interpretation of results, and is urgently needed.

  10. Nails in Forensic Toxicology: An Update.

    Science.gov (United States)

    Solimini, Renata; Minutillo, Adele; Kyriakou, Chrystalla; Pichini, Simona; Pacifici, Roberta; Busardo, Francesco Paolo

    2017-01-01

    The analysis of nails as a keratinized matrix to detect drugs or illicit substances has been increasingly used in forensic and clinical toxicology as a complementary test, especially for the specific characteristics of stably accumulating substances for long periods of time. This allows a retrospective investigation of chronic drug abuse, monitoring continuous drug or pharmaceutical use, reveal in utero drug exposure or environmental exposures. We herein review the recent literature investigating drug incorporation mechanisms and drug detection in nails for forensic toxicological purposes. Mechanisms of drug incorporation have not yet been fully elucidated. However, some research has lately contributed to a better understanding of how substances are incorporated into nails, suggesting three potential mechanisms of drug incorporation: contamination from sweat, incorporation from nail bed and incorporation from germinal matrix. In addition, numerous methods dealing with the determination of drugs of abuse, medications and alcohol biomarkers in nails have been reported in studies over the years. The latter methods could find application in clinical and forensic toxicology. The studies herein reviewed point out how important it is to standardize and harmonize the methodologies (either pre-analytical or analytical) for nails analysis and the optimization of sampling as well as the development of proficiency testing programs and the determination of cut-off values. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  11. 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.

  12. [Intramedullary nailing of the tibia with the expert tibia nail].

    Science.gov (United States)

    Hansen, Matthias; El Attal, René; Blum, Jochen; Blauth, Michael; Rommens, Pol Maria

    2009-12-01

    Restoration of axis, length, and rotation of the lower leg. Sufficient primary stability of the osteosynthesis for functional aftercare. Early functional aftercare to maintain joint mobility. Good bony healing in closed and open fractures. All closed and open fractures of the tibia and complete lower leg fractures (AO 42). Certain extraarticular fractures of the proximal and distal tibia (AO 41 A2/A3; AO 43 A1/A2/A3). Segmental fractures of the tibia. Certain intraarticular fractures of the tibia with use of additional implants (AO 41 C1/C2; AO 43 C1/C2). Stabilization during and after segmental bone transport or callus distraction of the tibia. Patients in poor general condition (e.g., bedridden). Flexion of the knee of less than 90 degrees . Infection in the nail's insertion area. Infection of the tibial cavity. Complex articular fractures of the proximal or distal tibia with joint depression. Closed reduction of the fracture. If necessary, use of reduction clamps through additional stab incisions or open surgical procedures. In some cases, additional osteosynthesis procedures are necessary (e.g., screws). Positioning of the patient may be performed on a radiolucent table or a traction table. Opening of the proximal tibia in line with the medullary canal. Cannulated or noncannulated insertion of the Expert Tibia Nail((R)) with or without reaming of the medullary canal depending on the fracture type and soft-tissue condition. Control of axis, length, and rotation. Distal interlocking with the radiolucent drill and proximal interlocking with the targeting device. Immediate mobilization of ankle joint and knee joint. Depending on the type of fracture, mobilization with 20 kg partial weight bearing or pain-dependent full weight bearing with crutches. X-ray control 6 weeks postoperatively and increased weight bearing depending on the fracture status. In a prospective, international multicentric study, 181 patients with 186 fractures were included between July 2004 and

  13. Perilaku Agresif Siswa dari Keluarga Broken Home

    Directory of Open Access Journals (Sweden)

    Randi Pratama

    2016-12-01

    Full Text Available This research is based because of the aggressive behavior shown by the students, especially students who come from a broken home. The purpose of this study is to describe the aggressive behavior that is owned by a student who comes from a broken home in terms of attacking people physically, verbally, and damaging and destroying property and wealth of others. The results of this research shows that in general student’s aggressivebehavior are on average level. Implications of research in guidance and counseling is as the basis for programs to prevent and cope with aggressive behavior that is owned by the students, especially students who come from a broken home. Cooperation with the homeroom teacher mentors, teachers and other school personnel will also help identify students who have an aggressive behavior, especially students who come from a broken home to immediately provided services.

  14. Open-string models with broken supersymmetry

    International Nuclear Information System (INIS)

    Sagnotti, A.

    2002-01-01

    I review the salient features of three classes of open-string models with broken supersymmetry. These suffice to exhibit, in relatively simple settings, the two phenomena of 'brane supersymmetry' and 'brane supersymmetry breaking'. In the first class of models, to lowest order supersymmetry is broken both in the closed and in the open sectors. In the second class of models, to lowest order supersymmetry is broken in the closed sector, but is exact in the open sector, at least for the low-lying modes, and often for entire towers of string excitations. Finally, in the third class of models, to lowest order supersymmetry is exact in the closed (bulk) sector, but is broken in the open sector. Brane supersymmetry breaking provides a natural solution to some old difficulties met in the construction of open-string vacua. (author)

  15. Open-string models with broken supersymmetry

    International Nuclear Information System (INIS)

    Sagnotti, Augusto

    2000-01-01

    We review the salient features of three classes of open-string models with broken supersymmetry. These suffice to exhibit, in relatively simple settings, the two phenomena of 'brane supersymmetry' and 'brane supersymmetry breaking'. In the first class of models, to lowest order supersymmetry is broken both in the closed and in the open sectors. In the second class of models, to lowest order supersymmetry is broken in the closed sector, but is exact in the open sector, at least for the low-lying modes, and often for entire towers of string excitations. Finally, in the third class of models, to lowest order supersymmetry is exact in the closed (bulk) sector, but is broken in the open sector. Brane supersymmetry breaking provides a natural solution to some old difficulties met in the construction of open-string vacua

  16. 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...

  17. Subconjunctival Hemorrhage (Broken Blood Vessel in Eye)

    Science.gov (United States)

    Subconjunctival hemorrhage (broken blood vessel in eye) Overview A subconjunctival hemorrhage (sub-kun-JUNK-tih-vul HEM-uh-ruj) ... may not even realize you have a subconjunctival hemorrhage until you look in the mirror and notice ...

  18. 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.)

  19. Symmetry restoration in spontaneously broken induced gravity

    International Nuclear Information System (INIS)

    Amati, D.; Russo, J.

    1990-01-01

    We investigate the recuperation of expected invariant behaviours in a non-metric gravity theory in which the full general relativistic invariance is broken spontaneously. We show how dangerous increasing energy behaviours of physical amplitudes cancel in a highly non-trivial way. This evidences the expected loss of the vacuum generated scale in the UV regime and gives support for the consistency of spontaneously broken gravity theories. (orig.)

  20. Bag model with broken chiral symmetry

    International Nuclear Information System (INIS)

    Efrosinin, V.P.; Zaikin, D.A.

    1986-01-01

    A variant of the bag model in which chiral symmetry is broken and which provides a description of all the experimental data on the light hadrons, including the pion, is discussed. The pion and kaon decay constants are calculated in this model. The problem of taking into account the center-of-mass motion in bag models and the boundary conditions in the bag model with broken chiral symmetry are also discussed

  1. Broken SU(4) symmetry and new resonance

    International Nuclear Information System (INIS)

    Ueda, Y.

    1975-11-01

    Weinberg's spectral function sum rules are modified to accommodate broken symmetry effects of SU(4). With a simple choice of the symmetry-breaking term, the spectral function sum rules yield the observed vector meson mass spectrum as well as sum rules for the e - e + decay rates of vector mesons. In particular, a new mass formula, which can be interpreted as the broken symmetry version of the Schwinger formula, is derived, the agreement with experiments is excellent. (Ueda, Y.)

  2. Nail gun injuries among construction workers.

    Science.gov (United States)

    Dement, John M; Lipscomb, Hester; Li, Leiming; Epling, Carol; Desai, Tejas

    2003-05-01

    Pneumatic nail guns greatly increase worker productivity and are extensively used in wood frame building construction, with especially high use in residential construction. One surveillance report of nail gun injuries in Washington State has been published; however, other literature consists largely of case reports and case series in trauma journals. The major objective of the current study was to investigate the occurrence of nail gun-associated injuries among construction workers and to identify preventable work-related factors associated with these injuries. Nail gun-related injuries occurring among a cohort of 13,347 carpenters in Ohio who worked union hours during the time period January 1, 1994, until September 30, 1997, were identified by matching the cohort with workers' compensation claims made to the Ohio Bureau of Workers' Compensation. We also analyzed workers' compensation claims for North Carolina Home Builders Association members for the period July 1996-November 1999 to identify nail gun-related injuries. Analyses included stratified analyses of claims by nature and body part injured, calculation of nail gun injury rates, and analyses of free text descriptions of injuries. Overall, nail gun injuries were responsible for 3.9 percent of workers' compensation claims with 8.3 percent to 25.5 percent of claims involving paid lost work time. The overall rate of nail gun injuries (cases per 200,000 work hours) was 0.33 in North Carolina and 0.26 in Ohio, reflecting the greater concentration of wood frame construction workers in the North Carolina population studied. Higher rates of injury were observed for carpenters in North Carolina and among residential carpenters in Ohio. The predominant body part injured was the hands/fingers, with 80 to 89 percent of injuries being nail punctures. Analyses of free text information for puncture injuries found approximately 70 percent of injuries to occur during the framing/sheathing stage of construction. Our data

  3. Iodixanol in femoral arteriography

    International Nuclear Information System (INIS)

    Thorstensen, Oe.; Albrechtsson, U.; Calissendorff, B.; Larusdottir, H.; Norgren, L.; Tengvar, M.; Bolstad, B.; Aspelin, P.

    1994-01-01

    Two contrast media, iodixanol (Visipaque, Nycomed) 270 mg I/ml and iohexol (Omnipaque, Nycomed) 300 mg I/ml, were compared in femoral arteriography, in 147 patients. Both contrast media were diagnostically effective for use in femoral arteriography, without any significant difference. Pain was reported in connection with injection of iohexol by 36% of the patients, after injection of iodixanol none reported pain. Seventy-two percent of the patients in the iodixanol group reported a sensation of warmth in connection with contrast injection versus 90% in the iohexol group. The average intensity of the warmth was greater with iohexol than with iodixanol. Fourteen percent of patients in the iodixanol group and 1% in the iohexol group reported one or more subjective adverse events. (orig.)

  4. Results of Closed Intramedullary Nailing using Talwarkar Square Nail in Adult Forearm Fractures

    Directory of Open Access Journals (Sweden)

    Nadeem A Lil

    2012-07-01

    Full Text Available The aim of the study was to evaluate results of closed intramedullary nailing using Talwarkar square nails in adult forearm fractures. We prospectively evaluated 34 patients with both bone forearm fractures. The average time to union was 12.8 (SD +3.2 weeks with cast support for a mean of 8.2 weeks. Union was achieved in 31 out of 34 patients. Using the Grace and Eversmann rating system, 17 patients were excellent, 10 were good, and 4 had an acceptable result. Three patients had non-unions, 2 for the radius and one for the ulna. There were two cases of superficial infection, one subject had olecranon bursitis, and one case of radio-ulnar synostosis. Complication rates associated with the use of square nails were lower compared to plate osteosynthesis and locked intramedullary nails. To control rotation post- operatively, there is a need for application of an above-elbow cast after nailing.

  5. 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

  6. 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...... and externally by 5° and 10° using plastic wedges. Accuracy of rotation was within +1°. Digital radiographs were obtained at each position. Varus angles were measured using ImageJ, employing two definitions of PFLA. Mean varus angles increased with 10° of either internal or external rotation with both PFLA...... rotation angles. The effect of rotation on varus angle measurements in these femoral specimens contradicts a previous report using CT. The most probable explanation is the difference in femoral positioning: the CT study used a slightly elevated position compared to that in this study, resulting in better...

  7. Nail psoriasis: clinical features, pathogenesis, differential diagnoses, and management

    Directory of Open Access Journals (Sweden)

    Haneke E

    2017-10-01

    Full Text Available Eckart Haneke1–4 1Department of Dermatology, Inselspital, University of Bern, Bern, Switzerland; 2Dermatology Practice Dermaticum, Freiburg, Germany; 3Centro de Dermatología Epidermis, Instituto CUF, Porto, Portugal; 4Department of Dermatology, University Hospital, Gent, Belgium Abstract: Psoriasis is the skin disease that most frequently affects the nails. Depending on the very nail structure involved, different clinical nail alterations can be observed. Irritation of the apical matrix results in psoriatic pits, mid-matrix involvement may cause leukonychia, whole matrix affection may lead to red lunulae or severe nail dystrophy, nail bed involvement may cause salmon spots, subungual hyperkeratosis, and splinter hemorrhages, and psoriasis of the distal nail bed and hyponychium causes onycholysis whereas that of the proximal nail fold causes psoriatic paronychia. The more extensive the involvement, the more severe is the nail destruction. Pustular psoriasis may be seen as yellow spots under the nail or, in case of acrodermatitis continua suppurativa, as an insidious progressive loss of the nail organ. Nail psoriasis has a severe impact on quality of life and may interfere with professional and other activities. Management includes patient counseling, avoidance of stress and strain to the nail apparatus, and different types of treatment. Topical therapy may be tried but is rarely sufficiently efficient. Perilesional injections with corticosteroids and methotrexate are often beneficial but may be painful and cannot be applied to many nails. All systemic treatments clearing widespread skin lesions usually also clear the nail lesions. Recently, biologicals were introduced into nail psoriasis treatment and found to be very effective. However, their use is restricted to severe cases due to high cost and potential systemic adverse effects. Keywords: nail psoriasis, etiology, pathology, quality of life, impact, treatment

  8. Additional Tension Screws Improve Stability in Elastic Stable Intramedullary Nailing: Biomechanical Analysis of a Femur Spiral Fracture Model.

    Science.gov (United States)

    Zachert, Gregor; Rapp, Marion; Eggert, Rebecca; Schulze-Hessing, Maaike; Gros, Nina; Stratmann, Christina; Wendlandt, Robert; Kaiser, Martin M

    2015-08-01

    For pediatric femoral shaft fractures, elastic stable intramedullary nailing (ESIN) is an accepted method of treatment. But problems regarding stability with shortening or axial deviation are well known in complex fracture types and heavier children. Biomechanical in vitro testing was performed to determine whether two modified osteosyntheses with an additional tension screw fixation or screw fixation alone without nails could significantly improve the stability in comparison to classical ESIN. A total of 24 synthetic adolescent-sized femoral bone models (Sawbones, 4th generation; Vashon, Washington, United States) with an identical spiral fracture (length 100 mm) were used. All grafts underwent retrograde fixation with two C-shaped steel nails (2C). Of the 24, 8 osteosyntheses were supported by one additional tension screw (2C1S) and another 8 by two screws (2S) in which the intramedullary nails were removed before testing. Each configuration underwent biomechanical testing in 4-point bending, external rotation (ER) and internal rotation (IR). Furthermore, the modifications were tested in axial physiological 9 degrees position for shifting and dynamic compression as well as dynamic load. Both screw configurations (2C1S and 2S) demonstrated a significantly higher stability in comparison to the 2C configuration in 4-point bending (anterior-posterior, 0.95 Nm/mm [2C] spiral fracture model, the stability of ESIN could be significantly improved by two modifications with additional tension screws. If transferred in clinical practice, these modifications might offer earlier weight bearing and less problems of shortening or axial deviation. Georg Thieme Verlag KG Stuttgart · New York.

  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. Guidance on maintaining personal hygiene in nail care.

    Science.gov (United States)

    Malkin, Bridget; Berridge, Pat

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

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

    Science.gov (United States)

    Douglas R. Rammer; Samuel L. Zelinka

    2015-01-01

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

  12. A-Frame free Vascularized Fibular Graft and Femoral Lengthening for Osteosarcoma Pediatric Patients.

    Science.gov (United States)

    Cashin, Megan; Coombs, Christopher; Torode, Ian

    2018-02-01

    Pediatric limb reconstruction after resection of a malignant tumor presents specific challenges. Multiple surgical techniques have been used to treat these patients. This paper describes a staged surgical technique for the reconstruction of large distal femoral defects due to tumor resection in skeletally immature patients. Three pediatric patients with osteosarcoma of the distal femur underwent staged reconstruction. Neoadjuvant chemotherapy was followed by en bloc tumor resection and immediate reconstruction of the distal femoral defect with a vascularized free fibular autograft utilizing a unique A-frame construct combined with intramedullary nail fixation. The second stage was a planned gradual lengthening of the healed construct, over a custom-made magnetically driven expandable intramedullary nail. All patients achieved bony union and satisfactory length with minimal complications. The patients all returned to full, unlimited physical activities. The early results confirm that the described technique is a safe and reliable procedure for the reconstruction of large femoral defects in pediatric patients with osteosarcoma. Level IV-therapeutic.

  13. Multi-element determination in cancellous bone of human femoral head by PIXE

    International Nuclear Information System (INIS)

    Yuanxun Zhang; Yongping Zhang; Yongpeng Tong; Shijing Qiu; Xiaotao Wu; Kerong Dai

    1996-01-01

    Proton Induced X-ray Emission (PIXE) method is used for the determination of elemental concentrations in cancellous bone of human femoral head from five autopsies and seven patients with femoral neck broken. The specimen preparation and experimental procedure are described in detail. Using the t test, the results show that the concentrations of P, Ca, Fe, Cu, Sr in control group are higher than those in patient group, but the concentrations of S, K, Zn, Mn are not significantly different. The physiological functions of metallic elements in human bone are also discussed. (author). 19 refs., 1 fig., 4 tabs

  14. 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.

  15. Endomedullar nail of metacarpal and proximal phalanges

    International Nuclear Information System (INIS)

    Mendez Olaya, Francisco Javier; Sanchez Mesa, Pedro Antonio

    2002-01-01

    Prospective study, series of cases; it included patients with diaphysis fractures and union diaphysis-neck or union diaphysis-base of metacarpal and proximal phalanges, in whom was practiced anterograde intramedullary nailing previous closed reduction of the fracture, using prevent intramedullary nail of 1.6 mm. (cem 16) for the metacarpal fractures, and two nail prevent of 1.0 mm. (cem 10) for the proximal phalangeal fractures. Indications: transverse and oblique short fractures, spiral and with comminuting bicortical. Pursuit average is 5.7 months. Frequency surgical intervened patient: 2.2 each month, using this surgical technique a total of 20 (twenty) patients have been operated, 21 (twenty one) fractures; 16 (sixteen) metacarcal fractures and 5 (five) proximal phalangeal fractures, all of them tested using clinical and radiological parameters. Results: good 82%, regular 18%, and bad 0% obtaining bony consolidation and early rehabilitation with incorporation to their habitual works

  16. Complications during removal of stainless steel versus titanium nails used for intramedullary nailing of diaphyseal fractures of the tibia.

    Science.gov (United States)

    Seyhan, Mustafa; Guler, Olcay; Mahirogullari, Mahir; Donmez, Ferdi; Gereli, Arel; Mutlu, Serhat

    2018-02-01

    Intramedullary nailing is the treatment of choice for fractures of the tibial shaft, which might necessitate the nail removal due to complications in the long-term. Although considered as a low-risk procedure, intramedullary nail removal is also associated with certain complications. Here, we compared the most commonly used stainless steel and titanium nails with respect to the complications during removal and clinical outcome for intramedullary nailing of diaphyseal fractures of the tibia. Sixty-two patients (26 females, 36 males) were included in this retrospective study. Of the removed nails, 24 were of stainless steel and 38 of titanium. Preoperative and intraoperative parameters, such as implant discomfort, anterior knee pain, operating time and amount of bleeding, and postoperative outcomes were evaluated for each patient. Titanium nail group had more, but not statistically significant, intraoperative complications than stainless steel group during the removal of nails (p = .4498). Operating time and amount of intraoperative bleeding were significantly higher in titanium group than stainless steel group (p = .0306 and p titanium nails than those of stainless steel nails, whereas there was no difference in terms of postoperative SF-36 and KSS scores. In conclusion, although greater bone contact with titanium increases implant stability, nail removal is more difficult, resulting in more longer surgical operation and more intraoperative bleeding. Therefore, we do not recommend titanium nail removal in asymptomatic patients.

