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Sample records for stable intramedullary nailing

  1. Elastic stable intramedullary nailing in paediatric traumatology at ...

    African Journals Online (AJOL)

    Context: Elastic stable intramedullary nailing has revolutionised the treatment of fractures in children. Aim: To report our experience with this current technique of management of fractures in children. Methods and Materials: A retrospective study of all children with fractures treated by this method from November 2003 to June ...

  2. Attritional rupture of extensor pollicis longus: a rare complication following elastic stable intramedullary nailing of a paediatric radial fracture.

    LENUS (Irish Health Repository)

    Sproule, James A

    2011-01-01

    Elastic stable intramedullary nail fixation has become established as an acceptable method of treatment for diaphyseal fractures of both forearm bones in the paediatric population. It is considered safe, minimally invasive and does not compromise physeal growth. We report a case of delayed rupture of extensor pollicis longus due to attrition over the sharp edges of a protruding nail end after elastic stable intramedullary nailing of a paediatric radial diaphyseal fracture.

  3. Surgical approach for elastic stable intramedullary nail in pediatric radius shaft fracture

    DEFF Research Database (Denmark)

    Nørgaard, Sandra L.; Schødt Riber, Sara; Danielsson, Frederik B.

    2018-01-01

    When using elastic stable intramedullary nailing in children’s distal radius shaft fractures, the surgical approach can either be lateral or dorsal. The aim of this article was to carry out a systematic review of the literature comparing the two types of approaches in terms of complications...

  4. 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...... in 6 children and 10 degrees of internal rotational deformity in 1 child. No angular deformity had occurred. Elastic stable intramedullary nailing seems to be a safe method for the treatment of femoral shaft fractures in children between 4 and 11 years of age....

  5. Complications of Elastic Stable Intramedullary Nailing for treating paediatric long bone fractures

    Science.gov (United States)

    Nisar, Aamer; Bhosale, Abhijit; Madan, Sanjeev S.; Flowers, Mark J.; Fernandes, James A.; Jones, Stanley

    2013-01-01

    This study reports the complications observed in children with long bone fractures treated using Elastic Stable Intramedullary Nailing (ESIN). One hundred and sixty-four (n = 164) fractures in 160 patients under the age of 16 years formed the basis of our review. This included 108 boys and 52 girls with the median age of 11 years and median follow up of 7.5 months. The analysis included fractures of the radius/ulna, humerus, femur and tibia. All pathological fractures were excluded. In this series 54 patients (34%) had complications however majority of these were minor complications with irritation due to prominent nail ends being the commonest complication. No long-term sequelae were encountered in our patients. PMID:24403743

  6. [Elastic stable intramedullary nailing (ESIN) in the treatment of both-bone forearm fractures in the child: about 87 cases].

    Science.gov (United States)

    Andaloussi, Saad; Amine Oukhouya, Mohamed; Alaoui, Othmane; Atarraf, Karima; Chater, Lamiae; Afifi, My Abderrahmane

    2017-01-01

    This study aims to describe the complications of elastic stable intramedullary nailing (ESIN) in the treatment of both-bone forearm diaphyseal fractures in the child. Between January 2009 and December 2013, 87 children with both-bone forearm diaphyseal fractures were treated by elastic stable intramedullary nailing with Métaizeau nails. 76 boys and 11 girls, with an average age of 12 years, were enrolled in the study. Nailing was promptly performed in 50 cases and after secondary displacement during plaster-cast treatment in the other cases. Both bones were nailed in all cases. All patients underwent systematic plaster immobilization for a period of about one month. On average, nails were removed after about 6 months. Functional outcomes were studied over a mean follow-up period of 10 months. Complications were marked by 14 superficial infections (14 cases), osteitis associated with material (2 cases), refracture (3 cases), pseudarthrosis (3 cases), delayed fracture consolidation (2 cases) and proximal radioulnar synostosis (1 case). Although intramedullary nailing ideally is an osteosynthesis technique suitable for the treatment of fractures in children, it is more invasive than orthopaedic treatment.Indications for treatment should remain within well-established limits.

  7. [Angle-stable intramedullary nailing of proximal humerus fractures with the PHN (proximal humeral nail)].

    Science.gov (United States)

    Blum, Jochen; Hansen, Matthias; Rommens, Pol Maria

    2009-09-01

    Stable fixation of two- and three-part fractures of the proximal humerus through minimally invasive operative technique and rapid bone healing as well as restoration of original anatomy. Early functional training with the goal of restoration of former mobility and daily activities. Unstabile two- and three-part fractures of the proximal humerus (AO classification: 11-A2, 11-A3, 11-B1, 11-B2, 11-B3). Subcapital nonunion of the humerus. Pathologic fractures. Pediatric fractures of the proximal humerus. Fractures of the proximal humerus types 11-C2 und 11-C3 according to the AO classification. Active local infection, e.g., after former operation. Closed reduction. Anterior acromial incision, splitting of the deltoid muscle and the rotator cuff. Opening of the medullary canal with the awl. Nail introduction. Spiral blade introduction in cannulated technique through stab incision. Distal interlocking through aiming device, angle-stable blocking of nail and blade through end cap. Postoperative fixation in Gilchrist sling until 2nd postoperative day; then physiotherapy respecting fracture type and stability, local swelling, patient's age and compliance, and concomitant injuries. 151 proximal humeral fractures were treated with a proximal humeral nail (PHN). 108 patients could be followed up 1 year postoperatively. Significant complications were perforation of the articular surface through bolts or blades (n = 8), implant-related pain (n = 10), fragment dislocation (n = 2), nonunion (n = 2), humeral head necrosis (n = 3), and superficial infection (n = 1). 1 year after the operation, the Constant-Murley Score showed a median value of 75.3 in the injured shoulder and of 89.9 in the uninjured shoulder. The DASH (Disability of the Arm, Shoulder and Hand) Score was 5.9 preoperatively and 9.3 at 1 year postoperatively. The worst results regarding the Constant-Murley Score as well as the DASH Score were found in C-type fractures.