  17. Clinical features and nail clippings in 52 children with psoriasis.

    Science.gov (United States)

    Uber, Marjorie; Carvalho, Vânia O; Abagge, Kerstin T; Robl Imoto, Renata; Werner, Betina

    2018-03-01

    Nail clipping, the act of cutting the distal portion of a nail for microscopic analysis, can complement the diagnosis of skin diseases with nail involvement, such as psoriasis. This study aimed to describe histopathologic findings on 81 nails from 52 children and adolescents with skin psoriasis and to determine whether these changes correlated with the severity of skin and nail involvement. Children with psoriasis were enrolled in this cross-sectional study to obtain Psoriasis Area and Severity Index (PASI) and Nail Psoriasis Severity Index (NAPSI) scores. The most altered nails were processed using periodic acid-Schiff with diastase staining. Fifty-two patients with a median age of 10.5 years were included. The median Nail Psoriasis Severity Index score of the 20 nails from these patients was 17 (range 3-80). The most common findings were pitting (94.2%), leukonychia (73.0%), and longitudinal ridges (63.5%). Eighty-one nail fragments were collected by clipping. Neutrophils were found in 6 samples (7.6%) and serous lakes in 15 (19%). Median nail plate thickness was 0.3 mm (range 0.1-0.63 mm). Patients whose nails had neutrophils had a higher median PASI score (6.1 vs 2.0, P = .03). Patients whose nails had serous lakes had higher median PASI (5.3 vs 1.9, P = .008) and NAPSI (median 45.0 vs 18.0, P = .006) scores. There seems to be a correlation between some microscopic nail features in children with psoriasis and their PASI and NAPSI scores, so nail clippings from children with suspected psoriasis may help with diagnosis, especially in the presence of neutrophils, and in excluding onychomycosis. © 2018 Wiley Periodicals, Inc.

  18. Complications during removal of stainless steel versus titanium nails used for intramedullary nailing of diaphyseal fractures of the tibia

    Directory of Open Access Journals (Sweden)

    Mustafa Seyhan

    2018-02-01

    Full Text Available Objectives: Intramedullary nailing is the treatment of choice for fractures of the tibial shaft, which might necessitate the nail removal due to complications in the long-term. Although considered as a low-risk procedure, intramedullary nail removal is also associated with certain complications. Here, we compared the most commonly used stainless steel and titanium nails with respect to the complications during removal and clinical outcome for intramedullary nailing of diaphyseal fractures of the tibia. Patients and methods: Sixty-two patients (26 females, 36 males were included in this retrospective study. Of the removed nails, 24 were of stainless steel and 38 of titanium. Preoperative and intraoperative parameters, such as implant discomfort, anterior knee pain, operating time and amount of bleeding, and postoperative outcomes were evaluated for each patient. Results: Titanium nail group had more, but not statistically significant, intraoperative complications than stainless steel group during the removal of nails (p = .4498. Operating time and amount of intraoperative bleeding were significantly higher in titanium group than stainless steel group (p = .0306 and p < .001, respectively. Preoperative SF-36 physical component and KSS scores were significantly lower in patients who had removal of titanium nails than those of stainless steel nails, whereas there was no difference in terms of postoperative SF-36 and KSS scores. Conclusion: In conclusion, although greater bone contact with titanium increases implant stability, nail removal is more difficult, resulting in more longer surgical operation and more intraoperative bleeding. Therefore, we do not recommend titanium nail removal in asymptomatic patients. Keywords: Fractures of tibial shaft, Removal of intramedullary nailing, Stainless steel nail, Titanium nail

  19. Spontaneously broken abelian gauge invariant supersymmetric model

    International Nuclear Information System (INIS)

    Mainland, G.B.; Tanaka, K.

    A model is presented that is invariant under an Abelian gauge transformation and a modified supersymmetry transformation. This model is broken spontaneously, and the interplay between symmetry breaking, Goldstone particles, and mass breaking is studied. In the present model, spontaneously breaking the Abelian symmetry of the vacuum restores the invariance of the vacuum under a modified supersymmetry transformation. (U.S.)

  20. Multiquark baryons with broken flavour symmetry 1

    International Nuclear Information System (INIS)

    Wroldsen, J.

    The calculation of the spectrum of 4qq multiquark baryons is carried out, taking into account that SU(3) flavour is broken. To handle this problem, which includes manipulation of giant expressions for the wavefunctions, methods suitable for programming in SCHOONSCHIP are developed and employed. (Auth)

  1. Spontaneously broken version of N=4 supersymmetry

    International Nuclear Information System (INIS)

    Terent'ev, M.V.

    1989-01-01

    The special scenario of reduction from the space of D=10 dimensions is used to construct the theory with describes interaction of supergravity with only one multiplet of matter in the framework of spontaneously broken N=4 supersymmetry. 6 refs.; 1 fig

  2. Broken Scale Invariance and Anomalous Dimensions

    Science.gov (United States)

    Wilson, K. G.

    1970-05-01

    Mack and Kastrup have proposed that broken scale invariance is a symmetry of strong interactions. There is evidence from the Thirring model and perturbation theory that the dimensions of fields defined by scale transformations will be changed by the interaction from their canonical values. We review these ideas and their consequences for strong interactions.

  3. Of Slot Machines and Broken Test Tubes

    Indian Academy of Sciences (India)

    Home; Journals; Resonance – Journal of Science Education; Volume 19; Issue 5. Of Slot Machines and Broken Test Tubes. S Mahadevan. General Article Volume 19 Issue 5 May 2014 pp 395-405. Fulltext. Click here to view fulltext PDF. Permanent link: https://www.ias.ac.in/article/fulltext/reso/019/05/0395-0405. Keywords.

  4. Holography with broken Poincaré symmetry

    NARCIS (Netherlands)

    Korovins, J.

    2014-01-01

    This thesis deals with the extensions of the holographic dualities to the situations where part of the Poincaré group has been broken. Such theories are particularly relevant for applications of gauge/gravity dualities to condensed matter systems, which usually exhibit non-relativistic symmetry.

  5. 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.

  6. How to Stop Biting Your Nails

    Medline Plus

    Full Text Available ... NP/PA laws Action center Public and patients SPOT Skin Cancer™ Community programs & events Learn about skin cancer ... mcat1=de12", ]; for (var c = 0; c public SPOT Skin Cancer™ Diseases and treatments Skin, hair, and nail ...

  7. Comparison of different nail bending apparatus

    NARCIS (Netherlands)

    Vianen, H.P.C.A.; Schot, F.; Vermeltfoort, A.Th.

    1992-01-01

    A research to develope a registrated testmethod to define the allowable bending moment of a nail was started in spring of this year. A request for a registrated testmethod is caused by the final project of ir. H.P.C.A. Vianen ‘s study. The consequence of developing new codes in The Netherlands and

  8. Nail Properties and Bone Health: A Review

    Directory of Open Access Journals (Sweden)

    Pouya Saeedi

    2018-04-01

    Full Text Available Physicochemical properties of nail may offer valuable insight into the health of bone. Currently, dual-energy X-ray absorptiometry (DXA is the gold standard technique for evaluating bone health through bone mineral density (BMD. However, only 70% of fractures are explained by low BMD according to DXA. Therefore, the World Health Organisation recommended the need for the development of alternative methods of assessing bone health. Keratin and collagen type I are major proteins in nail and bone, respectively. Both of these proteins undergo post-translational modifications, with a possible correlation between the degree of post-translational modifications in keratin and collagen. Raman spectroscopy is a technique used to detect changes in protein composition and structure. As changes in protein function and structure may be associated with the development of osteoporosis, Raman spectroscopy may be a valuable adjunct to assess bone health and fracture risk. This review critically evaluates various methods and techniques to identify the link between nail properties and bone health. The strengths and limitations of various studies and the potential use of nail protein and minerals to evaluate bone health have been also presented.

  9. How to Stop Biting Your Nails

    Medline Plus

    Full Text Available ... and rosacea Bumps and growths Color problems Contagious skin diseases Cosmetic treatments Dry / sweaty skin Eczema / dermatitis Hair ... de12", ]; for (var c = 0; c public SPOT Skin Cancer™ Diseases and treatments Skin, hair, and nail care Skin ...

  10. 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.

  11. Side Effects: Skin and Nail Changes

    Science.gov (United States)

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

  12. reoperation rates following intramedullary nailing versus external

    African Journals Online (AJOL)

    Results: Fifty patients were enrolled and completed follow-up at all-time points; twenty-six were treated with IM nail and ... patients over 18 years with Gustilo Type 3A open tibia .... in a randomized fashion with larger sample sizes are.

  13. How to Stop Biting Your Nails

    Medline Plus

    Full Text Available ... of hangnails, or other triggers, such as boredom, stress, or anxiety. By figuring out what causes you to bite your nails, you can figure out how to avoid these situations and develop a plan to stop. Just knowing when you’re inclined to bite may help solve the problem. Try to gradually stop biting ...

  14. Unstable intertrochanteric femur fractures in geriatric patients treated with the DLT trochanteric nail.

    Science.gov (United States)

    Temiz, Aytun; Durak, Aslihan; Atici, Teoman

    2015-07-01

    To evaluate clinical-functional and radiological results of geriatric patients with unstable intertrochanteric femur fracture treated with intramedullary nail. Thirty-two patients treated with intramedullary nail (DLT trochanteric nail) due to unstable intertrochanteric femur fractures were reviewed retrospectively. Fractures 31-A2 and 31-A3 (AO classification) were evaluated. Operation time, blood loss, and blood transfusion requirements, hospitalization period, time to fracture union were evaluated and perioperative and postoperative complications were recorded. According to the modified Baumgaertner criteria fracture reduction was analyzed radiologically, and nail tip-apex distance was measured. Femoral neck-shaft angle was also evaluated. Harris Hip Score for clinical evaluation and Kyo criteria for walking capacity were used. The mean age was 72 years (65-81), mean follow up time was 18.3 months (12-26). Nineteen patients had type 31-A2 and 13 had type 31-A3 fractures. Mean operation time was 36.3min (25-45), blood loss 185.9ml (100-250). Blood transfusion was required in 7 patients. The average hospitalization duration was 6 days (4-14) while the time to surgery from admission was 2.9 days (2-6). Radiologically, in 21 of the cases fracture reduction was well (65.6%), acceptable in 9 (28.1%), and poor in 2 (6.3%). In early postoperative period, the mean collo-diaphyseal angle was 129.1° (120-140°), mean tip-apex distance was 15.5mm (10-27). The mean Harris Hip Score was 63.4 (38-90). Two patients (6.3%) had excellent, 21 patients (65.6%) had good, 7 patients (21.8%) had moderate, and 2 patients (6.3%) had poor results. Walking capacity in the last follow-up in 20 of the cases (62.5%) was pre-fracture level. While complications were observed in seventeen patients (53.1%) (5 superficial wound infections, 5 fractures of the greater trochanter, 3 cases of secondary varus angulation and 4 cases of heterotopic ossification) none of them required additional surgery

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

    Science.gov (United States)

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

    2016-05-01

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

  16. 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.

  17. Proximal femoral fractures: Principles of management and review of literature

    Science.gov (United States)

    Mittal, Ravi; Banerjee, Sumit

    2012-01-01

    Purpose The purpose of this study was to review the principles involved in the management of proximal femoral fractures as reported in the literature. Methods: A medical literature search in the MEDLINE (PubMed) and Cochrane database was undertaken to review strategies and principles in proximal femoral fracture treatment. Randomized control trials and meta analysis were given preference while case reports/small series were rejected. Results and conclusions: Early anatomical reduction and surgical fixation remains the best option to reduce the risk of complications like non-union and avascular necrosis in treating fracture neck femurs. Cancellous screws continue to be the preferred treatment for fixation of neck femur fractures in younger population until the benefit of using sliding hip screws is validated by large multicentric studies. In the geriatric age group, early prosthetic replacement brings down the mortality and morbidity associated with neck femur fractures. Sliding hip screw (DHS) is the best available option for stable inter trochanteric fractures. The use of intramedullary nails e.g. PFN is beneficial in treating inter trochanteric fractures with comminution and loss of lateral buttress. Intramedullary implants have been proven to have increased success rates in subtrochanteric fractures and should be preferred over extramedullary plate fixation systems. PMID:25983451

  18. Nontraumatic Fracture of the Femoral Condylar Prosthesis in a Total Knee Arthroplasty Leading to Mechanical Failure

    Directory of Open Access Journals (Sweden)

    Girish N. Swamy

    2014-01-01

    Full Text Available This paper reports a case of fatigue fracture of the femoral component in a cruciate-retaining cemented total knee arthroplasty (TKA. A 64-year-old man had undergone a primary TKA for osteoarthritis 10 years previously at another institution using the PFC-Sigma prosthesis. The patient recovered fully and was back to his regular activities. He presented with a history of sudden onset pain and locking of the left knee since the preceding three months. There was no history of trauma, and the patient was mobilizing with difficulty using crutches. Radiographs revealed fracture of the posterior condyle of the femoral prosthesis. Revision surgery was performed as an elective procedure revealing the broken prosthesis. The TC3RP-PFC revision prosthesis was used with a medial parapatellar approach. The patient recovered fully without any squeal. Mechanical failure of the knee arthroplasty prosthesis is rare, and nontraumatic fracture of the femoral metallic component has not been reported before.

  19. Nontraumatic fracture of the femoral condylar prosthesis in a total knee arthroplasty leading to mechanical failure.

    Science.gov (United States)

    Swamy, Girish N; Quah, Conal; Bagouri, Elmunzar; Badhe, Nitin P

    2014-01-01

    This paper reports a case of fatigue fracture of the femoral component in a cruciate-retaining cemented total knee arthroplasty (TKA). A 64-year-old man had undergone a primary TKA for osteoarthritis 10 years previously at another institution using the PFC-Sigma prosthesis. The patient recovered fully and was back to his regular activities. He presented with a history of sudden onset pain and locking of the left knee since the preceding three months. There was no history of trauma, and the patient was mobilizing with difficulty using crutches. Radiographs revealed fracture of the posterior condyle of the femoral prosthesis. Revision surgery was performed as an elective procedure revealing the broken prosthesis. The TC3RP-PFC revision prosthesis was used with a medial parapatellar approach. The patient recovered fully without any squeal. Mechanical failure of the knee arthroplasty prosthesis is rare, and nontraumatic fracture of the femoral metallic component has not been reported before.

  20. Ratchet device with broken friction symmetry

    DEFF Research Database (Denmark)

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

    2002-01-01

    An experimental setup (gadget) has been made for demonstration of a ratchet mechanism induced by broken symmetry of a dependence of dry friction on external forcing. This gadget converts longitudinal oscillating or fluctuating motion into a unidirectional rotation, the direction of which is in ac......An experimental setup (gadget) has been made for demonstration of a ratchet mechanism induced by broken symmetry of a dependence of dry friction on external forcing. This gadget converts longitudinal oscillating or fluctuating motion into a unidirectional rotation, the direction of which...... is in accordance with given theoretical arguments. Despite the setup being three dimensional, the ratchet rotary motion is proved to be described by one simple dynamic equation. This kind of motion is a result of the interplay of friction and inertia....

  1. Random-phase approximation and broken symmetry

    International Nuclear Information System (INIS)

    Davis, E.D.; Heiss, W.D.

    1986-01-01

    The validity of the random-phase approximation (RPA) in broken-symmetry bases is tested in an appropriate many-body system for which exact solutions are available. Initially the regions of stability of the self-consistent quasiparticle bases in this system are established and depicted in a 'phase' diagram. It is found that only stable bases can be used in an RPA calculation. This is particularly true for those RPA modes which are not associated with the onset of instability of the basis; it is seen that these modes do not describe any excited state when the basis is unstable, although from a formal point of view they remain acceptable. The RPA does well in a stable broken-symmetry basis provided one is not too close to a point where a phase transition occurs. This is true for both energies and matrix elements. (author)

  2. 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.

  3. N=1 superstrings with spontaneously broken symmetries

    International Nuclear Information System (INIS)

    Ferrara, S.

    1988-01-01

    We construct N=1 chiral superstrings with spontaneously broken gauge symmetry in four space-time dimensions. These new string solutions are obtained by a generalized coordinate-dependent Z 2 orbifold compactification of some non-chiral five-dimensional N=1 and N=2 superstrings. The scale of symmetry breaking is arbitrary (at least classically) and it can be chosen hierarchically smaller than the string scale (α') -1/2 . (orig.)

  4. Spontaneously broken global symmetries and cosmology

    International Nuclear Information System (INIS)

    Shafi, Q.; Vilenkin, A.

    1984-01-01

    Phase transitions associated with spontaneously broken global symmetries, in case these occur in nature, can have important cosmological implications. This is illustrated through two examples. The first one shows how the spontaneous breaking of a global U(1) symmetry, present, for instance, in the minimal SU(5) model, can lead to an inflationary phase. The second example illustrates how topologically stable strings associated with the breaking of U(1) symmetry make an appearance at (or near) the end of the inflationary era

  5. Broken colour symmetry and liberated quarks

    International Nuclear Information System (INIS)

    Ma, E.

    1976-01-01

    A quark model of hadrons is presented and discussed, in which local SU(3) gauge symmetry is completely broken and yet asymptotic freedom is preserved. There is no infrared slavery in this model, and isolated quarks are free to exist. Colour becomes a global symmetry which is only approximate under SU(3) but nearly exact under SU(2) x U(1), as far as the usual hadron spectroscopy is concerned. (Auth.)

  6. Extent and Morbidity of Lateralization of a Trochanteric Fixation Nail Blade.

    Science.gov (United States)

    Sandifer, Phillip A; Hulick, Robert M; Graves, Matthew L; Spitler, Clay A; Russell, George V; Hydrick, Josie M; Jones, LaRita C; Bergin, Patrick F

    2017-09-01

    This study examined the incidence and risk factors associated with lateral helical blade migration and trochanteric pain with the trochanteric fixation nail. A retrospective review was performed of 141 cases of pertrochanteric femur fracture treated with a trochanteric fixation nail at a level I trauma center over a period of 42 months. Exclusion criteria included follow-up of less than 60 days, preexisting osteonecrosis of the femoral head, and prophylactic trochanteric fixation nail treatment. Patient demographics, operative findings, and radiographic findings were recorded. Medical records were reviewed to identify symptomatic hardware. Overall, 27 patients (19.1%) were symptomatic, and 3 (2.1%) required revision surgery for blade prominence. Of the patients, 42 (30%) had lateralization of greater than 1 cm, and 16 of these (38.1%) were symptomatic (Pfractures showing lateralization of greater than 1 cm. The quality of calcar reduction nearly reached statistical significance, and 44.8% of patients who had inadequate reduction had lateralization of greater than 1 cm compared with 26.4% of patients who had adequate reduction (P=.054). Lateralization of greater than 1 cm was directly associated with the presence of symptoms (Ptrochanteric pain (P=.007). Multivariate analysis showed that increasing tip-apex distance, inadequate calcar reduction, and greater fracture severity were predictive of excessive lateralization of greater than 1 cm. Nearly 20% of patients had lateral hip pain associated with cephalomedullary fixation. Final lateralization of the helical blade of greater than 1 cm was a very strong predictor of symptoms. During preoperative counseling, surgeons should caution patients about this relatively frequent and likely underreported complication. [Orthopedics. 2017; 40(5):e886-e891.]. Copyright 2017, SLACK Incorporated.

  7. Spontaneously broken realization of supersymmetry in supergravity

    International Nuclear Information System (INIS)

    Ferrara, S.; Trieste Univ.

    1979-01-01

    It is shown that if supersymmetry is relevant for the physical world it must be broken either spontaneously or explicitly. Renormalizability and simplicity are in favor of a spontaneous realization of the symmetry breaking. When supersymmetry is spontaneously broken the spinorial analogue of the Goldstone phenomenon occurs, namely massless particles arise in the spectrum of the theory which carry the same quantum numbers of the broken generators Qsup(i) they are N spin 1/2 Goldstone fermions (goldstinos). These particles may be eaten by spin 3/2 gauge particles (gravitinos) when supersymmetry is gauged. It is shown that both the Higgs effect and super Higgs effect have taken place. 8 of the spin 1/2 particles have been eaten by the spin 3/2 particles and 24 of 70 scalars have been eaten by the spin 3/2 particles and 24 of 70 scalars have been eaten by 24 of the 28 vector particles to provide them with mass. The conclusion is that the number of mass relations is, in general, equal to r-1, where r is the rank of the algebra which generates the spectrum

  8. 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.)

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

    International Nuclear Information System (INIS)

    Albers, Brittany K.; Garner, Hillary W.; Sluzevich, Jason C.

    2016-01-01

    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.)

  10. Femoral head necrosis; Hueftkopfnekrose

    Energy Technology Data Exchange (ETDEWEB)

    Kramer, J.; Scheurecker, G.; Scheurecker, A.; Stoeger, A.; Huber, A. [Roentgeninstitut am Schillerpark, Linz (Austria); Hofmann, S. [Orthopaedisches Landeskrankenhaus Stolzalpe (Austria)

    2009-05-15

    The epidemiology and pathohistogenesis of avascular femoral head necrosis has still not been clarified in detail. Because the course of the disease runs in stages and over a long time period nearly always culminates in the necessity for a total hip prosthesis, an exact radiological evaluation is of paramount importance for the treatment. There is a need for a common staging system to enable comparison of different therapy concepts and especially their long-term results. In this article the ARCO staging system is described in full detail, which includes all radiological modalities as well as histopathological alterations. (orig.) [German] Bei der avaskulaeren Femurkopfnekrose handelt es sich um ein Krankheitsbild, dessen Ursachen noch immer nicht vollstaendig geklaert sind. Da die Erkrankung stadienhaft verlaeuft und ueber einen laengeren Zeitraum betrachtet nahezu immer in einem prothetischen Hueftersatz muendet, ist eine genaue radiologische Abklaerung fuer die Behandlung von enormer Bedeutung. Um Langzeiterfolge verschiedener Therapiekonzepte vergleichen zu koennen, sind eine exakte Beschreibung und darauf basierend die Verwendung einer einheitlichen Stadieneinteilung wuenschenswert. In der vorliegenden Arbeit wird die ARCO-Stadieneinteilung im Detail beschrieben, die alle bildgebenden Methoden beruecksichtigt und histopathologische Veraenderungen mit einbezieht. (orig.)

  11. Mismatch analysis of humeral nailing. Antegrade versus retrograde insertion

    International Nuclear Information System (INIS)

    Mahaisavariya, B.; Jiamwatthanachai, P.; Aroonjarattham, P.; Aroonjarattham, K.; Wongcumchang, M.; Sitthiseripratip, K.

    2011-01-01

    Closed humeral nailing is now considered an alternative treatment for humeral-shaft fracture. The nail can be inserted with either the antegrade or retrograde method. We investigated and compared the problem of geometric mismatch of the humeral nail to the humerus between the two methods of insertion. The study was performed using virtual simulation based on computed tomography (CT) data of 76 Thai cadaveric humeri and the commonly used Russell-Taylor humeral nail 8 mm in diameter and 220 mm long. Mismatch of the nail to the intact humerus was analyzed and compared between the antegrade and retrograde nailing approaches. The results showed: the diameter of the medullary canal averaged 7.9-13.8 mm; the minimal reaming diameter to accommodate virtual nail insertion averaged 8.8-14.8 mm for the antegrade and 8.8-29.3 mm for the retrograde approach; the minimal reaming thickness of the inner cortex averaged 0.1-1.5 mm for the antegrade and 0.1-9.9 mm for the retrograde approach; the percentages of cortical bone removed prior to nail insertion were 3.8-107.1% and 3.8-1,287.6% for the antegrade and retrograde approaches, respectively; the eccentricity of the nail-medullary canal center were 0.4-3.4 and 0.4-10.6 mm for the antegrade and retrograde approaches, respectively. Less mismatching occurred with antegrade nailing than with the retrograde approach. Retrograde nailing requires excessive reaming at the distal part of the humerus to accommodate nail insertion. This may create bone weakness and the risk of supracondylar fracture. (author)

  12. Correlation of trace metals in hair and nails

    International Nuclear Information System (INIS)

    Benischek-Huber, I.; Benischek, F.

    1985-01-01

    Correlation of Cd, Cu, Hg, Pb and Zn was studied in 350 hair and nail samples of 12 persons. Determination was performed by atomic absorption spectrometry. Cd, Pb and Hg concentrations are fluctuating significantly in the specimens. Correlation was found for these elements in hair and finger nails and for Pb in hair and toe nails. Zn and Cu are more stable, the ratios of contents in corresponding samples are within a small range. (author)

  13. Nail changes in alopecia areata: Incidence and pattern

    Directory of Open Access Journals (Sweden)

    Gandhi V

    2003-03-01

    Full Text Available One hundred consecutive patients with alopecia areata were examined for presence of nail abnormalities. Nail changes were seen in 44/100 (44% of patients with most frequent occurrence in multifocal variety (30/44=68%. The commonest abnormality observed was superficial pits seen in 28(64% patients. Presence and severity of nail changes may indicate a more severe and recalcitrant disease.

  14. Broken Homes: Stable Risk, Changing Reasons, Changing Forms.

    Science.gov (United States)

    Sweetser, Dorrian Apple

    1985-01-01

    Cohort membership and two measures of social disadvantage were used as explanatory variables in analysis of the risk of growing up in a broken home and of the living arrangements of children with broken homes. The risk of a broken home by age 16 proved to be stable across cohorts and greater for those from disadvantaged homes. (Author/BL)

  15. Quantum restoration of broken symmetry in onedimensional loop ...

    Indian Academy of Sciences (India)

    Home; Journals; Pramana – Journal of Physics; Volume 82; Issue 6. Quantum restoration of broken symmetry in ... Keywords. Non-local transformation; broken symmetry; sine-Gordon; sech interaction. ... A specific type of classically broken symmetry is restored in quantum theory. One-dimensional sine-Gordon system and ...

  16. Image Analysis for Nail-fold Capillaroscopy

    OpenAIRE

    Vucic, Vladimir

    2015-01-01

    Detection of diseases in an early stage is very important since it can make the treatment of patients easier, safer and more ecient. For the detection of rheumatic diseases, and even prediction of tendencies towards such diseases, capillaroscopy is becoming an increasingly recognized method. Nail-fold capillaroscopy is a non-invasive imaging technique that is used for analysis of microcirculation abnormalities that may lead todisease like systematic sclerosis, Reynauds phenomenon and others. ...

  17. 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.

  18. Posterior Femoral Single Limb Osteotomy for the Removal of Well-Fixed Modular Femoral Neck Components

    Directory of Open Access Journals (Sweden)

    Keith A Fehring

    2017-07-01

    Full Text Available Modular neck femoral components were introduced to optimize femoral neck anteversion, leg length, offset, and stability in total hip arthroplasty. However, concerns have been raised in recent years regarding early failure of these implants due to corrosion, pseudotumor, as well as fracture of the modular neck. Removing modular neck femoral implants is challenging as removal of the modular femoral neck leaves a proximally coated femoral stem level with the proximal bone of the femoral neck. We describe a posterior femoral single limb osteotomy  (posterior cut of an extended trochanteric osteotomy for the removal of a modular neck femoral component.

  19. Precise placement of lag screws in operative treatment of trochanteric femoral fractures with a new guide system.

    Science.gov (United States)

    Poyanli, Oguz S; Soylemez, Salih; Ozkut, Afsar T; Uygur, Esat; Kemah, Bahattin; Unal, Omer K

    2015-11-01

    We assessed the accuracy of a new guide system that we developed to place lag screws in the proper position with the minimum number of attempts for operative treatment of trochanteric femoral fractures. A total of 55 consecutive trochanteric femoral fractures were treated with a cephalomedullary nail. The first 27 consecutive patients were treated with the standard operation (group A), while the new guide system was used in the last 28 consecutive patients (group B). The numbers of attempts to place K wires and the duration of surgery were noted. Accuracy of lag screw placement was evaluated by measuring the angle of deviation from the central axis of the femoral head. Deviation values ranged from -11̊ to +15̊ for the 27 cases in group A, with a median absolute deviation of 8̊±6̊. That in the 28 cases after the introduction of the new guide system (group B) ranged from -5̊ to +6̊, with a median absolute deviation of 0.5̊±3̊ (Pfractures. The present study indicated that this new guide system and nail facilitate accurate placement of lag screws in the appropriate position with the minimum number of attempts. Copyright © 2015 Elsevier Ltd. All rights reserved.

  20. Effective theories with broken flavour symmetry

    International Nuclear Information System (INIS)

    Miller, R.D.C.; McKellar, B.H.J.

    1981-07-01

    The work of Ovrut and Schnitzer on effective theories derived from a non Abelian Gauge Theory is generalised to include the physically interesting case of broken flavour symmetry. The calculations are performed at the 1-loop level. It is shown that at an intermediate stage in the calculations two distinct renormalised gauge coupling constants appear, one describing gauge field coupling to heavy particles and the other describing coupling to light particles. Appropriately modified Slavnov-Taylor identities are shown to hold. A simple alternative to the Ovrut-Schnitzer rules for calculating with effective theories is also considered

  1. Neutrino masses and spontaneously broken flavor symmetries

    International Nuclear Information System (INIS)

    Staudt, Christian

    2014-01-01

    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) R symmetry which explains the fermion mass hierarchies and, when amended with additional singlet fields, ameliorates the fine-tuning problem.

  2. Investigation of spontaneously broken gauge theories

    International Nuclear Information System (INIS)

    Nagy, T.

    1978-01-01

    Spontaneously broken gauge theories (SBGT) with effects treated perturbatively are investigated. The general structure of SBGT is exhibited and gauge invariant renormalization program for practical calculations is set up. The proof of renormalizability of Lee and Zinn-Justin are extended to the problems of SBGT. A general semisimple compact gauge group is used. Arbitrary fermion and scalar multiplets are considered. The structure of the Lagrangian is discussed. The problem of quantization is described and the definition of the generating functionals of the Green functions and the Green functions themselves is given

  3. Structure of pheomenological lagrangians for broken supersymmetry

    International Nuclear Information System (INIS)

    Uematsu, T.; Zachos, C.K.

    1982-01-01

    We consider the explicit connection between linear representations of supersymetry and the non-linear realizations associated with the generic effective lagrangians of the Volkov-Akulov type. We specify and illustrate a systematic approach for deriving the appropriate phenomenological lagrangian by transforming a pedagogical linear model, in which supersymmetry is broken at the tree level, into its corresponding non-linear lagrangian, in close analogy to the linear sigma model of pion dynamics. We discuss the significance and some properties of such phenomenological lagrangians. (orig.)

  4. Femoral revision with impaction allografting and an uncemented femoral component

    DEFF Research Database (Denmark)

    Nickelsen, T N; Erenbjerg, M; Retpen, J B

    2008-01-01

    A technique for uncemented revision of the femoral component which combines impaction allografting and the use of a long-stemmed proximally coated titanium prostheses (Bimetric, Biomet Inc.) is described. The results after a mean follow-up of 112 months are reported. From 1991 to 1995 femoral...... implants 88% had no pain, 10% had slight pain and only 2% had severe pain. Thirty-eight patients had radiographic signs of remodelling of the graft and/or cortical repair. In cases with a successful outcome, the results have been encouraging in relation to clinical performance, regeneration of bone...

  5. 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.

  6. Review of Proximal Nail Antirotation (PFNA and PFNA-2 – Our Local Experience

    Directory of Open Access Journals (Sweden)

    WL Loo

    2011-07-01

    Full Text Available The proximal femoral nail antirotation (PFNA device was recently introduced as an option for intramedullary management of pertrochanteric hip fractures. We report here local results with this relatively new implant. Sixty-two patients with pertrochanteric or subtrochanteric fractures underwent intramedullary fixation with PFNA devices in our centre during the 14 month period from September 2008 to October 2009. Data for this report were retrieved from clinical case records and operative notes. We recorded the age, gender, length of stay and operative time, preoperative ambulatory status and days required to regain mobility. Fractures were classified using the AO classification (A1, A2 and A3. Complications were also identified.There were 15 male and 47 female patients and the mean age was 74.3 years. The mean surgical duration was 76.1min and the average length of hospitalisation was 14.5 days. Five cases were noted to have femoral shaft fracture and no occurrences of screw cutout. We found that 83.9% of the patients were able to regain preoperative mobility status by 6 months following surgery. We conclude that the PFNA is an effective implant for stabilisation of proximal hip fractures and that the local complication rate is similar to reports from other centres.

  7. 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.

  8. The Hammer-and-Nail Phenomenon in Mathematics Education

    Science.gov (United States)

    Lim, Kien H.

    2012-01-01

    This paper uses the hammer-and-nail metaphor to highlight the rigidity and impulsiveness that can be found in student mathematical behaviour. The hammer-and-nail phenomenon can be attributed to two plausible causes: (1) the way the human mind works; and (2) the way mathematics is traditionally taught in school. In this paper, the following aspects…

  9. 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...

  10. 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

  11. Nail psoriasis masqueraded by secondary infection with Rhodotorula mucilaginosa.

    Science.gov (United States)

    Martini, K; Müller, H; Huemer, H P; Höpfl, R

    2013-11-01

    A 38-year-old man presented with whitish nail changes on all fingers as the sole symptom. The condition had developed within a few days and led to dystrophy of the proximal part of the nail plates. As microscopic examination of nail scrapings demonstrated budding hyphae and the patient working as a teacher reported frequent use of a wet sponge, antifungal therapy was initiated. Subsequent cultures and molecular typing identified Rhodotorula mucilaginosa (formerly R. rubra). This environmental yeast was repeatedly isolated despite of therapy with itraconazole. As no improvement was achieved and testing of the biological activity of the fungus revealed only marginal keratolytic activity, it was considered as a coloniser of a destructed nail matrix. Finally, a biopsy of the nail bed confirmed the diagnosis of nail psoriasis, which rapidly responded to treatment with acitretin and topical calcipotriol/betamethasone cream. Fungal growth in destructed nails masqueraded the underlying disease and may have triggered the psoriatic nail reaction. © 2013 Blackwell Verlag GmbH.

  12. Use of flexible facing for soil nail walls.

    Science.gov (United States)

    2011-11-01

    Soil nail walls are a widely used technology for retaining vertical and nearly vertical cuts in soil. A : significant portion of the cost of soil nail wall construction is related to the construction of a reinforced : concrete face. The potential for...

  13. 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.

  14. Nail lesions as a main manifestation of lichen nitidus

    Directory of Open Access Journals (Sweden)

    Michał Sobjanek

    2015-09-01

    Full Text Available Introduction . Lichen nitidus (LN is a rare, chronic, inflammatory dermatosis usually affecting children and young adults. Nails involvement is very rare. Until now, 7 cases of LN with nail involvement have been described. Objective. To present a rare case of childhood lichen nitidus where trachyonychia was the main manifestation of the disease. Case report. A 7-year-old, Caucasian, previously healthy boy presented thumbnail longitudinal ridges, distal splitting and subungual hyperkeratosis for 7 months. Numerous mycological and bacteriological examinations were negative. Dermatological examination also revealed erythematous lesions on the proximal nail fold as well as small skin-pigmented papules on the thumb. Similar papules grouped into patches were also observed on the upper limbs, trunk and forehead. Treatment was not recommended. Conclusions . Lichen nitidus may rarely affect nails and should be considered as a possible cause of nail lesions in childhood.

  15. Drug delivery into microneedle-porated nails from nanoparticle reservoirs.

    Science.gov (United States)

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

    2015-12-28

    This study demonstrates the potential of polymeric nanoparticles as drug reservoirs for sustained topical drug delivery into microneedle-treated human nail. Laser scanning confocal microscopy was used to image the delivery of a fluorescent model compound from nanoparticles into the nail. A label-free imaging technique, stimulated Raman scattering microscopy, was applied, in conjunction with two-photon fluorescence imaging, to probe the disposition of nanoparticles and an associated lipophilic 'active' in a microneedle-porated nail. The results provide clear evidence that the nanoparticles function as immobile reservoirs, sequestered on the nail surface and in the microneedle-generated pores, from which the active payload can be released and diffuse laterally into the nail over an extended period of time. Copyright © 2015 Elsevier B.V. All rights reserved.

  16. Fe distribution and speciation in human nails

    Energy Technology Data Exchange (ETDEWEB)

    Katsikini, M., E-mail: katsiki@auth.g [Aristotle University of Thessaloniki, School of Physics, 54124 Thessaloniki (Greece); Pinakidou, F.; Mavromati, E.; Paloura, E.C. [Aristotle University of Thessaloniki, School of Physics, 54124 Thessaloniki (Greece); Gioulekas, D. [Aristotle University of Thessaloniki, Medical School, 54124 Thessaloniki (Greece); Grolimund, D. [Swiss Light Source, Paul Scherer Institut, 5232 Villigen (Switzerland)

    2010-02-15

    Micro-X-ray Fluorescence (mu-XRF) and Fe-K edge micro-X-ray Absorption Near Edge Structure (mu-XANES) spectroscopies are applied for the study of the distribution and the spatially-resolved bonding environment of Fe in human nails. The mu-XRF maps reveal that Fe forms islands where its concentration is up to six times higher than in the rest of the sample. Comparison of the map characteristics of two nails that belong to healthy and ill donors (affected by lung cancer), reveals that there is no significant variation in the size distribution of the Fe-rich inclusions contrary to their spatial density which is found higher in the nail of the ill donor. However, a relation between the variations of the spatial density and the illness can not be established due to the small number of the studied samples. The analysis of the Fe-K mu-XANES spectra reveals that the bonding environment of Fe varies between the samples and between different spots of the same sample with different Fe concentration. The characteristics of the pre-edge peak in the Fe-K XANES spectra indicate the presence of both Fe{sup +3} and Fe{sup +2} that participate in the formation of distorted octahedra. Finally, the area under the pre-edge peak depends linearly on the position of the absorption edge indicating variation of the Fe ligation between the samples and/or between different spots in the same sample.

  17. Dosimetry during intramedullary nailing of the tibia.

    Science.gov (United States)

    Kirousis, George; Delis, Harry; Megas, Panagiotis; Lambiris, Elias; Panayiotakis, George

    2009-10-01

    Intramedullary nailing under fluoroscopic guidance is a common operation. We studied the intraoperative radiation dose received by both the patient and the personnel. 25 intramedullary nailing procedures of the tibia were studied. All patients suffered from tibial fractures and were treated using the Grosse-Kempf intramedullary nail, with free-hand technique for fixation of the distal screws, under fluoroscopic guidance. The exposure, at selected positions, was recorded using an ion chamber, while the dose area product (DAP) was measured with a DAP meter, attached to the tube head. Thermoluminescent dosimeters (TLDs) were used to derive the occupational dose to the personnel, and also to monitor the surface dose on the gonads of some of the patients. The mean operation time was 101 (48-240) min, with a mean fluoroscopic time of 72 seconds and a mean DAP value of 75 cGy x cm(2). The surface dose to the gonads of the patients was less than 8.8 mGy during any procedure, and thus cannot be considered to be a contraindication for the use of this technique. Occupational dose differed substantially between members of the operating personnel, the maximum dose recorded being to the operator of the fluoroscopic equipment (0.11 mSv). Our findings underscore the care required by the primary operator not to exceed the dose constraint of 10 mSv per year. The rest of the operating personnel, although they do not receive very high doses, should focus on the dose optimization of the technique.

  18. [Are nail polish, artificial nails and piercings allowed outside the surgical area?Recommendations for the perioperative policy

    NARCIS (Netherlands)

    Bucx, M.J.L.; Krijtenburg, P.; Scheffer, G.J.

    2017-01-01

    - An increasing number of patients wear nail polish, artificial nails or have piercings.- There is uncertainty about the perioperative management of these items, especially when located outside the surgical area.- In the majority of hospitals, patients are urged to remove these items preoperatively,

  19. Partial-limb salvage after persistent infection in the distal femoral prosthesis: straight-plasty - a novel technique

    International Nuclear Information System (INIS)

    Kundu, Z. S.; Gupta, V.; Gogna, P.

    2014-01-01

    A 35 years old female had giant cell tumour (GCT) of the distal femur for which wide resection and distal femoral endoprosthetic replacement was performed. Massive infection of prosthesis required removal and replacement of the prosthesis with nail antibiotic cement spacer, which also proved to be futile. Ultimately the whole of the infected thigh had to be excised. The limb could be preserved partially using straight-plasty instead of amputation. Patient is well rehabilitated and doing well at a follow-up of 3 years. (author)

  20. 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 provided with sonic internal structure realizing such a velocity- or force-friction dependence. For demonstration of a ratchet mechanism of this type, an experimental setup (gadget) that converts longitudinal oscillating or fluctuating motion into a unidirectional rotation has been built and experiments...... with it have been carried out. In this device, an asymmetry of friction dependence on an applied force appears, resulting in rectification of rotary motion, In experiments, our setup is observed to rotate only in one direction, which is in accordance with given theoretical arguments, Despite the setup being...

  1. Effective action of softly broken supersymmetric theories

    International Nuclear Information System (INIS)

    Groot Nibbelink, S.; Nyawelo, T.S

    2006-12-01

    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. (author)

  2. Spontaneously broken extended supersymmetry: Full superfield formulation

    International Nuclear Information System (INIS)

    Kandelakis, E.S.