  8. A prospective multi-center study of intramedullary nailing vs casting of stable tibial shaft fractures.

    Science.gov (United States)

    Obremskey, William T; Cutrera, Norele; Kidd, Christopher M

    2017-03-01

    The purpose of this study was to determine optimal treatment of stable tibial shaft fractures using intramedullary nailing (IMN) or casting. We performed a multi-center prospective study cohort. Patients with stable tibia shaft fractures meeting Sarmiento's criteria (isolated closed fractures with less than 12 mm of shortening and 10° of angulation) were enrolled prospectively and treated with either a reamed IMN with static interlocking screws or closed reduction followed by long-leg casting. Both groups were weight bearing following surgery. Radiographs were taken until union, and range of motion of knee and ankle joints was assessed. Malalignment (>5°) and malunion (>10°) were determined. Functional outcome measures using short musculoskeletal assessment scores (SMFA) and a knee pain score were scheduled at 6 weeks, 3 months and 6 months. At 3 months, differences between the casting and IMN groups were noted in return to work (6/15 vs 3/17, P casting group and in 1/17 in the IMN group (P = 0.02). Malunion was present in 1/15 in the cast group. One fracture in the casting group went on to nonunion and required late IMN placement at 7 months and eventually healed. There were no differences in ankle motion, SMFA scores, or return to work. There was no difference in knee pain between the groups as measured by VAS and Court-Brown pain scale at 6 months. Patients with stable tibia fractures treated with intramedullary nailing have improved clinical and functional outcomes at 3 months compared with those treated with casting, but there are no differences in any other outcome measure. Patients treated in a cast may have a higher incidence of malalignment or malunion. Level-II prognostic.

  9. Low complication rate of elastic stable intramedullary nailing (ESIN) of pediatric forearm fractures

    Science.gov (United States)

    Kruppa, Christiane; Bunge, Pamela; Schildhauer, Thomas A.; Dudda, Marcel

    2017-01-01

    Abstract Elastic stable intramedullary nailing (ESIN) has been established as state of the art treatment for forearm fractures in children, if operative stabilization is required. Their use has been expanded to single bone shaft fractures, and also more complex injuries such as Monteggia fractures or Monteggia-like lesions. A wide range of complications has been reported in the literature, up to 70% in certain investigations. The purpose of this study was to assess the complication rate after ESIN treatment of forearm fractures in children and adolescents in a representative cohort of patients from a level 1 trauma center in Germany. Between 2000 and 2015, we retrospectively analyzed all patients, up to the age of 16 years, with forearm fractures, who were operatively treated using ESIN in our department of general and trauma surgery. The main outcome measurements were the rates of postoperative complications after ESIN such as re-fracture, malunion, nonunion, tendon lesion, wound infection, and limited range of motion. In all, 201 consecutive patients with 202 forearm fractures were included in this study. Age averaged 9.7 years (range 3–16 years). Fifteen (7.4%) fractures were open. Fractures were 82.2% diaphyseal both-bone forearm fractures. Follow-up averaged 10.2 months (range 0.7–176.3 months). Complications were 10 re-fractures, 2 malunions, 3 extensor pollicis longus tendon ruptures, 1 superficial wound infection, and 2 limited range of motions. Fourteen (6.9%) children required a secondary operative intervention for their complication. Time to implant removal averaged 3.8 months (range 0.4–16.3 months). Elastic stable intramedullary nailing is a minimally invasive and reliable technique with a low complication rate. Both-bone forearm fractures and single bone fractures, and also Monteggia and Monteggia-equivalent fractures can be successfully treated with this method. As a major complication, re-fractures are frequently seen, even with ESIN in situ

  10. Elastic stable intramedullary nailing in paediatric forearm fractures: the rate of open reduction and complications.

    Science.gov (United States)

    Makki, Daoud; Matar, Hosam E; Webb, Mark; Wright, David M; James, Leroy A; Ricketts, David M

    2017-09-01

    The aim of this study was to evaluate the rate of open reduction and complications of elastic stable intramedullary nailing (ESIN) in treating unstable diaphyseal forearm fractures in children. We performed a retrospective review of a consecutive series of 102 paediatric patients with a mean age of 9 years (range: 7-14 years) who underwent ESIN of unstable closed forearm fractures at three different centres. Closed reduction of one or both bones was achieved in 68 (67%) patients and open reduction was required in 34 (33%) patients. The rate of open reduction in single-bone fractures (52.2%) was significantly higher than that in both-bone fractures (27.8%) (P=0.04, Fisher's exact test). All the fractures united within 3 months. There were six refractures following nail removal. Five patients had superficial wound infections. Seven patients developed neuropraxia of the sensory branch of the radial nerve. All resolved spontaneously within 3 months of the surgery. ESIN is an effective technique in treating unstable diaphyseal forearm fractures. The need for open reduction should be decided promptly following failed attempts of closed reduction. Single-bone fractures are more likely to require open reduction than both-bone fractures. The radius should be reduced and stabilized first. If open reduction is required, this should be performed through a volar approach rather than a dorsal one.

  11. Median Nerve Palsy following Elastic Stable Intramedullary Nailing of a Monteggia Fracture: An Unusual Case and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Surjit Lidder

    2011-01-01

    Full Text Available Monteggia fractures are rare in children, and subtle radial head dislocations, with minor plastic deformation of the ulna, may be missed in up to a third of cases. Complications of Monteggia fractures-dislocations include persistent radial head dislocation, forearm deformity, elbow stiffness, and nerve palsies at the time of presentation. An unusual case of median nerve palsy following elastic stable intramedullary nailing of a type I Monteggia lesion in a 6-year-old girl is presented, and we highlight that, although most nerve palsies associated with a Monteggia fracture-dislocations are treated expectantly in children, early intervention here probably provided the best outcome.

  12. Clinical evaluation of end caps in elastic stable intramedullary nailing of femoral and tibial shaft fractures in children.

    Science.gov (United States)

    Slongo, T; Audigé, L; Hunter, J B; Berger, S M

    2011-06-01

    Elastic stable intramedullary nailing (ESIN) may be complicated by the loss of reduction following push out of the nails at the entry site in unstable femoral and tibial fractures, especially in older and heavier children and following technical failures. An end cap system addressing this complication was evaluated clinically. In a retrospective case series, 49 femoral and five tibial fractures in 54 pediatric patients treated by ESIN and end caps were documented in two European tertiary centers. End caps were used to interlock standard ESIN nails. The results were evaluated regarding difficulties in the placement and removal of the end cap system, fracture stability and healing, and return to normal activities by analyzing patient charts and X-rays. Fifty-three of 54 fractures were stabilized sufficiently with ESIN and end caps. Loss of reduction was observed in one patient, requiring additional surgery. Six complications were observed, five of which were not related to end caps. There were no significant leg length differences or varus/valgus deformities. A rotational difference of >10°-20° was found in one patient. Removal of the end caps and nails was rated as simple and uncomplicated in 35/37 cases. End caps avoided postoperative instability in the majority of pediatric patients with lower limb shaft fractures, even in heavier, older patients and those with instable fracture types. End caps, however, will not compensate for operative technical insufficiency concerning reduction or nail placement. To maximize the stability of ESIN-instrumented unstable fractures, end caps require properly placed nails.