    1984-01-01

    The superfield description, given by Samuel and Wess, of the non-linear Akulov-Volkov realization of (broken) supersymmetry, is generalized for the interesting cases of N=2 and 4 extended supersymmetry. The generalization, in terms of the full-superfield formulation, is straightforward. For the proof we first define the corresponding THETA-algebras; we then present explicitly many of the calculations. The schematic explanation makes the generalization manifest. We perform, for N=2, the coupling of the A-V field to standard-matter, in the way introduced by S-W, and schematically we make manifest the generalization for every N. The importance of our results consists in a complete, calculable description of the A-V fields (goldstinos) and of their interactions, easily applied to the tasks of today's phenomenology. (orig.) [de

  3. Broken superfluid in dense quark matter

    Energy Technology Data Exchange (ETDEWEB)

    Parganlija, Denis; Schmitt, Andreas [Institut fuer Theoretische Physik, Technische Universitaet Wien, 1040 Vienna (Austria); Alford, Mark [Department of Physics, Washington University St Louis, MO, 63130 (United States)

    2014-07-01

    Quark matter at high densities is a superfluid. Properties of the superfluid become highly non-trivial if the effects of strange-quark mass and the weak interactions are considered. These properties are relevant for a microscopic description of compact stars. We discuss the effect of a (small) explicitly symmetry-breaking term on the properties of a zero-temperature superfluid in a relativistic φ{sup 4} theory. If the U(1) symmetry is exact, chemical potential and superflow can be equivalently introduced either via (1) a background gauge field or (2) a topologically nontrivial mode. However, in the case of the explicitly broken symmetry, we demonstrate that the scenarios (1) and (2) lead to quantitatively different results for the mass of the pseudo-Goldstone mode and the critical velocity for superfluidity.

  4. Trace elements in nail polish as a source of contamination of nail clippings when used in epidemiological studies

    International Nuclear Information System (INIS)

    Favaro, P.C.; Bode, P.; De Nadai Fernandes, E.A.

    2005-01-01

    Trace elements were determined in 27 brands of nail polish using INAA so as to estimate the impact of nail polish remainders when using (finger, toe) nail clippings as a bioindicator for epidemiological studies. Fe was found to be present up to almost 1.7% in one brand. No unambiguous correlation between trace elements and color was established, though transparent polish has the lowest trace element concentrations. An estimate of the maximum effect (no removal of the paint) indicates that over-estimates of some trace element levels in nail with more than 200.000% may occur. If nail clippings will be used to study trace elements, very high demands have to be set to the efficiency and selectivity of the cleaning procedure. (author)

  5. 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.

  6. A comparison of locked versus nonlocked Enders rods for length unstable pediatric femoral shaft fractures.

    Science.gov (United States)

    Ellis, Henry Bone; Ho, Christine A; Podeszwa, David A; Wilson, Philip L

    2011-12-01

    Stainless steel flexible Enders rods have been used for intramedullary fixation of pediatric femur fractures with good success. Despite intraoperative anatomic alignment, length unstable femur fractures can present postoperatively with fracture shortening. The purpose of this study was to review all length unstable pediatric femoral shaft fractures in which Enders rods were used and compare those that were locked to those that were not locked. A retrospective clinical and radiographic review of all patients at a single institution undergoing flexible intramedullary fixation for length unstable femoral shaft fractures from 2001 to 2008. A length unstable fracture was defined as either a comminuted fracture or a spiral fracture longer than twice the diameter of the femoral shaft. A total of 107 length unstable femoral shaft fractures fixed with Enders rods were identified, of which 37 cases (35%) had both Enders rods "locked" through the eyelet in the distal femur with a 2.7 mm fully threaded cortical screw. Patient demographics, clinical course, complications, fracture characteristics, and radiographic outcomes were compared for the locked and nonlocked groups. There were no statistical differences between the groups in demographic data, operative variables, fracture pattern, fracture location, time to union, femoral alignment, or major complications. Shortening of the femur and nail migration measured at 1 to 6 weeks postoperatively was significantly greater for the nonlocked cases. The medial and lateral locked Enders rods moved 1.3 and 1.9 mm, respectively, and the unlocked Enders each moved 12.1 mm (P < 0.05). At final follow-up there were significantly more (P < 0.05) clinical complaints in nonlocked group, including limp, clinical shortening, and painful palpable rods. Locking Enders rods for length unstable pediatric fractures is an excellent option to prevent shortening and resulted in no additional complications, added surgical time, or increased blood loss

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

    DEFF Research Database (Denmark)

    Nielsen, Jacob

    nail-plates are designed for trusses. For many years, joints were made of boards with nails, but the increasing industrialism and the need for quick and usable assembly had the result that today nearly all trusses are pre-fabricated with nail-plates. The word "nail-plate" has been used for different...... 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...

  8. Logotherapy Counseling to Improve Acceptance of Broken Home Child

    OpenAIRE

    Erlangga, Erwin

    2017-01-01

    This study aims to increase the enrollment of children of a broken home that life has meaning. Subjects are 100 children in Demak whose families experiencing divorce. Research themes include three things: individual counseling, engineering logotherapy, reception, and a child of a broken home. Data obtained based on interviews, observation, and psychological scale showed that of the 100 children of a broken home has a low acceptance that individual counseling with logotherapy techniques were c...

  9. Finite Element Analysis of Absorbable Sheath to Prevent Stress Shielding of Tibial Interlocking Intramedullary Nail

    Science.gov (United States)

    Dong, Yansheng; Wang, Yongqing; Dong, Limin; Jia, Peng; Lu, Fengcheng

    2017-07-01

    The nail with absorbable sheath (AS nail) is designed to reduce the stress shielding effect of internal fixation with interlocking intramedullary nail. In order to verify its feasibility, two types of the finite element models of internal fixation of tibia with the AS nail and the common metal nail (CM nail) are established using the Softwares of Mimics, Geomagic, SolidWorks and ANSYS according to the CT scanning data of tibia. The result of the finite element analysis shows that the AS nail has great advantages compared with the CM nail in reducing the stress shielding effect in different periods of fracture healing. The conclusion is that the AS nail can realize the static fixation to the dynamic fixation from the early to the later automatically to shorten the time of fracture healing, which also provides a new technique to the interlocking intramedullary nail.

  10. Logotherapy Counseling to Improve Acceptance of Broken Home Child

    Directory of Open Access Journals (Sweden)

    Erwin Erlangga

    2017-08-01

    Full Text Available This study aims to increase the enrollment of children of a broken home that life has meaning. Subjects are 100 children in Demak whose families experiencing divorce. Research themes include three things: individual counseling, engineering logotherapy, reception, and a child of a broken home. Data obtained based on interviews, observation, and psychological scale showed that of the 100 children of a broken home has a low acceptance that individual counseling with logotherapy techniques were considered appropriate to increase the enrollment of children of a broken home. Factors - factors that affect the acceptance of a child of a broken home is self-blame, anger and did not have a purpose in life again. In addition the environment is also a significant effect on the enrollment of children of a broken home. Environmental labeling of families experiencing divorce as a family that failed so that children are increasingly stressed with the stamp of the community. Based on the field test results, the level of acceptance of the child of a broken home increases after the individual is given counseling services with logotherapy techniques. Indicated by changes in the level of acceptance of children of a broken home before being given treatment (initial evaluation and after (final evaluation of 130 points. The results of effectiveness test statistic t test calculations also showed 0,010 <0.05.It was concluded that counseling individuals with logotherapy effective technique to increase the enrollment of children of a broken home

  11. Model for predicting the frequency of broken rails

    Directory of Open Access Journals (Sweden)

    S. Vesković

    2012-04-01

    Full Text Available Broken rails can cause train delays, trains cancelations and, unfortunately, they are common causes of accidents. This affects planning of a resources, budget and organization of railway track maintenance. Planning of railway track maintenance cannot be done without an estimation of number of rails that will be replaced due to the broken rail incidents. There are many factors that influence broken rails and the most common are: rail age, annual gross tonnage, degree of curve and temperature in the time of breakage. The fuzzy logic model uses acquired data as input variables to predict the frequency of broken rails for the certain rail types on some Sections.

  12. A FUNCTIONAL EVALUATION STUDY OF DISTAL FEMORAL FRACTURES FIXED WITH DISTAL FEMORAL LOCKING PLATE

    Directory of Open Access Journals (Sweden)

    Manikumar C. J

    2017-04-01

    Full Text Available BACKGROUND Fractures of the distal femur present considerable challenges in management. Older patients especially women sustain fractures due to osteoporosis. Supracondylar fractures of femur have a bimodal distribution. They account for 6% of all femur fractures and 31% if hip fractures were excluded. Nearly, 50% of distal femur intra-articular fractures are open fractures. Before 1970, most supracondylar fractures were treated nonoperatively; however, difficulties were often encountered including persistent angulatory deformity, knee joint incongruity, loss of knee motion and delayed mobilisation. The trend of open reduction and internal fixation has become evident in recent years with good results being obtained with AO blade plate, dynamic condylar screw, intramedullary supracondylar nail and locking compression plate. Elderly patients and osteoporosis pose difficulty in treating intra-articular fractures of the lower end of femur. Loss of stable fixation is of great concern in these cases. Hence, locking compression plate use has an advantage in these patients. MATERIALS AND METHODS In this study, 20 patients with closed fracture of distal femur were studied. All the cases were treated at the Department of Orthopaedics, Rangaraya Medical College/Government General Hospital, Kakinada, Andhra Pradesh, between November 2013 and November 2015. The method used for fracture fixation was open reduction and internal fixation with distal femoral locking plate. The duration of follow up ranged from 3 months to 24 months. All the fractures in this series were posttraumatic. The patients were functionally evaluated with Neer’s scoring system. 1 RESULTS Twenty distal femoral fractures were treated with distal femoral locking plates. 15 patients were males and 5 patients were females. The median age was 47 years ranging from 28-70 years. 16 of the fractures were caused by road traffic accidents and 2 were due to fall, 2 were due to assault. 12 patients

  13. Cephalomedullary fixation for femoral neck/intertrochanteric and ipsilateral shaft fractures: surgical tips and pitfalls

    Directory of Open Access Journals (Sweden)

    Bali Kamal

    2013-02-01

    Full Text Available 【Abstract】Objective: Surgical management op-tions for femoral shaft fracture and ipsilateral proximal fe-mur fracture vary from single-implant to double-implant fixation. Cephalomedullary fixation in such fractures has rela-tive advantages over other techniques especially because of less soft tissue dissection and immediate postoperative weight bearing 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 of ipsilateral proximal femur and shaft fractures were treated by single-stage cephalomedullary fixa-tion 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 tech-nical challenges unique to each fracture pattern was kept for all the patients. Results: 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 frac-tures 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 frac-ture pattern for trauma surgeons. Cephalomedullary nail is an excellent implant for such fractures but it requires careful insertion to avoid complications. Surgery is technically de-manding with a definite learning curve. Nevertheless, a ma-jority of these

  14. 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

  15. 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.

  16. 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.

  17. Nail changes secondary to docetaxel chemotherapy : a case report

    Directory of Open Access Journals (Sweden)

    Ghafoor Qamar

    2008-01-01

    Full Text Available Abstract Introduction Docetaxel is a chemotherapy agent used in the management of many neoplastic conditions. Various side effects are known. Nail changes are often under-recognised or attributed to other causes. Case presentation We report the case of a 66 year old gentleman who received docetaxel chemotherapy for non-small cell lung cancer. He had nail changes as a complication of the treatment. Conclusion Nail toxicity is a recognised side-effect of taxane chemotherapy agents and can often persist for many months after finishing the treatment. We would like to highlight this problem, so it can be considered as a differential diagnosis in the appropriate population.

  18. High revision rate but good healing capacity of atypical femoral fractures. A comparison with common shaft fractures.

    Science.gov (United States)

    Schilcher, Jörg

    2015-12-01

    Healing of complete, atypical femoral fractures is thought to be impaired, but the evidence is weak and appears to be based on the delayed healing observed in patients with incomplete atypical fractures. Time until fracture healing is difficult to assess, therefore we compared the reoperation rates between women with complete atypical femoral fractures and common femoral shaft fractures. We searched the orthopaedic surgical registry in Östergötland County for patients with subtrochanteric and femoral shaft fractures (ICD-10 diagnosis codes S72.2, S72.3 and M84.3F) between January 1st 2007 and December 31st 2013. Out of 895 patients with surgically treated femoral shaft fractures, 511 were women 50 years of age or older. Among these we identified 24 women with atypical femoral shaft fractures, and 71 with common shaft fractures. Reoperations were performed in 6 and 5 patients, respectively, odds ratio 4.4 (95% CI 1.2 to 16.1). However, 5 reoperations in the atypical fracture group could not be ascribed to poor healing. In 3 patients the reoperation was due to a new fracture proximal to a standard intramedullary nail. In 2 patients the distal locking screws were removed due to callus formation that was deemed incomplete 5 months post-operatively. The one patient with poor healing showed faint callus formation at 5 months when the fracture was dynamised and callus remained sparse at 11 months. Among patients with common shaft fractures, 2 reoperations were performed to remove loose screws, 2 because of peri-implant fractures and 1 reoperation due to infection. Reoperation rates in patients with complete atypical femoral fractures are higher than in patients with common shaft fractures. The main reason for failure was peri-implant fragility fractures which might be prevented with the use of cephalomedullary nails at the index surgery. Fracture healing however, seems generally good. A watchful waiting approach is advocated in patients with fractures that appear to

  19. Broken symmetries and the Cabibbo angle

    International Nuclear Information System (INIS)

    Lanik, J.

    1975-04-01

    Under the assumption that the SU(3) symmetry is broken down by the strong and electromagnetic interactions, a phenomenological theory of the Cabibbo angle theta is proposed. In this theory the angle theta is fixed, linking together the Cabibbo rotation in the SU(3) space and complete SU(3) breaking consisting of both the SU(3) Hamiltonian and vacuum non-invariances. Assuming that the value of theta is zero in the soft-pion limit and that, in this limit, the only forces responsible for the isotopic symmetry breaking are the usual photonic forces it is shown that the usual electromagnetic interactions can contribute for the value of theta only through the non-vanishing vacuum expectation value of a certain scalar field. Within the framework of the (3,average3)+(3,average3) chiral symmetry-breaking model and through the use of the experimental value of the ratio GAMMA (K→μν)/GAMMA(π→μν), the presented Cabibbo angle theory predicts the value sintheta=0.25 which is in good agreement with experiment. (Lanik, J.)

  20. 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...

  1. Mammary and femoral hydatid cysts.

    Science.gov (United States)

    Shamim, Muhammad

    2010-08-01

    Hydatid cyst disease most commonly affects liver and lungs, but it can affect all viscera and soft tissues of the body. Simultaneous mammary and femoral hydatid cysts, without any other visceral involvement, are extremely rare. This is a case report of 25-years-old female, presenting with lump in left breast mimicking fibroadenoma and lump in right thigh mimicking fibroma. Both turned out to be hydatid cysts.

  2. Nailed timber beams with I composed section

    Directory of Open Access Journals (Sweden)

    Jorge Luís Nunes de Góes

    2003-01-01

    Full Text Available The employment of built-up timber beams, made of commercial dimensions pieces, is becoming increasingly important in timber structures in Brazil, mainly due to the ever-growing scarcity of timber elements in larger sizes. The built-up system has vast application, from beams for residential buildings to girders for small bridges. The objective of this work is the theoretical and experimental study of nailed timber beams with composed cross section I. The design procedure of EUROCODE 5/93 and NBR 7190/97 are shown and evaluated, as well as the theory about the subject matter. The experimental evaluation of the theoretical models was made by means of bending tests in prototypes of built-up timber beams. The obtained results shows that the EUROCODE 5/93 procedure is the most indicated for evaluating effective bending stiffness, normal and shear stresses as well as the load on fasteners.

  3. Biomechanics – Elastic Foundation Applied in Modelling of Calcaneal Nails

    Directory of Open Access Journals (Sweden)

    Sejda František

    2015-12-01

    Full Text Available This paper presents a strength analysis of a calcaneal nail (material Ti6Al4V and stainless steel which is used to treat complex heel fractures. The application focuses on a unique calcaneal nail, the C-NAIL, produced by Medin a.s. (Nové Město na Moravě, Czech Republic. The paper first presents an analysis of fracture types, treatment methods and loading of the calcaneus. It then presents an analysis of limit conditions and loading. Calculations (displacement and stress are performed for 6 and 7 fixing screws using FEM (Ansys Workbench 14 software. The calculation involves a new, original application of an elastic foundation, which effectively replaces the complex interaction of the calcaneal nail and the heel bone.

  4. 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.

  5. 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, Adolpho de Alencar; Pantaleão, Luciana

    2016-01-01

    We describe a fifty-six-year old, Afro-descendent female patient showing dystrophy of her twenty nails and hyperchromic, asymptomatic macule on her face. Histopathological examination of the macule showed vacuolization of the basal layer, melanophages in the superficial dermis and lymphoplasmocytic inflammatory infiltrate. Nail biopsy revealed orthokeratotic hyperkeratosis and lichenoid inflammatory infiltrate. Lichen planus pigmentosus is an uncommon variety of lichen planus. It is characterized by typical hyperpigmented macules on the face and neck. Nail changes might be present in 10% of lichen planus cases, but no associations with lichen planus pigmentosus have been described. We report a case of lichen planus in twenty nails associated with lichen planus pigmentosus on the patient's face.

  6. Nail Biting: Does It Cause Long-Term Damage?

    Science.gov (United States)

    ... June 13, 2017. Singal A, et al. Nail tic disorders: Manifestations, pathogenesis and management. Indian Journal of ... logo are trademarks of Mayo Foundation for Medical Education and Research. © 1998-2018 Mayo Foundation for Medical ...

  7. Common cutaneous dermatophyte infections of the skin and nails

    African Journals Online (AJOL)

    structures of the dermis, subcutaneous tissues, muscle and fascia ... African health-care providers and briefly describes the available treatment options, which may differ from ..... warts, dermatitis, psoriasis, lichen planus or nail dystrophy.23.

  8. A novel surgical method for total nail ablation: Use of triple flap technique

    Directory of Open Access Journals (Sweden)

    Berna Aksoy

    2017-11-01

    Full Text Available Total nail ablation for the treatment of onychodystrophies can be performed by using chemicals, surgical resection or laser ablation of nail matrix. A female patient with bilateral severe onychodystrophy as a result of inadvertent previous nail surgeries was treated surgically. Proximal complete nail matrix resection and distal 10 mm wide transverse strip partial nail bed resection were performed. A 5 mm wide transverse strip of nail bed was left intact proximally. Proximal nail matrix defect was closed by using the skin of proximal nail fold. The distal nail bed defect was reconstructed by using triple flap technique which was composed of a main central advancement flap containing ventral toe skin and two side flaps containing nail fold skin. The patient healed without any problem and her nail problem was treated successfully. The cosmetic appearance of her first toes was acceptable. Surgical nail ablation followed by volar skin coverage of dorsal surface of the distal phalanx bone by using triple flap technique is an effective surgical treatment method for the correction of advanced nail plate deformities requiring total nail ablation. 

  9. Confocal Raman spectrocopy for the analysis of nail polish evidence.

    Science.gov (United States)

    López-López, Maria; Vaz, Joana; García-Ruiz, Carmen

    2015-06-01

    Nail polishes are cosmetic paints that may be susceptible of forensic analysis offering useful information to assist in a crime reconstruction. Although the nail polish appearance could allow a quick visual identification of the sample, this analysis is subjected to the perception and subjective interpretation of the forensic examiner. The chemical analysis of the nail polishes offers great deal of information not subjected to analyst interpretation. Confocal Raman spectroscopy is a well-suited technique for the analysis of paints due to its non-invasive and non-destructive nature and its ability to supply information about the organic and inorganic components of the sample. In this work, 77 regular and gel nail polishes were analyzed with confocal Raman spectroscopy using two laser wavelengths (532 and 780 nm). The sample behavior under the two laser wavelengths and the differences in the spectra taken at different points of the sample were studied for each nail polish. Additionally, the spectra obtained for all the nail polishes were visually compared. The results concluded that the longer laser wavelength prevents sample burning and fluorescence effects; the similarity among the spectra collected within the sample is not directly related with the presence of glitter particles; and 64% of the samples analyzed showed a characteristic spectrum. Additionally, the use of confocal Raman spectroscopy for the forensic analysis of nail polishes evidence in the form of flakes or smudges on different surfaces were studied. The results showed that both types of evidence can be analyzed by the technique. Also, two non-invasive sampling methods for the collection of the evidence from the nails of the suspect or the victim were proposed: (i) to use acetone-soaked cotton swabs to remove the nail varnishes and (ii) to scrape the nail polish from the nail with a blade. Both approaches, each exhibiting advantages and drawbacks in terms of transport and handling were appropriate

  10. Preparation of hair and nail samples for trace element analysis

    International Nuclear Information System (INIS)

    Scoble, H.A.; Litman, R.

    1978-01-01

    The method of washing of human hair and nail samples is examined by neutron activation and γ-ray analysis. The amounts of Na, K, Br, Au, Zn, and La that are removed by successive washings determine the optimum number of washing for removing these trace elements as surface contaminants. A total solution contact time with the nails is 5 minutes, and leaching effcts are observed after 6 washings

  11. Modelling the strength of an aluminium-steel nailed joint

    Science.gov (United States)

    Goldspiegel, Fabien; Mocellin, Katia; Michel, Philippe

    2018-05-01

    For multi-material applications in automotive industry, a cast aluminium (upper layer) and dual-phase steel (lower layer) superposition joined with High-Speed Nailing process is investigated through an experimental vs numerical framework. Using FORGE® finite-element software, results from joining simulations have been inserted into models in charge of nailed-joint mechanical testings. Numerical Shear and Cross-tensile tests are compared to experimental ones to discuss discrepancy and possible improvements.