  13. reoperation rates following intramedullary nailing versus external

    African Journals Online (AJOL)

    hardware failure or malrotation. Conclusion: Treatment of Gustilo Type 3A open tibia shaft fractures with interlocking intramedullary nailing results in lower reoperation rate in the early stages of treatment compared to uniplanar external fixation. Keywords: Orthopaedic surgery, Tanzania, Intramedullary nail, External fixation, ...

  14. Slow Recovery of Weight Bearing After Stabilization of Long-Bone Fractures Using Elastic Stable Intramedullary Nails in Children.

    Science.gov (United States)

    Lardelli, Patrizia; Frech-Dörfler, Martina; Holland-Cunz, Stefan; Mayr, Johannes

    2016-03-01

    Stabilization of diaphyseal long-bone fractures using elastic stable intramedullary nails (ESIN) in children promises early mobilization and rapid resumption of full weight bearing. We evaluated the duration of postoperative functional rehabilitation after ESIN, measured by the time from stabilization until first partial weight bearing, full weight bearing, and resumption of school sports. Fifty children with unstable, displaced fractures of the femur or lower leg treated with ESIN between 2002 and 2012 were included in this retrospective analysis. We classified fractures according to the pediatric comprehensive classification of fractures (PCCF). Thirty-five children sustained a femur fracture, and 15 children had a fracture of the lower leg or tibia. The surgeons in charge applied an additional plaster cast in 7 of 15 children who suffered a lower leg fracture. The postoperative time interval until full weight bearing in the group of children who had suffered transverse or short oblique femur fractures was significantly shorter (median: 4.4 weeks; range: 0.1-9.1 weeks) than that in the group who had sustained more complex fracture patterns (median: 6.8 weeks; range: 2.9-13.9 weeks; P = 0.04). Similarly, transverse and short oblique lower leg and tibia fractures required less time until full weight bearing (median: 4.1 weeks; range 2.7-6.0 weeks) than complex lower leg fractures (median: 6.1 weeks; range: 1.3-12.9 weeks; P = 0.04). ESIN proved fairly effective in restoring full weight bearing in transverse or short oblique fractures of the lower extremities but was less effective in complex fractures.

  15. Radiation exposure during intramedullary nailing.

    Science.gov (United States)

    Hak, David J

    2017-06-01

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

  16. 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.

  17. Elastic Stable Intramedullary Nailing (ESIN), Orthoss® and Gravitational Platelet Separation - System (GPS®): An effective method of treatment for pathologic fractures of bone cysts in children

    Science.gov (United States)

    2011-01-01

    Background The different treatment strategies for bone cysts in children are often associated with persistence and high recurrence rates of the lesions. The safety and clinical outcomes of a combined mechanical and biological treatment with elastic intramedullary nailing, artificial bone substitute and autologous platelet rich plasma are evaluated. Methods From 02/07 to 01/09 we offered all children with bone cysts the treatment combination of elastic intramedullary nailing (ESIN), artificial bone substitute (Orthoss®) and autologous platelet rich plasma, concentrated by the Gravitational Platelet Separation (GPS®) - System. All patients were reviewed radiologically for one year following the removal of the intramedullary nailing, which was possible because of cyst obliteration. Results A cohort of 12 children (4 girls, 8 boys) was recruited. The mean patient age was 11.4 years (range 7-15 years). The bone defects (ten humeral, two femoral) included eight juvenile and four aneurysmal bone cysts. Five patients suffered from persistent cysts following earlier unsuccessful treatment of humeral bone cyst after pathologic fracture; the other seven presented with acute pathologic fractures. No peri- or postoperative complications occurred. The radiographic findings showed a total resolution of the cysts in ten cases (Capanna Grade 1); in two cases a small residual cyst remained (Capanna Grade 2). The intramedullary nails were removed six to twelve months (mean 7.7) after the operation; in one case, a fourteen year old boy (Capanna Grade 2), required a further application of GPS® and Orthoss® to reach a total resolution of the cyst. At follow-up (20-41 months, mean 31.8 months) all patients showed very good functional results and had returned to sporting activity. No refracture occurred, no further procedure was necessary. Conclusions The combination of elastic intramedullary nailing, artificial bone substitute and autologous platelet rich plasma (GPS®) enhances the

  18. Elastic Stable Intramedullary Nailing (ESIN, Orthoss® and Gravitational Platelet Separation - System (GPS®: An effective method of treatment for pathologic fractures of bone cysts in children

    Directory of Open Access Journals (Sweden)

    Wessel Lucas M

    2011-02-01

    Full Text Available Abstract Background The different treatment strategies for bone cysts in children are often associated with persistence and high recurrence rates of the lesions. The safety and clinical outcomes of a combined mechanical and biological treatment with elastic intramedullary nailing, artificial bone substitute and autologous platelet rich plasma are evaluated. Methods From 02/07 to 01/09 we offered all children with bone cysts the treatment combination of elastic intramedullary nailing (ESIN, artificial bone substitute (Orthoss® and autologous platelet rich plasma, concentrated by the Gravitational Platelet Separation (GPS® - System. All patients were reviewed radiologically for one year following the removal of the intramedullary nailing, which was possible because of cyst obliteration. Results A cohort of 12 children (4 girls, 8 boys was recruited. The mean patient age was 11.4 years (range 7-15 years. The bone defects (ten humeral, two femoral included eight juvenile and four aneurysmal bone cysts. Five patients suffered from persistent cysts following earlier unsuccessful treatment of humeral bone cyst after pathologic fracture; the other seven presented with acute pathologic fractures. No peri- or postoperative complications occurred. The radiographic findings showed a total resolution of the cysts in ten cases (Capanna Grade 1; in two cases a small residual cyst remained (Capanna Grade 2. The intramedullary nails were removed six to twelve months (mean 7.7 after the operation; in one case, a fourteen year old boy (Capanna Grade 2, required a further application of GPS® and Orthoss® to reach a total resolution of the cyst. At follow-up (20-41 months, mean 31.8 months all patients showed very good functional results and had returned to sporting activity. No refracture occurred, no further procedure was necessary. Conclusions The combination of elastic intramedullary nailing, artificial bone substitute and autologous platelet rich plasma

  19. Outcome of Interlocking Intramedullary Nailing in the Treatment of ...

    African Journals Online (AJOL)

    Introduction: Fracture of the tibia is one of the commonest musculoskeletal injuries. The current practice is a locked intramedullary nailing of these fractures. This retrospective study aims to review the use of, and assess the clinical outcome of reamed locked antegrade intramedullary nailing of the tibia. Material and Methods: ...