  12. Attic Retrofits Using Nail-Base Insulated Panels

    Energy Technology Data Exchange (ETDEWEB)

    Mallay, David [Home Innovation Research Labs; Kochkin, Vladimir [Home Innovation Research Labs

    2018-03-26

    This project developed and demonstrated a roof/attic energy retrofit solution using nail-base insulated panels for existing homes where traditional attic insulation approaches are not effective or feasible. Nail-base insulated panels (retrofit panels) consist of rigid foam insulation laminated to one face of a wood structural panel. The prefabricated panels are installed above the existing roof deck during a reroofing effort.

  13. 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.

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

    International Nuclear Information System (INIS)

    Pak, Daniel; Vineberg, Karen A.; Griffith, Kent A.; Sabolch, Aaron; Chugh, Rashmi; Ben-Josef, Edgar; Biermann, Janet Sybil; Feng, Mary

    2012-01-01

    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 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.

  15. A Morphological Insight of the Femoral Vein

    Directory of Open Access Journals (Sweden)

    Ferreira AH

    2015-10-01

    Full Text Available A total of 13 cadavers (12 men and 1 women of different age group were used for the study with the purpose to determine the prevalence of femoral vein duplication. Lower limb regions (26 sides were carefully dissected as per the standard dissection procedure. Femoral vein (unitruncular was found in 96.15% of specimen. Bitruncular configurations (total bifidity was found in a male cadaver of 75 years of age (3.85%. In the right lower limb, 6.5 cms below the inguinal ligament the femoral vein - lateral ramus received the lateral circumflex femoral vein, and the medial circumflex femoral vein, and the lateral and medial ramii formed a common venous trunk. Knowledge of the truncular venous variations is important to recognize and avoid potential errors in diagnosis of deep venous thrombosis of the femoral vein, in the case of an occluded duplicated trunk.

  16. Robotic technique improves entry point alignment for intramedullary nailing of femur fractures compared to the conventional technique: a cadaveric study.

    Science.gov (United States)

    Suero, Eduardo M; Westphal, Ralf; Citak, Musa; Hawi, Nael; Liodakis, Emmanouil; Krettek, Christian; Stuebig, Timo

    2017-08-11

    We aimed to test whether a robotic technique would offer more accurate access to the proximal femoral medullary cavity for insertion of an intramedullary nail compared to the conventional manual technique. The medullary cavity of ten femur specimens was accessed in a conventional fashion using fluoroscopic control. In ten additional femur specimens, ISO-C 3D scans were obtained and a computer program calculated the ideal location of the cavity opening based on the trajectory of the medullary canal. In both techniques, the surgeon opened the cavity using a drill and inserted a radiopaque tube that matched the diameter of the cavity. The mean difference in angle between the proximal opening and the medullary canal in the shaft of the femur was calculated for both groups. Robotic cavity opening was more accurate than the manual technique, with a mean difference in trajectory between the proximal opening and the shaft canal of 2.0° (95% CI 0.6°-3.5°) compared to a mean difference of 4.3° (95% CI 2.11°-6.48°) using the manual technique (P = 0.0218). The robotic technique was more accurate than the manual procedure for identifying the optimal location for opening the medullary canal for insertion of an intramedullary nail. Additional advantages may include a reduction in total radiation exposure, as only one ISO-C 3D scan is needed, as opposed to multiple radiographs when using the manual technique.

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

    Directory of Open Access Journals (Sweden)

    Eric Fernando de Souza

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

  18. Neurovascular Structures at Risk With Curved Retrograde TTC Fusion Nails.

    Science.gov (United States)

    de Cesar Netto, Cesar; Johannesmeyer, David; Cone, Brent; Araoye, Ibukunoluwa; Hudson, Parke William; Sahranavard, Bahman; Johnson, Michael; Shah, Ashish

    2017-10-01

    The purpose of this study was to assess the risk of iatrogenic injury to plantar neurovascular structures of the foot during insertion of a curved retrograde tibiotalocalcaneal (TTC) fusion nail. Ten below-knee thawed fresh-frozen cadaveric specimens underwent curved retrograde nailing of the ankle. The shortest distance between the nail and the main plantar neurovascular branches and injured structures were recorded during dissection. We also evaluated the relative position of these structures along 2 lines (AB, connecting the calcaneus to the first metatarsal, and BC, connecting the first and fifth metatarsal). The lateral plantar artery was found to be in direct contact with the nail 70% of the time, with a macroscopic laceration 30% of the time. The Baxter nerve was injured 20% of the time, as was the lateral plantar nerve. The medial plantar artery and nerve were never injured. The most proximal structure to cross line AB was the Baxter nerve followed by the lateral plantar artery, the nail, the lateral plantar nerve, and the medial plantar nerve. Our cadaveric anatomic study found that the most common structures at risk for iatrogenic injury by lateral curved retrograde TTC fusion nails were the lateral plantar artery and nerve, and the Baxter nerve. Determination of a true neurovascular safe zone is challenging and therefore warrants careful operative dissection to minimize neurovascular injuries.

  19. 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.

  20. [Are nail polish, artificial nails and piercings allowed outside the surgical area?Recommendations for the perioperative policy].

    Science.gov (United States)

    Bucx, M J L; Krijtenburg, P; Scheffer, G J

    2017-01-01

    - An increasing number of patients wear nail polish, artificial nails or have piercings.- There is uncertainty about the perioperative management of these items, especially when located outside the surgical area.- In the majority of hospitals, patients are urged to remove these items preoperatively, under the assumption that they might cause problems.- Frequently, however, these items cannot be removed straightforwardly.- Nail polish and artificial nails only very rarely cause perioperative problems and therefore do not need to be removed pre-operatively.- The same applies to most piercings, except when located in or near the respiratory tract, if they have sharp endings or if they might cause problems as a result of the perioperative positioning of the patient.- Providing adequate information to the patient, knowledge about removal of these items and documentation of agreed arrangements are all important.- A national guideline concerning perioperative policy is urgently required.

  1. Itching for nail fashion: chronic urticaria and chronic hand dermatitis secondary to acrylate and methacrylate allergy in gel nail varnish.

    Science.gov (United States)

    Dickison, P; Smith, S D

    2018-01-01

    Allergic contact dermatitis (ACD) secondary to acrylates and methacrylates is a well- described occurrence, particularly in those who wear or handle gel nail varnish. Management involves avoidance of the identified allergen. The cause of chronic urticaria (CI) is often not identified, and CU is not known to be associated with acrylates or methacrylates. We report a case of a 50-year-old woman who initially presented with hand dermatitis exacerbated by gel nail varnish on a background of CU. Avoiding all nail varnishes because of her ACD also resulted in improvement of her CU. To our knowledge, this is the first documented case of CU secondary to the acrylates and methacrylates found in nail cosmetics. © 2017 British Association of Dermatologists.

  2. Evaluation of perfusion of the femoral head after femoral neck fracture using bone scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Yamaguchi, Satoshi; Ishido, Yasuhiro [Saiseikai Sendai Hospital, Kagoshima (Japan); Okano, Toshihiro [Ibusuki National Hospital, Kagoshima (Japan); Komiya, Setsuro [Kagoshima Univ. (Japan). Faculty of Medicine

    2002-09-01

    We treated 13 patients for femoral neck fracture. They consisted of 2 males and 11 females, and were classified according to Garden stage classification; Stage I, 3 cases; Stage II, 2 cases; Stage III, 2 cases; Stage IV, 4 cases. Two trochanteric fracture cases were used by control. We evaluated perfusion of the femoral head after femoral neck fracture using bone scintigraphy, which is considered useful for evaluation of perfusion of the femoral neck before operation. (author)

  3. Evaluation of perfusion of the femoral head after femoral neck fracture using bone scintigraphy

    International Nuclear Information System (INIS)

    Yamaguchi, Satoshi; Ishido, Yasuhiro; Okano, Toshihiro; Komiya, Setsuro

    2002-01-01

    We treated 13 patients for femoral neck fracture. They consisted of 2 males and 11 females, and were classified according to Garden stage classification; Stage I, 3 cases; Stage II, 2 cases; Stage III, 2 cases; Stage IV, 4 cases. Two trochanteric fracture cases were used by control. We evaluated perfusion of the femoral head after femoral neck fracture using bone scintigraphy, which is considered useful for evaluation of perfusion of the femoral neck before operation. (author)

  4. An investigation into UV-curable gel formulations for topical nail medicines

    OpenAIRE

    Kerai, L. V.

    2016-01-01

    UV gels are nail cosmetics which are applied on the nail plate surface and polymerised by placing the nail under a UVA nail lamp. The polymeric film formed can reside on the nail plate for up to 3 weeks without developing any visible defects. Using such a formulation as a drug carrier for the treatment of nail diseases, e.g. fungal infections, could address current issues with topical formulations, such as the failure to maintain a drug depot at the desired site and the need for frequent appl...

  5. [A favourable outcome in yellow nail syndrome: role of respiratory physiotherapy].

    Science.gov (United States)

    Fournier, C; Just, N; Leroy, S; Wallaert, B

    2003-12-01

    The yellow nail syndrome is a rare condition that is easily diagnosed but the nail manifestations are poorly understood. A 51 year old patient presented with a chronic cough. The diagnosis was based on the typical appearance of the nails. The patient had bilateral basal bronchiectasis. Daily physiotherapy with bronchial drainage lead to a progressive improvement in the respiratory symptoms without recourse to antibiotics. Surprisingly the abnormalities of the nails disappeared after 2 years treatment. This observation illustrates the possibility of spontaneous resolution of severe nail abnormalities during the course of the yellow nail syndrome.

  6. Broken ergodicity in two-dimensional homogeneous magnetohydrodynamic turbulence

    International Nuclear Information System (INIS)

    Shebalin, John V.

    2010-01-01

    Two-dimensional (2D) homogeneous magnetohydrodynamic (MHD) turbulence has many of the same qualitative features as three-dimensional (3D) homogeneous MHD turbulence. These features include several ideal (i.e., nondissipative) invariants along with the phenomenon of broken ergodicity (defined as nonergodic behavior over a very long time). 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 3D MHD turbulence that is manifest in the lowest wavenumbers was found. Here, we study the origin of broken ergodicity in 2D MHD turbulence. It will be seen that broken ergodicity in ideal 2D 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. The origins of broken ergodicity in an ideal 2D homogeneous MHD turbulence are found through an eigenanalysis of the covariance matrices of the probability density function and by an examination of the associated entropy functional. When the values of ideal invariants are kept fixed and grid size increases, it will be shown that the energy in a few large modes remains constant, while the energy in any other mode is inversely proportional to grid size. Also, as grid size increases, we find that broken ergodicity becomes manifest at more and more wavenumbers.

  7. Do PFNA devices and Intertan nails both have the same effects in the treatment of trochanteric fractures? A prospective clinical study.

    Science.gov (United States)

    Seyhan, Mustafa; Turkmen, Ismail; Unay, Koray; Ozkut, Afsar Timucin

    2015-11-01

    To clinically and radiologically compare third-generation intramedullary nails used in the treatment of trochanteric hip fractures and to determine their efficacy. Seventy-five of 88 patients admitted to our hospital with trochanteric fractures were enrolled in the study; 43 were treated with PFNA devices and 32 with Intertan nails. The amount of compression applied during the procedure, duration of the procedure, amount of subsequent shortening in the proximal femoral area, subsequent backup of proximal screws, and changes in the tip-apex and tip-cortex distances were compared between groups. The postoperative change in the varus angle of the proximal femur and times to mobilization, full weight bearing, and fracture union were also evaluated. On early postoperative radiographs, the tip-apex distance was ≤25 mm in 86 % of patients in the PFNA group and 96.9 % of those in the Intertan group. Twelve months postoperatively, the tip-apex distance did not differ between groups. No cut-out of the screws into the coxofemoral joint was observed. Fracture healing was achieved in all patients. At 12 months postoperatively, the rates of proximal screw backup, proximal femoral shortening, and decrease in the varus angle of the proximal femur were significantly higher in the PFNA group than in the Intertan group. Trochanteric fractures may be treated effectively with PFNA devices or Intertan nails. During the healing period, the rates of reverse displacement of the proximal screw, shortening of the proximal femur, and decrease in the varus angle of the proximal femur were significantly higher in the PFNA group than in the Intertan group. Surgical technique, implant positioning, and the choice of implant play roles in the successful treatment of trochanteric fractures. Level 1, prospective, prognostic study.

  8. Evaluation of the Legibility of Broken Lines for Partial Sight

    OpenAIRE

    小林, 秀之

    2000-01-01

    The present study was designed to investigate the legibility of broken lines for persons with partial sight. The subjects were 10 persons with simulated partial sight, and 4 persons with partial sight. The simulation was obtained using filters and convex lenses. The 30 kind of broken lines was evaluated by the original test that the subjects were read directions of the broken lines in distinction from solid lines. The thickness of lines varied from 0.1mm. to 0.7mm. in 4 steps. The results...

  9. The nail as an investigative tool in medicine: What a dermatologist ought to know

    Directory of Open Access Journals (Sweden)

    Chander Grover

    2017-01-01

    Full Text Available The nail is an important skin appendage, but not many dermatologists are aware of the importance it receives outside our specialty. This article focuses on the nail in non-dermatological contexts. The nail is a keratinized matrix capable of continuous growth with the ability to incorporate various compounds within its structure. Therefore it can be used to monitor long-term consumption of drugs. It is also an excellent source of germ-line DNA for genetic analyses. With an increased undrstanding of nail physiology, there is now a better understanding of its connection to various pathologies as well. Nails, being peripherally placed, are easy to sample without significant discomfort to the patient, making them a valuable diagnostic tool. For this narrative review, we carried out a PubMed search using the key words “nail clipping,” “nail DNA,” “nail diabetes mellitus;” “nail clipping oncology,” and “nail forensics”. Retrieved articles were searched for information pertaining to non-dermatologic uses of nail for evaluation, which is presented in a narrative fashion. It is clear from recent literature that the nail is not just an inert skin appendage, but a dynamic window into the ever-changing metabolic and genetic milieu. We highlight the numerous roles of nail specimens, as well as point towards future research needed therein.

  10. Long versus short cephalomedullary nail for trochanteric femur fractures (OTA 31-A1, A2 and A3): a systematic review.

    Science.gov (United States)

    Dunn, John; Kusnezov, Nicholas; Bader, Julia; Waterman, Brian R; Orr, Justin; Belmont, Philip J

    2016-12-01

    Both long and short cephalomedullary nails (CMN) may be used to treat trochanteric femur fractures. The objective of this paper was to compare the clinical outcomes between long and short CMN in the treatment of trochanteric hip fractures. A literature search was performed, identifying 135 papers; 4 of which met inclusion and exclusion criteria. Papers included were those that compared cohorts of long and short nails for stable trochanteric femur fractures of level III evidence or superior. Data was pooled and analyzed, focusing on reoperation rate, secondary femoral shaft fracture rate, estimated blood loss, transfusion rate, operative time and length of stay. Included in the analysis were 1276 patients, with 438 short and 838 long CMN. The average age was 82.0 years for short CMN and 79.0 years for long CMN (P = 0.0002). The average follow up was 18 months, 46 % were male, and 71 % had an ASA (American Society of Anesthesiologists score) classification ≥3. The rate of reoperation was 5.0 % and 3.8 % for short and long CMN, respectively (P = 0.31). The rate of refracture was 1.6 % and 0.95 % for short and long CMN, respectively (P = 0.41). As compared to long nails, short nails had an average blood loss of 39 mL less (P = 0.0003), an 8.8 % decrease in transfusion rate (P = 0.07), and incurred 19 min less operative time (P trochanteric femur fractures, short CMN have a low reoperation rate while significantly decreasing operative time and estimated blood loss with the additional benefit of being cost effective. Level 3.

  11. Superconducting cosmic strings in models with spontaneously broken family symmetry

    International Nuclear Information System (INIS)

    Bibilashvili, T.M.; Dvali, G.R.

    1990-01-01

    It is shown that superconducting cosmic strings with some specific properties naturally exist in models of spontaneously broken family symmetry. Superconductivity may be of both types - bosonic and fermionic. There exists a possible mechanism of string conservation. (orig.)

  12. 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

  13. Broken homes, parental psychiatric illness, and female delinquency.

    Science.gov (United States)

    Offord, David R; Abrams, Nola; Allen, Nancy; Poushinsky, Mary

    1979-04-01

    Fifty-nine families with delinquent daughters were compared with 59 families, matched on socioeconomic class, with daughters of the same age who were not delinquent. The frequency of broken homes was found to be the strongest distinguishing factor between probands and controls. Parental disabilities appeared to play a part in the incidence of delinquency among girls, particularly when the disabilities result in a broken home.

  14. Characterization and Preparation of Broken Rice Proteins Modified by Proteases

    Directory of Open Access Journals (Sweden)

    Lixia Hou

    2010-01-01

    Full Text Available Broken rice is an underutilized by-product of milling. Proteins prepared from broken rice by treatments with alkaline protease and papain have been characterized with regard to nutritional and functional properties. The protein content and the protein recovery were 56.45 and 75.45 % for alkaline protease treatment, and 65.45 and 46.32 % for papain treatment, respectively. Protease treatment increased the lysine and valine content, leading to a more balanced amino acid profile. Broken rice proteins had high emulsifying capacity, 58.3–71.6 % at neutral pH, and adequate water holding capacity, ranging from 1.96 to 2.93 g/g of proteins. At pH=7.0, the broken rice protein had the highest water holding capacity and the best interfacial activities (emulsifying capacity, emulsifying stability, foaming capacity and foaming stability, which may be the result of the higher solubility at pH=7.0. The interfacial activities increased with the increase in the mass fraction of broken rice proteins. The proteins prepared by the papain treatment had higher water holding capacity (p>0.05, emulsifying capacity (p0.05 than alkaline protease treatment at the same pH or mass fraction. To test the fortification of food products with broken rice proteins, pork sausages containing the proteins were prepared. Higher yield of the sausages was obtained with the increased content of broken rice proteins, in the range of 2.0–9.0 %. The results indicate that broken rice proteins have potential to be used as the protein fortification ingredient for food products.

  15. 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.

  16. Dose--effect relationships for femoral fractures after multimodality limb-sparing therapy of soft-tissue sarcomas of the proximal lower extremity.

    Science.gov (United States)

    Pak, Daniel; Vineberg, Karen A; Griffith, Kent A; Sabolch, Aaron; Chugh, Rashmi; Ben-Josef, Edgar; Biermann, Janet Sybil; Feng, Mary

    2012-07-15

    We investigated the clinical and dosimetric predictors for radiation-associated femoral fractures in patients with proximal lower extremity soft tissue sarcomas (STS). 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(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. 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 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. 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. Copyright © 2012 Elsevier Inc. All rights reserved.

  17. Sensory factors affecting female consumers' acceptability of nail polish.

    Science.gov (United States)

    Sun, C; Koppel, K; Adhikari, K

    2015-12-01

    The objectives of this study were to determine what sensory factors impact consumers' acceptability of nail polishes, to explore how these sensory factors impact consumers' acceptability of nail polishes, to investigate whether there are any consumer segments according to their overall acceptability on different nail polishes and to scrutinize how the consumer segments are related to the sensory factors. Ninety-eight females participated in a nail polish consumer study at Kansas State University. Eight commercial products belonging to four categories - regular (REG), gel (GEL), flake (FLK) and water-based (WAT) - were evaluated. Each nail polish sample was evaluated twice by each participant in two different tasks - a task devoted to applying and evaluating the product and a task devoted to observing the appearance and evaluating the product. Pearson's correlation analysis, analysis of variance (ANOVA), external preference mapping, cluster analysis and internal preference mapping were applied for data analysis. Participants' scores of overall liking of the nail polishes were similar in the application task and in the observation task. In general, participants liked the REG and GEL product samples more than the FLK and WAT samples. Among all the sensory attributes, appearance attributes were the major factors that affected participants' overall liking. Aroma seemed to be a minor factor to participants' overall liking. Some sensory attributes, such as runny, shininess, opacity, spreadability, smoothness, coverage and wet appearance, were found to drive participants' overall acceptability positively, whereas others such as pinhole, fatty-edges, blister, brushlines, pearl-like, flake-protrusion, glittery and initial-drag impacted participants' overall acceptability negatively. Four clusters of participants were identified according to their overall liking scores from both the application task and the observation task. Participants' acceptability, based on different

  18. Isolated nail lichen planus with primary sclerosing cholangitis in a child

    International Nuclear Information System (INIS)

    Al-Ajroush, N.; Al-Khenaizan, S.

    2007-01-01

    Lichen planus (LP) is an uncommon, inflammatory dermatosis with characteristic lesions affecting the skin, nails and the mucous membranes. It is rare in childhood. Although nail abnormalities have been reported in 1-10% of patients with LP, the prevalence of nail involvement in affected children is unknown. Here we report a 2-year-old child with isolated nail LP, in association with primary sclerosing cholangitis. (author)

  19. Elastoplasticity analysis of the nails used in long bone fractures

    International Nuclear Information System (INIS)

    Paterson, R; Paterson, A; Miralles, M T; Del Sel, G; Del Sel, N

    2011-01-01

    Elastoplastic endomedullary nail-insertion system in long bone fractures is a method which allows generating forces, moments, frictions and stress states in parts of the bone previously selected. Adding previous knowledge on the distribution of forces and acting moments over the bone fragments to be threaded, as well as on the elastoplastic and mechanical properties of the nails to be inserted (designing a special, specific structure for each case), the results, coming from 26 years of applying this technique, have been promising. It is from this perspective that we call this threading and anchoring procedure 'Selective Tension System' (STS). Physicochemical analyses and mechanical trials on elastoplastic nails used in the osteosynthesis in long bone fractures are presented. The magnitude of the forces produced by flattening the nails and the reacting forces at both ends are measured. It is expected that the evidence provided on the elastic variability of these nails will be useful as guidance on the availability and choice of the elastoplastic combinations that best fit each patient.

  20. Yellow nail syndrome – report of a rare disorder | Ikuabe | Highland ...

    African Journals Online (AJOL)

    Background: The Yellow Nail Syndrome (YNS) is a rare disorder of unknown cause characterized by the trail of yellow and thickened nails, lymphoedema and respiratory manifestation. We have no record of any case report of yellow nail syndrome in our setting. Methods: We reviewed the records of an 80 year old woman ...

  1. 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.

  2. An outbreak of contact dermatitis from toluenesulfonamide formaldehyde resin in a nail hardener

    NARCIS (Netherlands)

    de Wit, F. S.; de Groot, A. C.; Weyland, J. W.; Bos, J. D.

    1988-01-01

    8 cases of contact dermatitis from toluenesulfonamide formaldehyde resin in a nail hardener are presented. Most patients had used nail lacquers containing this resin for many years without trouble, but became sensitized to the resin shortly after the introduction of this particular nail hardener. A

  3. Nail involvement in patients with moderate-to-severe alopecia areata treated with oral tofacitinib.

    Science.gov (United States)

    Lee, Ji Su; Huh, Chang-Hun; Kwon, Ohsang; Yoon, Hyun-Sun; Cho, Soyun; Park, Hyun-Sun

    2018-05-07

    A few anecdotal case reports demonstrated that tofacitinib improved nail changes associated with AA. To investigate nail changes in patients with AA treated with tofacitinib and evaluate the relationship between nail and hair responses to tofacitinib. This is a retrospective study of 33 adult patients with moderate-to-severe AA treated with oral tofacitinib monotherapy for at least 4 months. Fifteen patients had nail involvement and demonstrated more severe hair loss than those without nail involvement (p = .040). However, there was no significant difference in hair regrowth between two groups. Of 15 patients with nail involvement, 11 (73.3%) showed improvement regardless of type of nail change; the first improvement was observed at a median of 5 months (range, 1-11) after administration. Nail improvement was associated with neither initial severity of hair loss nor hair response to tofacitinib. Nail improvement tended to occur later than hair regrowth. Oral tofacitinib monotherapy improves nail involvement associated with AA. Nail involvement is not a poor prognosis factor in hair regrowth with tofacitinib treatment and there is no evident relationship between nail and hair responses.

  4. Creep behavior of soil nail walls in high plasticity index (PI) soils : technical report.

    Science.gov (United States)

    2017-04-01

    An aspect of particular concern in the Geotechnical Engineering Circular No. 7: Soil Nail Walls (i.e., the soil : nail wall manual and construction guidelines) is the creep behavior of soil nail systems in high-plasticity : clays. This research proje...

  5. Treatment of neglected femoral neck fracture

    Directory of Open Access Journals (Sweden)

    Anil K Jain

    2015-01-01

    Full Text Available Intra-capsular femoral neck fractures are seen commonly in elderly people following a low energy trauma. Femoral neck fracture has a devastating effect on the blood supply of the femoral head, which is directly proportional to the severity of trauma and displacement of the fracture. Various authors have described a wide array of options for treatment of neglected/nonunion (NU femoral neck fracture. There is lack of consensus in general, regarding the best option. This Instructional course article is an analysis of available treatment options used for neglected femoral neck fracture in the literature and attempt to suggest treatment guides for neglected femoral neck fracture. We conducted the "Pubmed" search with the keywords "NU femoral neck fracture and/or neglected femoral neck fracture, muscle-pedicle bone graft in femoral neck fracture, fibular graft in femoral neck fracture and valgus osteotomy in femoral neck fracture." A total of 203 print articles were obtained as the search result. Thirty three articles were included in the analysis and were categorized into four subgroups based on treatment options. (a treated by muscle-pedicle bone grafting (MPBG, (b closed/open reduction internal fixation and fibular grafting (c open reduction and internal fixation with valgus osteotomy, (d miscellaneous procedures. The data was pooled from all groups for mean neglect, the type of study (prospective or retrospective, classification used, procedure performed, mean followup available, outcome, complications, and reoperation if any. The outcome of neglected femoral neck fracture depends on the duration of neglect, as the changes occurring in the fracture area and fracture fragments decides the need and type of biological stimulus required for fracture union. In stage I and stage II (Sandhu′s staging neglected femoral neck fracture osteosynthesis with open reduction and bone grafting with MPBG or Valgus Osteotomy achieves fracture union in almost 90

  6. 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.

  7. 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.

  8. Total knee arthroplasty using patient-specific blocks after prior femoral fracture without hardware removal

    Directory of Open Access Journals (Sweden)

    Raju Vaishya

    2018-01-01

    Full Text Available Background: The options to perform total knee arthroplasty (TKA with retained hardware in femur are mainly – removal of hardware, use of extramedullary guide, or computer-assisted surgery. Patient-specific blocks (PSBs have been introduced with many potential advantages, but their use in retained hardware has not been adequately explored. The purpose of the present study was to outline and assess the usefulness of the PSBs in performing TKA in patients with retained femoral hardware. Materials and Materials and Methods: Nine patients with retained femoral hardware underwent TKA using PSBs. All the surgeries were performed by the same surgeon using same implants. Nine cases (7 males and 2 females out of total of 120 primary TKA had retained hardware. The average age of the patients was 60.55 years. The retained hardware were 6 patients with nails, 2 with plates and one patient had screws. Out of the nine cases, only one patient needed removal of a screw which was hindering placement of pin for the PSB. Results: All the patients had significant improvement in their Knee Society Score (KSS which improved from 47.0 to postoperative KSS of 86.77 (P < 0.00. The mechanical axis was significantly improved (P < 0.03 after surgery. No patient required blood transfusion and the average tourniquet time was 41 min. Conclusion: TKA using PSBs is useful and can be used in patients with retained hardware with good functional and radiological outcome.

  9. Subchondral insufficiency fractures of the femoral head

    Energy Technology Data Exchange (ETDEWEB)

    Davies, M.; Cassar-Pullicino, V.N. [Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic and District Hospital, Oswestry, SY10 7AG, Shropshire (United Kingdom); Darby, A.J. [Department of Pathology, Robert Jones and Agnes Hunt Orthopaedic and District Hospital, Oswestry, SY10 7AG, Shropshire (United Kingdom)

    2004-02-01

    The aim of this study was to increase awareness of, and to show the variable clinical and radiological features of, subchondral insufficiency fractures of the femoral head. The clinical and radiological findings in 7 patients with subchondral insufficiency fractures of the femoral head were reviewed retrospectively. The diagnosis was confirmed histologically in 4 patients. Radiographs were performed in all patients, MRI in 5 and scintigraphy in 4 patients. Radiographs showed varying degrees of femoral head collapse in 4 patients. In the remaining 3 patients radiographs showed a normal femoral head, regional osteoporosis and focal sclerosis, respectively. Magnetic resonance imaging showed a low-signal band on T1- and T2-weighted images in the subchondral bone adjacent or parallel to the articular surface associated with bone marrow oedema. Scintigraphy showed increased uptake in the femoral head. Insufficiency fractures of the femoral head are easily overlooked or confused with avascular necrosis and, when there is significant joint destruction, osteoarthritis. Unsuspected insufficiency fracture of the femoral head can lead to significant and rapid loss of bone stock in osteoporotic patients waiting for arthroplasty for osteoarthritis. Increased awareness of this condition will hopefully lead to earlier diagnosis and a successful outcome of conservative treatment. (orig.)

  10. 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.

  11. Retrospective dosimetry of nail by Electron Paramagnetic Resonance

    International Nuclear Information System (INIS)

    Giannoni, Ricardo A.; Rodrigues Junior, Orlando

    2015-01-01

    The purpose of this study is to characterize samples of human nails, subjected to irradiation of high doses through Technical Electron Paramagnetic Resonance (EPR). The goal is to establish a dose/response relationship in order to assess dose levels absorbed by individuals exposed in radiation accidents situations, retrospectively. Samples of human nails were irradiated with gamma radiation, and received a dose of 20 Gy. EPR measurements performed on samples before irradiation identified EPR signals associated with defects caused by the mechanical action of the sample collection. After irradiation other species of free radicals, associated with the action of gamma radiation, have been identified

  12. Proton-neutron correlations in a broken-pair model

    International Nuclear Information System (INIS)

    Akkermans, J.N.L.

    1981-01-01

    In this thesis nuclear-structure calculations are reported which were performed with the broken-pair model. The model which is developed, is an extension of existing broken-pair models in so far that it includes both proton and neutron valence pairs. The relevant formalisms are presented. In contrast to the number-non-conserving model, a proton-neutron broken-pair model is well suited to study the correlations which are produced by the proton-neutron interaction. It is shown that the proton-neutron force has large matrix elements which mix the proton- with neutron broken-pair configurations. This occurs especially for Jsup(PI)=2 + and 3 - pairs. This property of the proton-neutron force is used to improve the spectra of single-closed shell nuclei, where particle-hole excitations of the closed shell are a special case of broken-pair configurations. Using Kr and Te isotopes it is demonstrated that the proton-neutron force gives rise to correlated pair structures, which remain remarkably constant with varying nucleon numbers. (Auth.)

  13. Broken-Rotor-Bar Diagnosis for Induction Motors

    International Nuclear Information System (INIS)

    Wang Jinjiang; Gao, Robert X; Yan Ruqiang

    2011-01-01

    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. Frequency of ipsilateral femoral neck fractures in patients with ...

    African Journals Online (AJOL)

    Background: Ipsilateral associated femoral neck and shaft fractures are reported to occur in 2.5-6% of all femoral shaft fractures. Objective: To establish the frequency of ipsilateral femoral neck fractures amongst all patients presenting with femoral shaft fractures in Mulago Hospital. Methodology: This was a descriptive ...

  15. Neutrino mixing: from the broken μ-τ symmetry to the broken Friedberg–Lee symmetry

    International Nuclear Information System (INIS)

    Xing, Zhizhong

    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 μ-τ permutation symmetry serves for such an example to interpret the almost maximal atmospheric neutrino mixing angle (θ 23 ~ 45°) and the strongly suppressed CHOOZ neutrino mixing angle (θ 13 < 10°). 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 θ 13 in the CP-conserving case: sinθ 13 = tanθ 12 |(1 - tanθ 23 )/(1 + tanθ 23 )|. 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. (author)

  16. 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

  17. A Longitudianl Study of the Link Between Broken Homes and Criminality.

    Science.gov (United States)

    McCord, Joan

    Possible explanatory theories of the relationship between broken homes and crime include the following: (1) broken homes lead to crimes if there are "catalytic agents"; (2) broken homes lead to crime if these homes fail to provide certain conditions which promote socialization; and (3) broken homes and crime have a common source, but not…

  18. Management of broken instrument by file bypass technique

    Directory of Open Access Journals (Sweden)

    Sultana Parveen

    2017-02-01

    Full Text Available Different devices and techniques have been developed to retrieve fractured instruments during the endodontic procedures. This case report describes the management of a broken instrument, which was accidentally broken during cleaning and shaping of the root canal in right 2nd molar tooth. A # 25 stainless steel K-file was separated in mesiobuccal canal of the treated tooth. At first, a radiograph was taken to confirm the level of separation of the instrument. The instrument was found to be separated at the apical 3rd of the mesial canal and then file bypass technique was performed. Calcium hydroxide dressing was given for 7 days followed by obturation with guttapercha cone and zinc oxide eugenol sealer in lateral condensation technique. It can be concluded that bypass technique can be considered as simple and effective technique for the management of broken instrument into the root canal.

  19. 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.

  20. 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....

  1. Herniography off femoral, obturator and perineal hernias

    International Nuclear Information System (INIS)

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

    1985-01-01

    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. (orig.) [de

  2. SEX DETERMINATION FROM FEMORAL HEAD DIAMETERS IN ...

    African Journals Online (AJOL)

    hi-tech

    2000-03-01

    Mar 1, 2000 ... In medico-legal cases where sophisticated methods of sex determination is lacking, these ... scientific methods(3). Using the visual method ... between the sexes and the values of the right and left femoral head diameters.

  3. 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.

  4. Broken Stone Marker Construction%碎石桩施工

    Institute of Scientific and Technical Information of China (English)

    高瑞娥

    2009-01-01

    随着我国高速公路建设的加快,在高速公路的路基设计和施工中引入并使用碎石桩处理软土地基. 文章就结合碎石桩处理软土地基,浅谈碎石桩的施工过程和检测方法.%This paper unifies the broken stone marker processing soft soil ground, discusses the broken stone marker shallowly the construction pro-cess and the examination method.

  5. Skeletal traction and intramedullary nailing cost-effectiveness

    African Journals Online (AJOL)

    In the operative group 24 patients had union with one delayed union while in the traction group 12 patients had union, 9 with mal union and 4 delayed union. Conclusion: Intramedullary nailing is more cost-effective than skeletal traction. It met the dominant strategy, because it was significantly less costly than skeletal ...

  6. Scientific Letter: Stabbing nails into the neck: an unusual self ...

    African Journals Online (AJOL)

    Scientific Letter: Stabbing nails into the neck: an unusual self-damaging behavior mandating neurosurgery. A Aghabiklooei, R Aghabiklooei, N Zamani. Abstract. Scientific Letter - No Abstract Available. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT.

  7. Self-inflicted transparietal intraventricular nail: case report and ...

    African Journals Online (AJOL)

    Background Deliberate self-harm with stone- or hammer-driven nail through the cranium is unusual. The need is stressed for comprehensive radiological evaluation with computed tomography (CT) scan, with or without angiography, and removal through an open cranial procedure under general anaesthesia, rather than ...

  8. Magnetic Resonance of the Normal and Pathologic Nail

    International Nuclear Information System (INIS)

    Toro, Nancy; Delgado, Jorge Andres; Rascovsky Simon; Sanz Alexander; Castrillon, Juan Gabriel

    2008-01-01

    In this article normal nail anatomy is compared with the anatomy visualized in MRI; we share the experience of the Instituto de Alta Tecnologia Medica de Antioquia (IATM ) in this small but promising, area such as is the use of MRI in dermatology.

  9. 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.

  10. Outcome of surgical implant generation network nail initiative in ...

    African Journals Online (AJOL)

    in Uganda, was propagated in to Kenya mainly in resource poor hospitals, and has changed long bone fractures' management and outcomes. The goal of this study was to describe applicability of the SIGN initiative in fracture care in a Kenyan hospital. AbstrAct. Background: Closed interlocked intra-medullary nailing (IM), ...

  11. Tibiotalocalcaneal arthrodesis with a curved, interlocking, intramedullary nail.

    Science.gov (United States)

    Budnar, Vijaya M; Hepple, Steve; Harries, William G; Livingstone, James A; Winson, Ian

    2010-12-01

    Tibiotalocalcaneal fusion with a straight rod has a risk of damaging the lateral plantar neurovascular structures and may interfere with maintaining normal heel valgus position.We report the results of a prospective study of tibiotalocalcaneal (TTC) arthrodesis with a short, anatomically curved interlocking, intramedullary nail. Forty-five arthrodesis in 42 patients, performed between Jan 2003 and Oct 2008, were prospectively followed. The mean followup was 48 (range, 10 to 74) months. The main indications for the procedure were failed ankle arthrodesis with progressive subtalar arthritis, failed ankle arthroplasty and complex hindfoot deformity. The outcome was measured by a combination of pre and postoperative clinical examination, AOFAS hindfoot scores, SF-12 scores and radiological assessment. Union rate was 89% (40/45). Eighty-two percent (37/45) reported improvement in pain and 73% (33/45) had improved foot function. Satisfactory hindfoot alignment was achieved in 84% (38/45). Postoperatively there was a mean improvement in the AOFAS score of 37. Complications included a below knee amputation for persistent deep infection, five nonunions, and three delayed unions. Four nails, six proximal and six distal locking screws were removed for various causes. Other complications included two perioperative fractures, four superficial wound infections and one case of lateral plantar nerve irritation. With a short, anatomically curved intramedullary nail, we had a high rate of tibiotalocalcaneal fusion with minimal plantar neurovascular complications. We believe a short, curved intramedullary nail, with its more lateral entry point, helped maintain hindfoot alignment.

  12. Nonunions of the distal tibia treated by reamed intramedullary nailing

    NARCIS (Netherlands)

    Richmond, Jeffrey; Colleran, Kevin; Borens, Olivier; Kloen, Peter; Helfet, David L.

    2004-01-01

    The purpose of this study is to determine the efficacy of reamed intramedullary nailing in the treatment of nonunions of the distal one-fourth of the tibia. Nonunions of the distal tibia are particularly difficult to treat given the short distal segment, the proximity to the ankle joint, and the

  13. Bilateral femoral neck fractures following pelvic irradiation

    International Nuclear Information System (INIS)

    Mitsuda, Kenji; Nishi, Hosei; Oba, Hiroshi

    1977-01-01

    Over 300 cases of femoral neck fractures following radiotherapy for intrapelvic malignant tumor have been reported in various countries since Baensch reported this disease in 1927. In Japan, 40 cases or so have been reported, and cases of bilateral femoral neck fractures have not reached to ten cases. The authors experienced a case of 75 year-old female who received radiotherapy for cancer of the uterus, and suffered from right femoral neck fracture 3 months after and left femoral neck fracture one year and half after. As clinical symptoms, she had not previous history of trauma in bilateral femurs, but she complained of a pain in a hip joint and of gait disturbance. The pain in left femoral neck continued for about one month before fracture was recognized with roentgenogram. As histopathological findings, increase of fat marrow, decrease of bone trabeculae, and its marked degeneration were recognized. Proliferation of some blood vessels was found out, but thickness of the internal membrane and thrombogenesis were not recognized. Treatment should be performed according to degree of displacement of fractures. In this case, artificial joint replacement surgery was performed to the side of fracture of this time, because this case was bilateral femoral neck fractures and the patient had received artificial head replacement surgery in the other side of fracture formerly. (Tsunoda, M.)

  14. Use of the Gamma3™ nail in a teaching hospital for trochanteric fractures: mechanical complications, functional outcomes, and quality of life.

    Science.gov (United States)

    Buecking, Benjamin; Bliemel, Christopher; Struewer, Johannes; Eschbach, Daphne; Ruchholtz, Steffen; Müller, Thorben

    2012-11-23

    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. 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. 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 fracture levels during the follow-up period of 12 months. The results showed a relatively low complication rate using the Gamma3™ nail, even if the nailing was performed

  15. 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.

  16. Assessing indoor air quality in New York City nail salons.

    Science.gov (United States)

    Pavilonis, Brian; Roelofs, Cora; Blair, Carly

    2018-05-01

    Nail salons are an important business and employment sector for recent immigrants offering popular services to a diverse range of customers across the United States. However, due to the nature of nail products and services, salon air can be burdened with a mix of low levels of hazardous airborne contaminants. Surveys of nail technicians have commonly found increased work-related symptoms, such as headaches and respiratory irritation, that are consistent with indoor air quality problems. In an effort to improve indoor air quality in nail salons, the state of New York recently promulgated regulations to require increased outdoor air and "source capture" of contaminants. Existing indoor air quality in New York State salons is unknown. In advance of the full implementation of the rules by 2021, we sought to establish reliable and usable baseline indoor air quality metrics to determine the feasibility and effectiveness of the requirement. In this pilot study, we measured total volatile organic compounds (TVOC) and carbon dioxide (CO 2 ) concentrations in 10 nail salons located in New York City to assess temporal and spatial trends. Within salon contaminant variation was generally minimal, indicating a well-mixed room and similar general exposure despite the task being performed. TVOC and CO 2 concentrations were strongly positively correlated (ρ = 0.81; p air quality for the purposes of compliance with the standard. An almost tenfold increase in TVOC concentration was observed when the American National Standards Institute/American Society of Heating, Refrigerating and Air-Conditioning Engineers (ANSI/ASHRAE) target CO 2 concentration of 850 ppm was exceeded compared to when this target was met.