  20. Open intramedullary nailing for segmental long bone fractures: an ...

    African Journals Online (AJOL)

    Background: Closed, locked intramedullary nailing has been accepted as the gold standard in the care of femoral fractures, with reported union rates as high as 98–100%. Closed, locked intramedullary nailing often requires expensive equipment which is a challenge in developing countries. Segmental long bone fractures ...

  1. Intramedullary nailing in distal tibial fracture

    Directory of Open Access Journals (Sweden)

    Damian Arroquy

    2015-11-01

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

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

    Directory of Open Access Journals (Sweden)

    Akakpo-Numado Gamedzi Komlatsè

    2014-01-01

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

  3. Retrograde Intramedullary Nailing for Distal Femur Fracture with Osteoporosis

    OpenAIRE

    Kim, Jihyeung; Kang, Seung-baik; Nam, Kyungpyo; Rhee, Seung Hwan; Won, Jong Won; Han, Hyuk-Soo

    2012-01-01

    Background The incidence of distal femur fracture in the elderly has been increasing recently, and commonly occurs with osteoporosis. Retrograde intramedullary nailing has been considered a good surgical option for distal femur fracture. The purpose of the present study was to present our surgical results with retrograde intramedullary nailing for distal femur fractures with osteoporosis. Methods Thirteen patients diagnosed with extra-articular distal femur fracture and osteoporosis and manag...

  4. Long term results of Intramedullary Nailing in childhood femur ...

    African Journals Online (AJOL)

    Six patients had lengthening; 4 had atrophy of the thigh and 7 patients had coxa valga of operated limb. All patients with coxa valga had undergone the intervention before the age of 12 years. Conclusion: intramedullary nailing using Küntschter nails to treat femoral fractures in children may have some long terms sequelae.

  5. Randomized trial of reamed and unreamed intramedullary nailing of tibial shaft fractures

    NARCIS (Netherlands)

    Bhandari, Mohit; Guyatt, Gordon; Tornetta, Paul; Schemitsch, Emil H.; Swiontkowski, Marc; Sanders, David; Walter, Stephen D.; Gregory Tennent Sanders, David W.; Macleod, Mark D.; Carey, Timothy; Leitch, Kellie; Bailey, Stuart; Gurr, Kevin; Konito, Ken; Bartha, Charlene; Low, Isolina; MacBean, Leila V.; Ramu, Mala; Reiber, Susan; Strapp, Ruth; Tieszer, Christina; Kreder, Hans J.; Stephen, David J. G.; Axelrod, Terry S.; Yee, Albert J. M.; Richards, Robin R.; Finkelstein, Joel; Ford, Michael; Gofton, Wade; Murnaghan, John; Schatztker, Joseph; Bulmer, Beverly; Conlan, Lisa; Laflamme, G. Yves; Berry, Gregory; Beaumont, Pierre; Ranger, Pierre; Laflamme, Georges-Henri; Gagnon, Sylvain; Malo, Michel; Fernandes, Julio; Poirier, Marie-France; McKee, Michael D.; Waddell, James P.; Bogoch, Earl R.; Daniels, Timothy R.; McBroom, Robert R.; Vicente, Milena R.; Storey, Wendy; Wild, Lisa M.; McCormack, Robert; Perey, Bertrand; Goetz, Thomas J.; Pate, Graham; Penner, Murray J.; Panagiotopoulos, Kostas; Pirani, Shafique; Dommisse, Ian G.; Loomer, Richard L.; Stone, Trevor; Moon, Karyn; Zomar, Mauri; Webb, Lawrence X.; Teasdall, Robert D.; Birkedal, John Peter; Martin, David Franklin; Ruch, David S.; Kilgus, Douglas J.; Pollock, David C.; Harris, Mitchel Brion; Wiesler, Ethan Ron; Ward, William G.; Shilt, Jeffrey Scott; Koman, Andrew L.; Poehling, Gary G.; Kulp, Brenda; Creevy, William R.; Stein, Andrew B.; Bono, Christopher T.; Einhorn, Thomas A.; Brown, T. Desmond; Pacicca, Donna; Sledge, John B.; Foster, Timothy E.; Voloshin, Ilva; Bolton, Jill; Carlisle, Hope; Shaughnessy, Lisa; Obremskey, William T.; LeCroy, C. Michael; Meinberg, Eric G.; Messer, Terry M.; Craig, William L.; Dirschl, Douglas R.; Caudle, Robert; Harris, Tim; Elhert, Kurt; Hage, William; Jones, Robert; Piedrahita, Luis; Schricker, Paul O.; Driver, Robin; Godwin, Jean; Kregor, Philip James; Tennent, Gregory; Truchan, Lisa M.; Sciadini, Marcus; Shuler, Franklin D.; Driver, Robin E.; Nading, Mary Alice; Neiderstadt, Jacky; Vap, Alexander R.; Vallier, Heather A.; Patterson, Brendan M.; Wilber, John H.; Wilber, Roger G.; Sontich, John K.; Moore, Timothy Alan; Brady, Drew; Cooperman, Daniel R.; Davis, John A.; Cureton, Beth Ann; Mandel, Scott; Orr, R. Douglas; Sadler, John T. S.; Hussain, Tousief; Rajaratnam, Krishan; Petrisor, Bradley; Drew, Brian; Bednar, Drew A.; Kwok, Desmond C. H.; Pettit, Shirley; Hancock, Jill; Sidorkewicz, Natalie; Cole, Peter A.; Smith, Joel J.; Brown, Gregory A.; Lange, Thomas A.; Stark, John G.; Levy, Bruce A.; Swiontkowski, Marc F.; Garaghty, Mary J.; Salzman, Joshua G.; Schutte, Carol A.; Tastad, Linda; Vang, Sandy; Seligson, David; Roberts, Craig S.; Malkani, Arthur L.; Sanders, Laura; Dyer, Carmen; Heinsen, Jessica; Smith, Langan; Madanagopal, Sudhakar; Frantz-Bush, Linda; Coupe, Kevin J.; Tucker, Jeffrey J.; Criswell, Allen R.; Buckle, Rosemary; Rechter, Alan Jeffrey; Sheth, Dhiren Shaskikant; Urquart, Brad; Trotscher, Thea; Anders, Mark J.; Kowalski, Joseph M.; Fineberg, Marc S.; Bone, Lawrence B.; Phillips, Matthew J.; Rohrbacher, Bernard; Stegemann, Philip; Mihalko, William M.; Buyea, Cathy; Augustine, Stephen J.; Jackson, William Thomas; Solis, Gregory; Ero, Sunday U.; Segina, Daniel N.; Berrey, Hudson B.; Agnew, Samuel G.; Fitzpatrick, Michael; Campbell, Lakina C.; Derting, Lynn; McAdams, June; Goslings, J. Carel; Ponsen, Kees Jan; Luitse, Jan; Kloen, Peter; Joosse, Pieter; Winkelhagen, Jasper; Duivenvoorden, Raphaël; Teague, David C.; Davey, Joseph; Sullivan, J. Andy; Ertl, William J. J.; Puckett, Timothy A.; Pasque, Charles B.; Tompkins, John F.; Gruel, Curtis R.; Kammerlocher, Paul; Lehman, Thomas P.; Puffinbarger, William R.; Carl, Kathy L.; Weber, Donald W.; Jomha, Nadr M.; Goplen, Gordon R.; Masson, Edward C. O.; Beaupre, Lauren A.; Greaves, Karen E.; Schaump, Lori N.; Jeray, Kyle J.; Goetz, David R.; Westberry, David E.; Broderick, J. Scott; Moon, Bryan S.; Tanner, Stephanie L.; Powell, James N.; Buckley, Richard E.; Elves, Leslie; Connolly, Stephen; Abraham, Edward P.; Steele, Trudy; Ellis, Thomas; Herzberg, Alex; Brown, George A.; Crawford, Dennis E.; Hart, Robert; Hayden, James; Orfaly, Robert M.; Vigland, Theodore; Vivekaraj, Maharani; Bundy, Gina L.; Miclau, Theodore; Matityahu, Amir; Coughlin, R. Richard; Kandemir, Utku; McClellan, R. Trigg; Lin, Cindy Hsin-Hua; Karges, David; Cramer, Kathryn; Watson, J. Tracy; Moed, Berton; Scott, Barbara; Beck, Dennis J.; Orth, Carolyn; Puskas, David; Clark, Russell; Jones, Jennifer; Egol, Kenneth A.; Paksima, Nader; France, Monet; Wai, Eugene K.; Johnson, Garth; Wilkinson, Ross; Gruszczynski, Adam T.; Vexler, Liisa

    2008-01-01

    BACKGROUND: There remains a compelling biological rationale for both reamed and unreamed intramedullary nailing for the treatment of tibial shaft fractures. Previous small trials have left the evidence for either approach inconclusive. We compared reamed and unreamed intramedullary nailing with

  6. Management of extra-articular fractures of the distal tibia: intramedullary nailing versus plate fixation.

    Science.gov (United States)

    Casstevens, Chris; Le, Toan; Archdeacon, Michael T; Wyrick, John D

    2012-11-01

    Intramedullary nailing and plate fixation represent two viable approaches to internal fixation of extra-articular fractures of the distal tibia. Although both techniques have demonstrated success in maintaining reduction and promoting stable union, they possess distinct advantages and disadvantages that require careful consideration during surgical planning. Differences in soft-tissue health and construct stability must be considered when choosing between intramedullary nailing and plating of the distal tibia. Recent advances in intramedullary nail design and plate-and-screw fixation systems have further increased the options for management of these fractures. Current evidence supports careful consideration of the risk of soft-tissue complications, residual knee pain, and fracture malalignment in the context of patient and injury characteristics in the selection of the optimal method of fixation.

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

    Science.gov (United States)

    Omerovic, Djemil; Lazovic, Faruk; Hadzimehmedagic, Amel

    2015-04-01

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

  8. Design and preliminary testing of an active intramedullary nail.

    Science.gov (United States)

    Letechipia, Jorge; Alessi, Aldo; Rodríguez, Gerardo; Asbun, Juan

    2014-07-01

    To enhance bone healing through controlled interfragmentary movements, numerous experiments have been conducted in animal models employing external fixation devices to apply mechanical stimulation to the fracture site. However, the efficacy of these fixators has been questioned. On the other hand, intramedullary nailing is a widely established clinical practice for reducing closed tibial fractures. In an effort to enhance bone healing, to overcome the disadvantages of external fixators (i.e., non-uniform linear movement), and to enhance the advantages of intramedullary nailing (i.e., reduced risk of infection), an active intramedullary nail has been designed and fabricated. Active nail will provide controlled in-situ stimulation (simultaneously axial and shear) from a selectable acceleration (0.35 to 8.17g - axial and 0.44g to 10.46 g - shear), associated to a discreet set of high-frequency values (29.82 - 172.05 Hz - axial and 29.68 to 172.13 - shear). Five active intramedullary nails were fabricated, capable of producing average acceleration between 0.35 and 10.4 g. Acceleration is applied simultaneously by all three axes (x, y, and z), resulting in axial and shear stimulation. For each acceleration level, there are a limited number of frequencies that can be selected. For each frequency, there are a limited number of acceleration levels that can be delivered. Bone morphology produces different levels of acceleration in each axe. Acceleration levels are controlled externally only by the variable power source (1.5VDC to 6VDC). Accelerated in-vitro testing showed that the life of the device exceeded the required active period. Mechanical test showed that in case of failure of the active component, the active intramedullary nail will act as a standard nail, allowing bone healing to continue its normal course. Ex vivo experiments were conducted inserting one active intramedullary nail in two intact adult sheep tibia. Results indicate that the strain induced by the

  9. Tibiotalocalcaneal arthrodesis with retrograde intramedullary nailing.

    Science.gov (United States)

    Mendicino, Robert W; Catanzariti, Alan R; Saltrick, Karl R; Dombek, Michael F; Tullis, Brandon L; Statler, Trenton K; Johnson, Brandi M

    2004-01-01

    Nineteen patients (20 feet) with severe hindfoot and ankle deformity underwent tibiotalocalcaneal fusion with a retrograde locked intramedullary nail as a limb-salvage procedure. The purpose of this study was to compare the complication rates of this procedure in diabetic versus nondiabetic patients. There were 8 men and 11 women with preoperative diagnoses including Charcot neuroarthropathy, primary osteoarthritis, rheumatoid arthritis, equinocavovarus, posttraumatic osteoarthritis, gouty arthritis, and ankle malunion. Ten of 20 procedures were performed in patients with diabetes. The average patient age was 56 years, and the average postoperative follow-up was 19.8 months. Nineteen of 20 ankles (95%) achieved successful fusion with an average time of 4.1 months. Four patients (21%) required either a fracture brace or an ankle foot orthosis at final follow-up. Five patients (25%) had major complications and 11 patients had minor complications. Major complications included osteomyelitis (n = 2), Charcot arthropathy (n = 2), failure of fixation (n =1), soft-tissue necrosis (n = 1), cardiac arrest (n = 1), cerebral vascular accident (n = 1), and fatal pulmonary embolus (n = 1). All patients with major complications were diabetic, and 14 of 20 combined major and minor complications occurred in patients with diabetes. The complication rate was found to be high in diabetic patients with end-stage deformity undergoing a limb salvage