  17. PREVALENCE OF NAIL BITINGAMONG PRESCHOOL CHILDREN IN BITOLA

    Directory of Open Access Journals (Sweden)

    Dominika RAJCHANOVSKA

    2011-04-01

    Full Text Available Nail biting may have a significant role in the development of some anomalies and harmful effects upon the oral-facial system.Objective: The objective of the study was to determine the prevalence of nail biting among preschool children in Bitola.Methods: Through an observational, intersection (cross-sectional study, 890 children who came to medical checkups during the period from January to December 2009 were included. The following methods were applied: psychological testing (Test of Chuturikj, pediatric examination, interview with parents and the questionnaire: Child Behaviour Checklist-Achenbach, 1981.Results: The study included 890 children, 401 of which were at the age of three, 489 were at the age of five, 51.6% of them were males and 48.4% females. The level of prevalence of nail biting was 22.02%. The statistical analysis showed that the habit is more insignificant (p>0.05 in children at the age of 5 and among the male gender. The tested difference in the frequency of nail biting among children from the cities or villages was not statistically significant (p>0.05. Children who do not have their own room more often manifest this habit statistically insignificantly (p>0.05.Depending on the number of members and children in the family, the tested differences were statistically significant (p0.05. Children whose parents have a high education level significantly less bite their nails (p<0.01. Increased presence of this habit is found among respondents in families with average incomes, with p=0.004. Conclusion: Dentists and pediatricians should work together on prevention, early diagnosis and treatment of this habit, in order to achieve an impact over dental development.

  18. How evolution of the nailing system improves results and reduces orthopedic complications: more than 2000 cases of trochanteric fractures treated with the Gamma Nail System.

    Science.gov (United States)

    Pascarella, R; Fantasia, R; Maresca, A; Bettuzzi, C; Amendola, L; Violini, S; Cuoghi, F; Sangiovanni, P; Cerbasi, S; Boriani, S; Tigani, D S

    2016-04-01

    The incidence of trochanteric fractures has increased significantly during the last few decades, especially in elderly patients with osteoporosis. The dynamic/sliding hip screw and the cephalomedullary nail are the most commonly used fixation methods to treat trochanteric fractures. The improvements in the Gamma Nail System (GNS) associated with a correct surgical technique reduced the postoperative orthopedic complications. The purpose of this study was to compare the results of the different Gamma Nails. The present study is a retrospective analysis of 2144 patients treated with GNS between January 1997 and December 2011 for trochanteric fractures, classified according to AO classification method. The patients were divided into three groups according to the nailing system: 525 were treated with Standard Gamma Nail (SGN), 422 with Trochanteric Gamma Nail (TGN) and 1197 with Gamma3 Nail. The overall incidence of intra-operative complications was 1.21 %; the incidence of intra-operative complications for each group was 1.71 % for SGN group, 0.47 % for TGN group and 1.25 % for Gamma3 Nail group. The overall incidence of postoperative complications was 5.48 %, and the incidence for each group was 10.73 % for SGN group, 9.92 % for TGN group and 2.92 % for Gamma3 Nail group. The GNS is a safe device with a low rate of intra-operative complications. The evolution of this nail system reduces postoperative complications, thus improving the results at follow-up and confirming that the Gamma3 Nail is a safe and predictable device to fix trochanteric fracture.

  19. Children and Broken Homes: Sources for the Teacher.

    Science.gov (United States)

    Bentley, Eloise

    The depreciating attitude toward family life in our society has intensified in the past few years. It is not unusual to find substantial numbers of children in a first grade classroom who live in broken homes. Divorce is the answer for more young couples than ever before, and as a result the children involved must face growing up with a parent…

  20. Unbroken versus broken mirror world: a tale of two vacua

    International Nuclear Information System (INIS)

    Foot, R.; Lew, H.; Volkas, R.R.

    2000-01-01

    If the Lagrangian of nature respects parity invariance then there are two distinct possibilities: either parity is unbroken by the vacuum or it is spontaneously broken. We examine the two simplest phenomenologically consistent gauge models which have unbroken and spontaneously broken parity symmetries, respectively. These two models have a Lagrangian of the same form, but a different parameter range is chosen in the Higgs potential. They both predict the existence of dark matter and can explain the MACHO events. However, the models predict quite different neutrino physics. Although both have light mirror (effectively sterile) neutrinos, the ordinary-mirror neutrino mixing angles are unobservably tiny in the broken parity case. The minimal broken parity model therefore cannot simultaneously explain the solar, atmospheric and LSND data. By contrast, the unbroken parity version can explain all of the neutrino anomalies. Furthermore, we argue that the unbroken case provides the most natural explanation of the neutrino physics anomalies (irrespective of whether evidence from the LSND experiment is included) because of its characteristic maximal mixing prediction. (author)

  1. Enticing arsonists with broken windows and social disorder

    Science.gov (United States)

    Douglas S. Thomas; David T. Butry; Jeffrey P. Prestemon

    2011-01-01

    In criminology, it is well understood that indicators of urban decay, such as abandoned buildings littered with broken windows, provide criminals with signals identifying neighborhoods with lower crime detection and apprehension rates than better maintained neighborhoods. Whether it is the resident population’s sense of apathy, lack of civic pride, or fear of...

  2. Review of "Spend Smart: Fix Our Broken School Funding System"

    Science.gov (United States)

    Baker, Bruce

    2011-01-01

    ConnCAN's Spend Smart: "Fix Our Broken School Funding System" was released concurrently with a bill introduced in the Connecticut legislature, based on the principles outlined in the report. However, the report is of negligible value to the policy debate over Connecticut school finance because it provides little or no support for any of…

  3. Light hadrons in the bag model with broken chiral symmetry

    International Nuclear Information System (INIS)

    Efrosinin, V.P.; Zaikin, D.A.

    1987-01-01

    A version of the bag model with broken chiral symmetry is proposed. A satisfactory description of the experimental data on light hadrons including the pion is obtained. The estimate of the pion-nucleon σ term is given in the framework of this model. The pion and kaon decay constants are calculated. The centre-of-mass motion problem in bag models is discussed

  4. INFLUENCE OF BROKEN ROTOR BARS LOCATION IN THE ...

    African Journals Online (AJOL)

    2013-06-30

    Jun 30, 2013 ... single-phase induction motor by general method coupling field and circuit equations. IEEE. Trans Magnetics 31(3): 1908-1911. [6] Zouzou S. E., Khelif S., Halem N., Sahraoui M, 2011. Analysis of induction motor with broken rotor bars using circuit-field coupled method. International conference on electric.

  5. Mass splittings within composite Goldstone supermultiplets from broken supersymmetry

    International Nuclear Information System (INIS)

    Clark, T.E.; Love, S.T.

    1985-01-01

    The supersymmetric (SUSY) Dashen formulas are modified to include effects of softly broken supersymmetry and are used to compute the mass splittings and differences in decay constants among the various components of a Goldstone supermultiplet. The general results are applied to chiral-symmetry breaking in two-flavor SUSY QCD

  6. Broken Heart Syndrome – An intra operative complication

    Directory of Open Access Journals (Sweden)

    Zara Wani

    2018-03-01

    Full Text Available We report a case of Broken Heart Syndrome in a 56 year old Postmenopausal woman suffered while undergoing simple biopsy procedure for vocal cord polyp that lead to physical, mental and financial burden both for the patient as well as the doctors. A team of cardiologists based on clinical and echocardiographic findings made the diagnosis of this case.

  7. Does the Angle of the Nail Matter for Pertrochanteric Fracture Reduction? Matching Nail Angle and Native Neck-Shaft Angle.

    Science.gov (United States)

    Parry, Joshua A; Barrett, Ian; Schoch, Bradley; Yuan, Brandon; Cass, Joseph; Cross, William

    2018-04-01

    To determine whether fixation of pertrochanteric hip fractures with cephalomedullary nails (CMNs) with a neck-shaft angle (NSA) less than the native NSA affects reduction and lag screw cutout. Retrospective comparative study. Level I trauma center. Patients treated with a CMN for unstable pertrochanteric femur fractures (OTA/AO 31-A2.2 and 31-A2.3) between 2005 and 2014. CMN fixation. NSA reduction and lag screw cutout. Patients fixed with a nail angle less than their native NSA were less likely to have good reductions [17% vs. 60%, 95% confidence interval (CI), -63% to -18%; P = 0.0005], secondary to more varus reductions (41% vs. 10%, 95% CI, 9%-46%; P = 0.01) and more fractures with ≥4 mm of displacement (63% vs. 35%, 95% CI, 3%-49%; P = 0.03). The cutout was not associated with the use of a nail angle less than the native NSA (60% vs. 76%, 95% CI, -56% to 18%; P = 0.5), varus reductions (60% vs. 32%, 95% CI, -13% to 62%; P = 0.3), or poor reductions (20% vs. 17%, 95% CI, -24% to 44%; P = 1.0). The fixation of unstable pertrochanteric hip fractures with a nail angle less than the native NSA was associated with more varus reductions and fracture displacement but did not affect the lag screw cutout. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

  8. Comparative Study Using Intramedullary K-wire Fixation Over Titanium Elastic Nail in Paediatric Shaft Femur Fractures.

    Science.gov (United States)

    Kumar, Sanjiv; Anand, Tushar; Singh, Sudhir

    2014-11-01

    Fracture shaft femur is common paediatric trauma leading to significant morbidity. Conservative treatments available are associated with prolonged periods of immobilization. Use of flexible intramedullary implant allows early rehabilitation in diaphyseal fractures of femur in children. The aim of the present study is to compare fixation of diaphyseal femur fracture by titanium elastic nail and intramedullary K-wires in children. Prospective randomized study in a tertiary care hospital. Fifty-two children between 6 years and 14 years of age with femoral shaft fracture were assigned either in Group I or Group II based on computer generated random numbers. In Group I closed percutaneous intramedullary K- wire fixation and in Group II closed percutaneous intramedullary titanium elastic nail was used to fix the fractures. Partial weight bearing was allowed after 6 weeks of surgery and full weight bearing at clinico-radiological union. Average time of radiological union was 6 to 10 weeks in both groups. In both the groups two cases had entry site irritation which resolved with early implant removal. One case in both the groups had unacceptable mal-alignment. Both the groups had few cases of limb-length discrepancy, which was in acceptable limit, except two cases of TENS. There was no statistically significant difference between the results of both the groups. But, using K-wires significantly reduced the cost of treatment. Most of such fractures in our society are neglected because of high cost of treatment. Providing a cheaper alternative in form of K-wires may be beneficial for the patients from low socio-economic status.

  9. Establishing a protocol for element determination in human nail clippings by neutron activation analysis

    International Nuclear Information System (INIS)

    Sanches, Thalita Pinheiro; Saiki, Mitiko

    2011-01-01

    Human nail samples have been analyzed to evaluate occupational exposure, nutritional status and to diagnose certain diseases. However, sampling and washing protocols for nail analyses vary from study to study not allowing comparisons between studies. One of the difficulties in analyzing nail samples is to eliminate only surface contamination without removing elements of interest in this tissue. In the present study, a protocol was defined in order to obtain reliable results of element concentrations in human nail clippings. Nail clippings collected from all 10 fingers or toes were previously pre cleaned using an ethyl alcohol solution to eliminate microbes. Then, the clippings were cut in small pieces and submitted to different reagents for washing by shaking. Neutron activation analysis (NAA) was applied for nail samples analysis which consisted of irradiating aliquots of samples together with synthetic elemental standards in the IEA-R1 nuclear research reactor followed by gamma ray spectrometry. Comparisons made between the results obtained for nails submitted to different reagents for cleaning indicated that the procedure using acetone and Triton X100 solution is more effective than that of nitric acid solution. Analyses in triplicates of a nail sample indicated results with relative standard deviations lower than 15% for most of elements, showing the homogeneity of the prepared sample. Qualitative analyses of different nail polishes showed that the presence of elements determined in the present study is negligible in these products. Quality control of the analytical results indicated that the applied NAA procedure is adequate for human nail analysis. (author)

  10. Nail unit in collagen vascular diseases: A clinical, histopathological and direct immunofluorescence study

    Directory of Open Access Journals (Sweden)

    Nabil P

    2006-01-01

    Full Text Available Background: Abnormalities of the nail unit are common in patients with connective tissue diseases. Clinical examination of the nail unit, coupled with biopsy of proximal nail fold offers an additional advantage in the diagnosis. Purpose: Our aim was to record clinical changes of the nail unit in connective tissue diseases and to study the histopathological (both H and E and periodic acid Schiff and direct immunofluorescence (DIF findings of nail-fold biopsy. Materials and Methods: Thirty-eight confirmed cases connective tissue diseases attending skin OPD were enrolled in the study. After detailed clinical examination of the nail unit, a crescentric biopsy was taken from the proximal nail fold (PNF. Histopathological and DIF studies were was carried out. Findings: Nail changes could be demonstrated in 65% connective tissue diseases. Specific histopathological (H and E and immunofluorescence findings were also encountered in many patients. Conclusion: Clinical examination of the nail unit offers additional clue in the diagnosis of connective tissue diseases. Though DIF of PNF biopsy is useful in the diagnosis, it is not an ideal site for H and E study, as the yield is very low. Limitations: Lack of adequate comparison group and non-utilization of capillary microscopy for the detection of nail fold capillary abnormalities.

  11. (Meth)Acrylate Occupational Contact Dermatitis in Nail Salon Workers: A Case Series.

    Science.gov (United States)

    DeKoven, Samuel; DeKoven, Joel; Holness, D Linn

    Recently, many cases of acrylate-associated allergic contact dermatitis have appeared among nail salon workers. Common acrylate-containing products in nail salons include traditional nail polish, ultraviolet-cured shellac nail polish, ultraviolet-cured gel nails, and press-on acrylic nails. Nail salon technicians seen in the occupational medicine clinic in 2015 and 2016 were identified, and their patch test results and clinical features were summarized. Patch testing was done with the Chemotechnique (Meth)Acrylate nail series, and either the North American Standard series or the North American Contact Dermatitis Group screening series. Six patients were identified, all women, ages 38 to 58. Common presentations included erythematous dermatitis of the dorsa of the hands, palms, and forearms and fissures on the fingertips. Less common sites of eruptions included the periorbital region, cheeks, posterior ears, neck, sacral area, lateral thighs, and dorsa of the feet. All patients reacted to hydroxyethyl methacrylate, and 5 patients reacted to ethyl acrylate. Each patient also reacted to (meth)acrylates that are not found on either standard series, including ethyleneglycol dimethacrylate, 2-hydroxypropyl methacrylate, and 2-hydroxyethyl acrylate. The authors report 6 cases of allergic contact dermatitis to acrylates in nail technicians seen over the past year, representing a new trend in their clinic. These cases are reflective of a growing trend of nail technicians with allergic contact dermatitis associated with occupational (meth)acrylate exposure. Efforts to improve prevention are needed.

  12. [Intramedullary nailing of the distal tibia illustrated with the Expert(TM) tibia nail].

    Science.gov (United States)

    El Attal, R; Hansen, M; Rosenberger, R; Smekal, V; Rommens, P M; Blauth, M

    2011-12-01

    Restoration of axis, length, and rotation of the lower leg. Sufficient primary stability of the osteosynthesis for functional aftercare and to maintain joint mobility. Good bony healing in closed and open fractures. Closed and open fractures of the tibia and complete lower leg fractures distal to the isthmus (AO 42), extraarticular fractures of the distal tibia (AO 43 A1/A2/A3), segmental fractures of the tibia with a fracture in the distal tibia, and certain intraarticular fractures of the distal tibia without impression of the joint line with the use of additional implants (AO 43 C1) Patient in reduced general condition (e.g., bed ridden), flexion of the knee of less than 90°, patients with knee arthroplasty of the affected leg, infection in the area of the nail's insertion, infection of the tibial cavity, complex articular fractures of the proximal or distal tibia with joint depression. Closed reduction of the fracture preferably on a fracture table or using a distractor or an external fixation frame. If necessary, use pointed reduction clamps or sterile drapery. In some cases, additional implants like percutaneous small fragment screws, poller screws or k-wires are helpful. Open reduction is rarely necessary and must be avoided. Opening of the proximal tibia in line with the medullary canal. Canulated insertion of the Expert(TM) tibia nail (ETN; Synthes GmbH, Oberdorf, Switzerland) with reaming of the medullary canal. Control of axis, length, and rotation. Distal interlocking with the radiolucent drill and proximal interlocking with the targeting device. Immediate mobilization of ankle and knee joint. Mobilization with 20 kg weight-bearing with crutches. X-ray control 6 weeks postoperatively and increased weight-bearing depending on the fracture status. In cases with simple fractures, good bony contact, or transverse fracture pattern, full weight-bearing at the end of week 6 is targeted. Between July 2004 and May 2005, 180 patients were included in a

  13. Femoral component rotation in patellofemoral joint replacement.

    Science.gov (United States)

    van Jonbergen, Hans-Peter W; Westerbeek, Robin E

    2018-06-01

    Clinical outcomes in patellofemoral joint replacement may be related to femoral component rotation. Assessment of rotational alignment is however difficult as patients with isolated patellofemoral osteoarthritis often have trochlear dysplasia. The use of the medial malleolus as a landmark to guide rotation has been suggested. The purpose of our study was to evaluate this technique with regard to femoral component rotation, and to correlate rotation with clinical outcomes at one-year follow-up. Forty-one knees in 39 patients had patellofemoral joint replacement using the Zimmer Gender-Solutions patellofemoral prosthesis. Intraoperatively, we determined femoral component rotational alignment using an extramedullary rod aimed at the inferior tip of the medial malleolus. Postoperatively, we measured the angle between the femoral component and the anatomical transepicondylar axis using CT. The amount of rotation was correlated with clinical outcomes at one-year follow-up. Forty knees in 38 patients were available for one-year follow-up. Mean femoral component rotation relative to the anatomical transepicondylar axis was 1.4° external rotation (range, -3.8 to 5.7°). We found no statistically significant correlation between femoral component rotation and change from baseline KOOS subscales at one-year follow-up. Our findings show that when using the medial malleolus as a landmark to guide rotation, the femoral component of the patellofemoral prosthesis was oriented in external rotation relative to the anatomical transepicondylar axis in 80% of knees. Our study did not show a relation between the amount of external rotation and clinical outcomes. Level III. Copyright © 2018 Elsevier B.V. All rights reserved.

  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...... femora at five degree intervals from 10° external rotation to 10° internal rotation. Using freely available software, a-LDFA measurements were made using two different a-PFA by a single observer on one occasion. Results: Mean a-LDFA was significantly greater at 10° external rotation than at any other...... rotation. The response of individual femora to rotation was unpredictable, although fairly stable within ±5° of zero rotation. Mean a-LDFA for the two a-PFA methods differed by 1.5°, but were otherwise similarly affected by femoral rotation. Clinical significance: If zero femoral elevation can be achieved...

  15. Clinical Outcomes after Open Locked Intramedullary Nailing of ...

    African Journals Online (AJOL)

    2018-02-07

    Feb 7, 2018 ... above who presented within 2 weeks of sustaining closed femoral shaft fractures ... tweak, and build upon the work non-commercially, as long as the author is ... was compressed, and proximal locking screws were then.

  16. Clinical Outcomes after Open Locked Intramedullary Nailing of ...

    African Journals Online (AJOL)

    2017-12-05

    Dec 5, 2017 ... Femoral Shaft Fractures for Adult Patients in a Nigerian Hospital .... posttreatment to assess for progression of healing. .... the most active and mobile members of the society and .... Prehospital management of lower limb.

  17. 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

  18. [Treatment of trochanteric fractures of the femoral bone].

    Science.gov (United States)

    Wierer, I; Pospísil, M; Holubár, J; Volf, V

    1994-01-01

    The authors present the evaluation of some most often methods of treatment of trochanteric fractures of femur. They analyze the group of 235 patients in the years 1987 - 1991 treated for fractures by the McLaughlin technique and by Ender nailing. The first method was performed on 121 people and the technique of Ender nailing on 97 people. The results and complications of these methods of osteosynthesis are presented in the paper. The experiences of the authors confirm the advantage of Ender nailing in treating fractures of the oldest injured patients. The Ender nailing method of osteosynthesis is the more advantageous, because the operation takes less time and is easier for patients. After Ender nailing, the possibility of functional rehabilitation and walking on crutches is greater. McLaughlin osteosynthesis of these fractures proved the more advantageous in younger injured patients.