  10. Distal femoral complications following antegrade intramedullary nail placement

    Directory of Open Access Journals (Sweden)

    Amanda J. Fantry

    2015-03-01

    Full Text Available While antegrade nailing for proximal and diaphyseal femur fractures is a commonly utilized fixation method with benefits including early mobilization and high rates of fracture union, both intraoperative and postoperative complications may occur. Intraoperative errors include leg length discrepancy, anterior cortical perforation, malreduction of the fracture, and neurovascular injury, and postoperative complications include nonunion, malunion, infection, and hardware failure. This case series reviews complications affecting the distal femur after intramedullary nailing including fracture surrounding a distal femoral interlocking screw (Case #1, nonunion after dynamization with nail penetration into the knee joint (Case #2, and anterior cortical perforation (Case #3. Prevention of intraoperative and postoperative complications surrounding intramedullary nailing requires careful study of the femoral anatomy and nail design specifications (radius of curvature, consideration of the necessity of distal interlocking screws, the need for close radiographic follow-up after nail placement with X-rays of the entire length of the nail, and awareness of possible nail penetration into the knee joint after dynamization.

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

    Science.gov (United States)

    Garnavos, Christos

    2011-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Christos Garnavos

    2011-01-01

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

  13. Retrograde intramedullary nailing for distal femur fracture with osteoporosis.

    Science.gov (United States)

    Kim, Jihyeung; Kang, Seung-Baik; Nam, Kyungpyo; Rhee, Seung Hwan; Won, Jong Won; Han, Hyuk-Soo

    2012-12-01

    The incidence of distal femur fracture in the elderly has been increasing recently, and commonly occurs with osteoporosis. Retrograde intramedullary nailing has been considered a good surgical option for distal femur fracture. The purpose of the present study was to present our surgical results with retrograde intramedullary nailing for distal femur fractures with osteoporosis. Thirteen patients diagnosed with extra-articular distal femur fracture and osteoporosis and managed with retrograde intramedullary nailing were retrospectively reviewed. Cement augmentation was used in four patients, shape memory alloy was used in eight patients and both were used in one patient. All patients were followed up for more than 2 years. Radiologic alignments were scored and Tegner and the Lysholm activity score was used for a functional assessment. The average time to clinical union was 13 weeks (range, 10 to 15 weeks). In 12 of our cases, the total alignment scores were excellent. At the last follow-up, the mean range of motion was 116° (range, 110° to 125°). The average functional score at postoperative 1 year was 2.6 (range, 1 to 5). Retrograde intramedullary nailing is a good surgical option for distal femur fracture with osteoporosis. Cement augmentation and shape memory alloy can also be used for added mechanical stability. This surgical technique is very useful for distal femur fracture with osteoporosis as it promotes fracture healing and early rehabilitation.

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

    African Journals Online (AJOL)

    2017-12-05

    Dec 5, 2017 ... Background: Femoral shaft fractures are common injuries in adults. Closed locked intramedullary nailing is the recommended treatment for femoral shaft fractures due to its high union rate. Objective: The objective of this study is to determine the outcome of management of closed femoral shaft fractures in ...

  15. Comparison of functional bracing and locked intramedullary nailing in the treatment of displaced tibial shaft fractures.

    Science.gov (United States)

    Alho, A; Benterud, J G; Høgevold, H E; Ekeland, A; Strømsøe, K

    1992-04-01

    Thirty-five displaced tibial shaft fractures, treated with functional bracing were compared with 43 similar fractures, treated with locked intramedullary nailing. There were 22 excellent/good results in the brace group and 38 in the nail group. There was one infection in the brace group and three in the nailed group. There were five delayed unions and two nonunions in the brace group and one delayed union in the nail group. The functional results in the nailed group were better than the braced group but locked intramedullary nailing of tibial shaft fractures require special resources and training. Locked intramedullary nailing fullfils all the functional criteria for acceptable fracture care.

  16. 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.

  17. 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.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2015-09-15

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

  19. 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 twenty-four were treated by EF. There were 9 (37.5%) EF patients who required reoperation compared to 1(3.8%) IM nail patient (p=0.004). Reasons for reoperation among EF patients were infection (2 ...

  20. Ankle fusion with a retrograde locked intramedullary nail

    Directory of Open Access Journals (Sweden)

    WANG Xu

    2012-06-01

    Full Text Available 【Abstract】Objective: To assess the value of ankle fusion with a retrograde locked intramedullary nail in the treatment of sequela of lower extremity compartment syndrome. Methods: Thirty-five cases of equinus deformity follow-ing tibiofibular compartment syndrome treated by means of ankle fusion with a retrograde locked intramedullary nail from January 2001 to December 2010 were retrospectively reviewed. The complications, the time needed for bony fu-sion of the ankle joint assessed by anteroposterior and lateral X-ray photographs as well as patients’ subjective evalua-tion were recorded and analysed. Results: Among the 35 patients, 15 had previously undergone surgical treatment twice on the same limb, 13 had thrice and 7 had to be operated on four times before ankle fusion. An anterior midpoint approach to the ankle joint was adopted in 29 cases, while anterior midpoint ap-proach plus a small incision on the posterior ankle joint was made in 17 cases, whereas lateral approach in 6 cases. Tar-sus joint fusion was performed on 4 cases. The follow-up period ranged 6-124 months, averaged 40.6 months. Bone grafting was not performed in this series. Preoperative tibial shaft fracture occurred in one patient and was healed after conservative treatment. Incision dehiscence located at pre-vious Achilles tendon incision was found in two patients. As a result, one received an intramedullary nail emplace-ment at calcaneoplantar part while the wound at anterosuperior part of the other one was healed by dressing change. Two patients failed to bony union 5 months postoperatively, in which one healed 10 weeks after retrieval of proximal tibial nail and another by iliac grafting. Terminal necrosis of the toe due to blood supply dysfunction was not found in this series. All the patients were satisfied with the ankle joint function postoperatively. The time for bony union on X-rays was 9.8 weeks on average. Except for one patient who demanded removal of

  1. 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.