  19. Comparison of femoral morphology and bone mineral density between femoral neck fractures and trochanteric fractures.

    Science.gov (United States)

    Maeda, Yuki; Sugano, Nobuhiko; Saito, Masanobu; Yonenobu, Kazuo

    2011-03-01

    Many studies that analyzed bone mineral density (BMD) and skeletal factors of hip fractures were based on uncalibrated radiographs or dual-energy xray absorptiometry (DXA). Spatial accuracy in measuring BMD and morphologic features of the femur with DXA is limited. This study investigated differences in BMD and morphologic features of the femur between two types of hip fractures using quantitative computed tomography (QCT). Forty patients with hip fractures with normal contralateral hips were selected for this study between 2003 and 2007 (trochanteric fracture, n=18; femoral neck fracture, n=22). Each patient underwent QCT of the bilateral femora using a calibration phantom. Using images of the intact contralateral femur, BMD measurements were made at the point of minimum femoral-neck cross-sectional area, middle of the intertrochanteric region, and center of the femoral head. QCT images also were used to measure morphologic features of the hip, including hip axis length, femoral neck axis length, neck-shaft angle, neck width, head offset, anteversion of the femoral neck, and cortical index at the femoral isthmus. No significant differences were found in trabecular BMD between groups in those three regions. Patients with trochanteric fractures showed a smaller neck shaft angle and smaller cortical index at the femoral canal isthmus compared with patients with femoral neck fractures. We conclude that severe osteoporosis with thinner cortical bone of the femoral diaphysis is seen more often in patients with trochanteric fracture than in patients with femoral neck fracture. Level IV, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

  20. Correlation of ultrasound appearance, gross anatomy, and histology of the femoral nerve at the femoral triangle.

    Science.gov (United States)

    Lonchena, Tiffany K; McFadden, Kathryn; Orebaugh, Steven L

    2016-01-01

    Correlation between ultrasound appearance, gross anatomic characteristics, and histologic structure of the femoral nerve (FN) is lacking. Utilizing cadavers, we sought to characterize the anatomy of the FN, and provide a quantitative measure of its branching. We hypothesize that at the femoral crease, the FN exists as a group of nerve branches, rather than a single nerve structure, and secondarily, that this transition into many branches is apparent on ultrasonography. Nineteen preserved cadavers were investigated. Ultrasonography was sufficient to evaluate the femoral nerve in nine specimens; gross dissection was utilized in all 19. Anatomic characteristics were recorded, including distances from the inguinal ligament to femoral crease, first nerve branch, and complete arborization of the nerve. The nerves from nine specimens were excised for histologic analysis. On ultrasound, the nerve became more flattened, widened, and less discrete as it coursed distally. Branching of the nerve was apparent in 12 of 18 images, with mean distance from inguinal ligament of 3.9 (1.0) cm. However, upon dissection, major branching of the femoral nerve occurred at 3.1 (1.0) cm distal to the inguinal ligament, well proximal to the femoral crease. Histologic analysis was consistent with findings at dissection. The femoral nerve arborizes into multiple branches between the inguinal ligament and the femoral crease. Initial branching is often high in the femoral triangle. As hypothesized, the FN exists as a closely associated group of nerve branches at the level of the femoral crease; however, the termination of the nerve into multiple branches is not consistently apparent on ultrasonography.

  1. 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.

  2. Reconstruction of large diaphyseal bone defect by simplified bone transport over nail technique: A 7-case series.

    Science.gov (United States)

    Ferchaud, F; Rony, L; Ducellier, F; Cronier, P; Steiger, V; Hubert, L

    2017-11-01

    Reconstruction of large diaphyseal bone defect is complex and the complications rate is high. This study aimed to assess a simplified technique of segmental bone transport by monorail external fixator over an intramedullary nail.A prospective study included 7 patients: 2 femoral and 5 tibial defects. Mean age was 31years (range: 16-61years). Mean follow-up was 62 months (range: 46-84months). Defects were post-traumatic, with a mean length of 7.2cm (range: 4 to 9.5cm). For 3 patients, reconstruction followed primary failure. In 4 cases, a covering flap was necessary. Transport used an external fixator guided by an intramedullary nail, at a rate of 1mm per day. One pin was implanted on either side of the distraction zone. The external fixator was removed 1 month after bone contact at the docking site. Mean bone transport time was 11 weeks (range: 7-15 weeks). Mean external fixation time was 5.1months (range: 3.5 to 8months). Full weight-bearing was allowed 5.7months (range: 3.5-13months) after initiation of transport. In one patient, a pin had to be repositioned. In 3 patients, the transported segment re-ascended after external fixatorablation, requiring repeat external fixation and resumption of transport. There was just 1 case of superficial pin infection. Reconstruction quality was considered "excellent" on the Paley-Marr criteria in 6 cases. The present technique provided excellent reconstruction quality in 6 of the 7 cases. External fixation time was shorter and resumption of weight-bearing earlier than with other reconstruction techniques, notably including bone autograft, vascularized bone graft or the induced membrane technique. Nailing facilitated control of limb axis and length. The complications rate was 50%, comparable to other techniques. This study raises the question of systematic internal fixation of the docking site, to avoid any mobilization of the transported segment. The bone quality, axial control and rapidity shown by the present technique make

  3. Avascular necrosis of the femoral head

    International Nuclear Information System (INIS)

    Kokubo, Takeshi; Takatori, Yoshio; Kamogawa, Morihide; Nakamura, Toshitaka; Ninomiya, Setsuo; Yoshikawa, Kohki; Itai, Yuji; Iio, Masahiro; Mitamura, Tadayuki

    1990-01-01

    T1-weighted MR images of thirty-six hips in 25 patients with avascular necrosis of the femoral head were obtained two to five times during the course of 2 to 26 months. We investigated these MR images in the light of the chronological change and compared them with plain radiographs. MR images changes in 16 femoral head; in general, the abnormal low intensity area in the femoral head reduced in extent and the internal high intensity area became smaller of disappeared. Thirteen femoral heads among them became more flattened on plain radiographs in the same period. It is noted that four different zones are defined in the femoral head after bone necrosis takes place: the dead bone marrow, the dead marrow which still contains fat, the reactive interface and the hyperemic bone marrow. In T1-weighted MR images, the dead bone marrow, the reactive interface and the hyperemic bone marrow are demonstrated as low intensity area, while the dead marrow containing fat may remain high in intensity. On the basis of this knowledge of histopathology and MR images of this disease, we suggest that reduction of the abnormal low intensity area and disappearance of the internal high intensity area on MR images can be regarded as diminution of hyperemia in the living bone marrow and loss of fat in the dead bone marrow, respectively. (author)

  4. 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.

  5. Changes in nail keratin observed by Raman spectroscopy after Nd:YAG laser treatment.

    Science.gov (United States)

    Shin, Min Kyung; Kim, Tae In; Kim, Wan Sun; Park, Hun-Kuk; Kim, Kyung Sook

    2017-04-01

    Lasers and photodynamic therapy have been considered a convergence treatment for onychomycosis, which is a fungal infection on the nail bed and nail plate. Laser therapies have shown satisfactory results without significant complications for onychomycosis; however, the mechanism of clearing remains unknown. In this work, we investigated changes in the chemical structure of nail keratin induced by Nd:YAG laser using Raman spectroscopy. Toe nails with onychomycosis were treated with 1064 nm Nd:YAG laser. After laser treatment, the disulfide band (490-590 cm -1 ) of nail keratin was rarely observed or was reduced in intensity. The amide I band (1500-1700 cm -1 ) also showed changes induced by the laser. The α-helical (1652 cm -1 ) structures dominated the β-sheet (1673 cm -1 ) in nontreated nail, but the opposite phenomenon was observed after laser treatment. © 2016 Wiley Periodicals, Inc.

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

    Science.gov (United States)

    El-Heis, S; Abadie, Al

    2016-11-15

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

  7. Selective arteriography in femoral head fractures

    Energy Technology Data Exchange (ETDEWEB)

    Mannella, P; Galeotti, R; Borrelli, M; Benea, G; Massari, L; Chiarelli, G M

    1986-01-01

    The choice between conservative and radical operation in case of femoral neck fractures is very important because it is the determining factor for a successfull therapy. In case of epiphysial necrosis, an endoprosthesis as well as an osteosynthesis will be carried out. Selective arteriography of the medical circumflex artery represents the most reliable study to establish, immediately after the fractures, the possible presence of a post-traumatic ischemic necrosis. Angiography, as a reliable diagnostic tool, has to be carried out in the most selective way and needs the image subtraction technique. The authors report their preliminary results on the reliability of angiography in the femoral epiphyseal ischemic necrosis diagnosed by comparing the results of angiography with the wood light test carried out on the surgically removed femoral head. 18 refs.

  8. 99mTc-MDP scintigraphy of femoral head necrosis following femoral neck fracture

    International Nuclear Information System (INIS)

    Lee, Soon Jin; Lee, Jun Hyung; Kim, Eun Kyung; Lee, Sun Wha; Kim, Soon Yong

    1985-01-01

    Secondary ischemic necrosis of femoral head due to loss of blood supply following to femoral neck fracture is well known. The regional distribution of bone-seeking radiopharmaceuricals in the skeleton can depend on a number of factors, but bone blood flow is a major physiological determinant of regional skeletal uptake of Tc-99m polyphosphate and bone imaging may thus be used for the evaluation of vascularity of the femoral head. The authors made a comparative study of scintigraphic findings and operative findings of 28 cases of femoral neck fracture treated at Kyung Hee University Hospital from April 1980 to May 1984. The results were as follows: 1. In 16 cases of proven avascular necorsis of femoral head, scintigraphy showed absent or decreased activity in 14 cases (87.5%), while radiography showed increased density in 10 cases (62.5%). 2. In 12 cases of proven vital femoral head, scintigraphy showed increased activity in 9 cases (75%) and radiography showed decreased density in 9 cases (75%). 3. 99mTc-MDP scintigraphy was an excellent and useful method for assessing bone vitality of femoral head

  9. {sup 99m}Tc-MDP scintigraphy of femoral head necrosis following femoral neck fracture

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Soon Jin; Lee, Jun Hyung; Kim, Eun Kyung; Lee, Sun Wha; Kim, Soon Yong [Kyung Hee University School of Medicine, Seoul (Korea, Republic of)

    1985-02-15

    Secondary ischemic necrosis of femoral head due to loss of blood supply following to femoral neck fracture is well known. The regional distribution of bone-seeking radiopharmaceuricals in the skeleton can depend on a number of factors, but bone blood flow is a major physiological determinant of regional skeletal uptake of Tc-99m polyphosphate and bone imaging may thus be used for the evaluation of vascularity of the femoral head. The authors made a comparative study of scintigraphic findings and operative findings of 28 cases of femoral neck fracture treated at Kyung Hee University Hospital from April 1980 to May 1984. The results were as follows: 1. In 16 cases of proven avascular necorsis of femoral head, scintigraphy showed absent or decreased activity in 14 cases (87.5%), while radiography showed increased density in 10 cases (62.5%). 2. In 12 cases of proven vital femoral head, scintigraphy showed increased activity in 9 cases (75%) and radiography showed decreased density in 9 cases (75%). 3. 99mTc-MDP scintigraphy was an excellent and useful method for assessing bone vitality of femoral head.

  10. An Exploratory Study of the Factors That May Affect Female Consumers’ Buying Decision of Nail Polishes

    OpenAIRE

    Sun, Chen; Adhikari, Koushik; Koppel, Kadri

    2015-01-01

    The objective of this study was to determine what factors female consumers valued more when they buy nail polish. Ninety-eight female consumers participated in a nail polish consumer study at the Sensory Analysis Center, Kansas State University. A questionnaire containing a check-all-that-apply (CATA) question, behavior questions and demographic questions was presented to each consumer. In the CATA question, the factors that may affect consumers’ decision to buy a nail polish were asked, incl...

  11. Allergic contact dermatitis caused by nail acrylates in Europe. An EECDRG study

    DEFF Research Database (Denmark)

    Gonçalo, Margarida; Pinho, André; Agner, Tove

    2018-01-01

    BACKGROUND: Allergic contact dermatitis (ACD) caused by nail acrylates, also including methacrylates and cyanoacrylates here, is being increasingly reported. METHODS: A retrospective study in 11 European Environmental Contact Dermatitis Research Group (EECDRG) clinics collected information on cases......-hydroxypropyl methacrylate (88.6%), ethylene glycol dimethacrylate (69.2%), and ethyl cyanoacrylate (9.9%). CONCLUSIONS: Nail cosmetics were responsible for the majority of ACD cases caused by acrylates, affecting nail beauticians and consumers, and therefore calling for stricter regulation and preventive...

  12. The use of topical minoxidil to accelerate nail growth: a pilot study.

    Science.gov (United States)

    Aiempanakit, Kumpol; Geater, Alan; Limtong, Preeyachat; Nicoletti, Kathleen

    2017-07-01

    Linear nail growth rate is affected by various conditions, one of which is the level of blood flow. Our supposition was that topical minoxidil, which has vasodilatory properties, can increase the rate of nail growth. The aim of this study was to determine the impact of topical minoxidil on nail growth. A 5% topical minoxidil solution was applied twice daily to the fingernails of 32 participants. Two groups of 16 participants were randomly chosen. In one group, the applications were made to the right index and left ring fingernails, and, in the other, the left index and right ring fingernails. During each visit (weekly during the first month and every 2 weeks during the second month), the nail length of six fingernails (index, middle, and ring of both hands) was measured using a digital caliper. Beginning in the first week, the mean nail length of the treated nails was greater than that of nails in the untreated group with statistical significance. There were no systemic or cutaneous side effects. During the first month, the mean growth of the treated nails was 4.27 mm/month compared with 3.91 mm/month in the untreated nails (P = 0.003). These findings suggest that a 5% concentration of topical minoxidil can stimulate nail growth with increased growth beginning in the first week of application. The results may have important implications for the treatment of nail disorders; however, a comparable study involving participants with nail disorders is highly recommended. © 2017 The International Society of Dermatology.

  13. Application research of 3D additive manufacturing technology in the nail shell

    Science.gov (United States)

    Xiao, Shanhua; Yan, Ruiqiang; Song, Ning

    2018-04-01

    Based on the analysis of hierarchical slicing algorithm, 3D scanning of enterprise product nailing handle case file is carried out, point cloud data processing is performed on the source file, and the surface modeling and innovative design of nail handling handle case are completed. Using MakerBot Replicator2X-based 3D printer for layered 3D print samples, for the new nail product development to provide reverse modeling and rapid prototyping technical support.

  14. [Clinical analysis of LPFP, PFNA and BPH in treating femoral intertrochanteric fractures in elderly patients].

    Science.gov (United States)

    Zhu, Li-Jun; Li, Xiao-Fei; Liu, Chao; Lyu, Cheng-Yu

    2017-07-25

    To evaluate the clinical results of locking proximal femur plate(LPFP), proximal femoral nail antirotation(PFNA) and bipolar hemiarthroplasty(BPH) in the treatment of femoral intertrochanteric fractures in elderly patients. Retrospective analysis of the 86 elderly patients with femoral intertrochanteric fractures during June 2011 and August 2016 were enrolled in this study. The patients were divided into 3 groups: 26 cases in LPFP group included 10 males and 16 females with an average age of (72.54±4.78) years old, 5 cases of type II of Evans, 12 cases of type III and 9 cases of type IV; 39 cases in PFNA group included 17 males and 22 females with an average age of 74.41±5.65, 11 cases of type II, 18 cases of type III and 10 cases of type IV; 21 cases in BPH group included 9 males and 12 females with an average age of 76.23±6.97, 1 case of type II, 10 cases of type III and 10 cases of type IV. The data of three groups were collected for statistical analysis on the following aspects: operation time, intraoperative blood loss, the length of hospital stay, postoperative complications and Harris score of the hip joint function. The wound healed well and no complication occurred. Eighty-four cases were follow-up, while 2 cases were lost, the follow-up rate was 97.6%. The patients were followed up for 22 to 41 months with an average of 26.3 months. For comparison of operation time and time of the hospital stay, BPH group was shorter than the LPFP and PFNA group( F =19.782, 21.981, P BPH group was less blood loss than the LPFP and PFNA group( F =12.976, P 0.05). For comparison of the postoperative complications, LPFP group was higher than BHP and PFNA group( F =30.976, P 0.05). For comparison of the Harris score of the hip joint at 1 year after operation, BPH and PFNA group were both higher than LPFP group( F =19.692, P BPH and PFNA group ( t =4.971, P >0.05). For elder patient with femoral intertrochanteric fracture, BPH could be the best optional for the shorter

  15. Duality transformation of a spontaneously broken gauge theory

    International Nuclear Information System (INIS)

    Mizrachi, L.

    1981-04-01

    Duality transformation for a spontaneously broken gauge theory is constructed in the CDS gauge (xsub(μ)Asub(μ)sup(a)=0). The dual theory is expressed in terms of dual potentials which satisfy the same gauge condition, but with g→ 1 /g. Generally the theory is not self dual but in the weak coupling region (small g), self duality is found for the subgroup which is not spontaneously broken or in regions where monopoles and vortices are concentrated (in agreement with t'Hooft's ideas that monopoles and vortices in the Georgi-Glashow model make it self dual). In the strong coupling regime a systematic strong coupling expansion can be written. For this region the dual theory is generally not local gauge invariant, but it is invariant under global gauge transformations. (author)

  16. Theoretical studies of radiative properties of broken clouds

    International Nuclear Information System (INIS)

    Titov, G.A.

    1994-01-01

    One of the three goals of the Atmospheric Radiation Measurement (ARM) Program is to improve the quality of radiation models under clear sky, homogeneous cloud, and broken cloud conditions. This report is concerned with the development of the theory of radiation transfer in the broken clouds. Our approach is based on a stochastic description of the interaction between the radiation and cloud field with stochastic geometry; In the following, we discuss (1) the mean radiation fluxes in the near IR spectral range 2.7 to 3.2 μm; (2) the influence of random geometry of individual cumulus clouds on the mean fluxes of visible solar radiation; (3) the equations of the mean radiance in the statistically inhomogeneous cloud fields

  17. Patient-relevant needs and treatment goals in nail psoriasis

    DEFF Research Database (Denmark)

    Blome, C; Costanzo, A; Dauden, E.

    2016-01-01

    , but not with age or disease duration. Manual dexterity and social interaction were of particular importance. Goal importance and quality of life were associated, but not redundant (r = 0.612, p ...PURPOSE: Patient-centered health care implies that medical decisions are made jointly by physician and patient, based on patient needs. Aims were to (a) identify treatment goals for a new questionnaire on patient needs and benefits in nail psoriasis treatment; (b) analyze the importance...... of treatment goals in patients with nail psoriasis in general and in defined subgroups; and (c) determine the association between overall treatment goal importance and quality of life. METHODS: The study comprised the following steps: qualitative survey on needs and burdens in 120 patients; development...

  18. Broken Esophageal Stent Successfully Treated by Interventional Radiology Technique

    International Nuclear Information System (INIS)

    Zelenak, Kamil; Mistuna, Dusan; Lucan, Jaroslav; Polacek, Hubert

    2010-01-01

    Esophageal stent fractures occur quite rarely. A 61-year-old male patient was previously treated for rupture of benign stenosis, occurring after dilatation, by implanting an esophageal stent. However, a year after implantation, the patient suffered from dysphagia caused by the broken esophageal stent. He was treated with the interventional radiology technique, whereby a second implantation of the esophageal stent was carried out quite successfully.

  19. Octonionic gauge theory from spontaneously broken SO(8)

    International Nuclear Information System (INIS)

    Lassig, C.C.; Joshi, G.C.

    1995-01-01

    An attempt is made to construct a gauge theory based on a bimodular representation of the octonion algebra, the non associativity of which is manifested as a non-closure of the bimodule algebra. It is found that this fact leads to gauge-noninvariance of the theory. However, the bimodule algebra can be embedded in SO(8), the gauge theory of which can be broken down to give a massless SO(7) theory together with a massive octonionic gauge theory. 7 refs

  20. Weak interaction models with spontaneously broken left-right symmetry

    International Nuclear Information System (INIS)

    Mohapatra, R.H.

    1978-01-01

    The present status of weak interaction models with spontaneously broken left-right symmetry is reviewed. The theoretical basis for asymptotic parity conservation, manifest left-right symmetry in charged current weak interactions, natural parity conservation in neutral currents and CP-violation in the context of SU(2)/sub L/ circled x SU (2)/sub R/ circled x U(1) models are outlined in detail. Various directions for further research in the theoretical and experimental side are indicated