  2. 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

  3. Intramedullary nailing without interlocking screws for femoral and tibial shaft fractures.

    Science.gov (United States)

    Kreb, Dieuwertje L; Blokhuis, Taco J; van Wessem, Karlijn J P; Bemelman, Mike; Lansink, Koen W W; Leenen, Luke P H

    2013-08-01

    Intramedullary fixation is the treatment of choice for diaphyseal fractures of the femur and tibia. Locking the implant can sometimes be cumbersome and time consuming. In our institution, fractures with axial and rotational stability are treated with intramedullary nailing without interlocking. All consecutive patients presented in the University Medical Center Utrecht from October 2003 to August 2009 with acute traumatic diaphyseal fractures of the tibia or femur that were considered axial and rotational stable were included. They underwent internal fixation using intramedullary nails without interlocking. Patient records were evaluated for duration of surgery, perioperative complications, consolidation time and re-operations. Twenty-nine long bone fractures were treated in 27 patients: 20 men and 7 women, with an average age of 28.9 years (range 15.6-54.4). There were 12 femoral fractures and 17 tibial fractures. Sixteen fractures were closed and 13 were open (10 Gustilo 1, 3 Gustilo 2). The mean operating time was 43 min (range 18-68 min) for tibial fractures and 55 min (range 47-150 min) for femoral fractures. Postoperative complications occurred in six patients. Two patients (three fractures) were lost to follow-up. Healing occurred in 25 of the 26 remaining fractures (96 %) without additional interventions. One tibia was secondarily converted to a standard locked nail because of axial and rotational instability. All patients returned to their pre-injury level of activity. The use of intramedullary nailing without interlocking is associated with minimal complications in selected fractures. The advantages include a short operating time and the simplicity of its application.

  4. Techniques for intramedullary nailing of proximal tibia fractures.

    Science.gov (United States)

    Stinner, Daniel J; Mir, Hassan

    2014-01-01

    Despite poor early results with intramedullary nailing of extra-articular proximal tibia fractures, improvements in surgical technique and implant design modifications have resulted in more acceptable outcomes. However, prevention of the commonly encountered apex anterior and/or valgus deformities remains a challenge when treating these injuries. It is necessary for the surgeon to recognize this and know how to neutralize these forces. Surgeons should be comfortable using a variety of the reduction techniques presented to minimize fracture malalignment. Copyright © 2014 Elsevier Inc. All rights reserved.

  5. Intramedullary nailing of clavicular midshaft fractures in adults using titanium elastic nail

    Directory of Open Access Journals (Sweden)

    CHEN Qing-yv

    2012-02-01

    Full Text Available 【Abstract】 Objective: Studies showed elastic stable intramedullary nailing (ESIN of displaced midclavicular fractures has excellent outcomes, as well as high complication rates and specific problems. The aim was to discuss ESIN of midshaft clavicular fractures. Methods: Totally 60 eligible patients (aged 18-63 years were randomized to either ESIN group or non-operative group between January 2007 and May 2008. Clavicular shortening was measured after trauma and osseous consolidation. Radiographic union and complications were assessed. Function analysis including Constant shoulder scores and disabilities of the arm, shoulder and hand (DASH scores were performed after a 15-month follow-up. Results: ESIN led to a signifcantly shorter time to union, especially for simple fractures. In ESIN group, all patients got fracture union, of which 5 cases had medial skin irritation and 1 patient needed revision surgery because of implant failure. In the nonoperative group, there were 3 nonunion cases and 2 symptomatic malunions developed requiring corrective osteotomy. At 15 months after intramedullary stabilization, patients in the ESIN group were more satisfied with the appearance of the shoulder and overall outcome, and they benefited a lot from the great improvement of post-traumatic clavicular shortening. Furthermore, DASH scores were lower and Constant scores were significantly higher in contrast to the non-operative group. Conclusion: ESIN is a safe minimally invasive surgical technique with lower complication rate, faster return to daily activities, excellent cosmetic and better functional results, restoration of clavicular length for treating mid-shaft clavicular fractures, resulting in high overall satisfaction, which can be regard as an alternative to plate fixation or nonoperative treatment of mid-shaft clavicular fractures. Key words: Clavicle; Fracture fixation intramedu- llary; Outcome assessment

  6. 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.

  7. 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.

  8. Expanding nail or expanding femur? An adverse event with the expandable intramedullary nail.

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    Gangopadhyay, Soham; Riley, Nicholas D; Sivaji, Chellappan K

    2010-01-01

    The expandable intramedullary nail is self-locking and has the advantage of reducing operating time and exposure to ionizing radiation. The nail is recommended for simple diaphyseal fractures involving the middle third of long bones, where the nail can bypass the fracture site by at least 5 cm. We encountered a unique complication with the expandable nail in a simple transverse shaft fracture at the junction of the middle and distal third of the left femur in an otherwise healthy 57-year-old man. The fracture was reduced and a 12-mm expandable nail was inserted. Following full expansion, intraoperative radiographs were obtained prior to closure. After six postoperative weeks, it was noted that the nail expanded the femoral canal, converting a simple fracture to a distally progressing comminuted fracture with a butterfly fragment. A review of the intraoperative radiographs showed slight widening of the medullary canal at the level of the fracture. As the alignment was satisfactory and callus was present, no further surgical intervention was considered. The patient was advised not to bear weight and was provided with a locked knee brace in extension to wear for six weeks. Radiographs at 12 weeks demonstrated good progress of healing with adequate callus and the patient was permitted to bear weight as tolerated and commence knee flexion. The fracture united satisfactorily at four months. This adverse experience emphasizes that caution should be exercised when expanding the nail, with close observation of the medullary canal diameter during the later stages of expansion.

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

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    Shepherd Lane

    2008-07-01

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

  10. 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 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.

  11. Elastic robust intramedullary nailing for forearm fracture in children

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    Wasem, Jürgen

    2006-01-01

    Full Text Available Background: Forearm fractures are the most common fractures in children (23% of all fractures. Basically there are two treatment options available for diaphyseal forearm fractures in children: closed reduction with cast immobilisation (conservative therapy and the elastic stable intramedullary nailing (ESIN. Treatment decision is influenced by the doctor's estimation of fracture instability. Stable fractures can be treated conservatively whereas instable forearm shaft fractures can be treated according the following three treatment strategies: 1. conservative therapy in an outpatient setting 2. conservative therapy in the operating room in attendance to change to ESIN in case that no stabilisation can be achieved with cast immobilisation 3. immediate treatment with ESIN in the operating room. Objectives: Aim of this Health Technology Assessment (HTA report is to assess and report the published evidence concerning effectiveness and cost-effectiveness of ESIN as a treatment option for diaphyseal forearm fractures in children and to identify future research need. Important parameters for the assessment of effectiveness are objective parameters (axis deviation, losses of motion, and numbers of reductions in case of redislocations and subjective parameters (pain or impairment in quality of life. Furthermore, a health economic evaluation shall be done which refers to the costs of the different therapy strategies. Methods: An extensive, systematic literature search in medical, economic, and HTA literature databases was performed. Relevant data were extracted and synthesised. Results: Three cohort studies and seven case series have been identified. Controlled clinical studies, systematic reviews and/or HTA reports that gave evidence to answer the own study question have not been found. The identified studies partly differed in respect of defined indication for ESIN, study population and treatment strategies. For that reason comparability of results was

  12. Intramedullary Nailing for Pathological Fractures of the Proximal Humerus.

    Science.gov (United States)

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

    2016-12-01

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

  13. Flexible intramedullary nailing in paediatric femoral shaft fractures.

    Science.gov (United States)

    Anastasopoulos, John; Petratos, Dimitrios; Konstantoulakis, Charalampos; Plakogiannis, Christos; Matsinos, George

    2010-06-01

    This retrospective study aims to evaluate the efficacy of flexible intramedullary (IM) nails as a fixation device of paediatric femoral shaft fractures. A total of 36 children with 37 closed fractures were treated by this method. The patients ranged in age from 7.2 to 13.5 years and the mean follow-up was 25.5 months. All patients had open femoral growth plates at the time of surgery. All fractures united and none of the patients needed re-operation. Complications included pain/irritation at the insertion site, superficial wound breakdown and one case of delayed union. No major complications were recorded. After nail removal, all children had full range of hip and knee motion. At final follow-up, although radiographs revealed that 44% of the children had malalignment at the fracture site in one or both planes, none of the children presented with clinical malalignment of the fractured limb. Maximum angulation that was calculated on the coronal plane was 5 degrees into varus and on the sagittal plane 7 degrees of anterior angulation (apex posteriorly). Leg-length discrepancy was assessed clinically and radiographically when needed. A total of 50% of the children had a leg-length inequality but none of them complained of a functional problem. Flexible nailing of diaphyseal fractures of the femur is a reliable method with a small learning curve and allows early mobilisation. Most of our minor complications were technique related and could be avoided. Copyright 2009 Elsevier Ltd. All rights reserved.

  14. Biomechanical analysis of a synthetic femoral spiral fracture model: Do end caps improve retrograde flexible intramedullary nail fixation?

    Directory of Open Access Journals (Sweden)

    Wessel Lucas M

    2011-09-01

    Full Text Available Abstract Background Elastic Stable intramedullary Nailing (ESIN of dislocated diaphyseal femur fractures has become an accepted method for the treatment in children and adolescents with open physis. Studies focused on complications of this technique showed problems regarding stability, usually in complex fracture types such as spiral fractures and in older children weighing > 40 kg. Biomechanical in vitro testing was performed to evaluate the stability of simulated spiral femoral fractures after retrograde flexible titanium intramedullary nail fixation with and without End caps. Methods Eight synthetic adolescent-size femoral bone models (Sawbones® with a medullar canal of 10 mm and a spiral fracture of 100 mm length identically sawn by the manufacturer were used for each group. Both groups underwent retrograde fixation with two 3.5 mm Titanium C-shaped nails inserted from medial and lateral entry portals. In the End Cap group the ends of the nails of the eight specimens were covered with End Caps (Synthes Company, Oberdorf, Switzerland at the distal entry. Results Beside posterior-anterior stress (4.11 Nm/mm vs. 1.78 Nm/mm, p Conclusion In this biomechanical study the use of End Caps did not improve the stability of the intramedullary flexible nail osteosynthesis.

  15. Intrapelvic Migration of the Lag Screw in Intramedullary Nailing

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    Tomoya Takasago

    2014-01-01

    Full Text Available Internal fixation with intramedullary devices has gained popularity for the treatment of intertrochanteric femoral fractures, which are common injuries in the elderly. The most common complications are lag screw cut out from the femoral head and femoral fracture at the distal tip of the nail. We report here a rare complication of postoperative lag screw migration into the pelvis with no trauma. The patient was subsequently treated with lag screw removal and revision surgery with total hip arthroplasty. This case demonstrated that optimal fracture reduction and positioning of the lag screw are the most important surgical steps for decreasing the risk of medial migration of the lag screw. Furthermore, to prevent complications, careful attention should be paid to subsequent steps such as precise insertion of the set screw.

  16. Intraoperative Distal Femoral Fine Wire Traction to Facilitate Intramedullary Nailing of the Femur.

    Science.gov (United States)

    Githens, Michael; Alton, Timothy B; Firoozabadi, Reza; Bishop, Julius A

    2016-01-01

    Many techniques have been employed to facilitate intramedullary nailing of femur fractures. Maintaining limb length during the operation can be difficult. The authors describe the use of distal femoral fine wire skeletal traction as a technique to maintain reduction while allowing intramedullary nailing of femur fractures. This technique is safe, is effective, and negates the need for a fracture table or an assistant. Copyright 2016, SLACK Incorporated.

  17. Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures in adults.

    Science.gov (United States)

    Parker, Martyn J; Handoll, Helen H G

    2008-07-16

    Two types of implants used for the surgical fixation of extracapsular hip fractures are cephalocondylic intramedullary nails, which are inserted into the femoral canal proximally to distally across the fracture, and extramedullary implants (e.g. the sliding hip screw). To compare cephalocondylic intramedullary nails with extramedullary implants for extracapsular hip fractures in adults. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (June 2007), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2007, Issue 2), MEDLINE (1966 to June week 3 2007), EMBASE (1988 to 2007 Week 27), the UK National Research Register, orthopaedic journals, conference proceedings and reference lists of articles. All randomised and quasi-randomised controlled trials comparing cephalocondylic nails with extramedullary implants for extracapsular hip fractures. Both authors independently assessed trial quality and extracted data. Wherever appropriate, results were pooled. Predominantly older people with mainly trochanteric fractures were treated in the 36 included trials.Twenty-two trials (3871 participants) compared the Gamma nail with the sliding hip screw (SHS). The Gamma nail was associated with an increased risk of operative and later fracture of the femur and an increased reoperation rate. There were no major differences between implants in the wound infection, mortality or medical complications.Five trials (623 participants) compared the intramedullary hip screw (IMHS) with the SHS. Fracture fixation complications were more common in the IMHS group; all cases of operative and later fracture of the femur occurred in this group. Results for post-operative complications, mortality and functional outcomes were similar in the two groups. Three trials (394 participants) showed no difference in fracture fixation complications, reoperation, wound infection and length of hospital stay for proximal femoral nail (PFN) compared with the SHS

  18. Comparison and analysis of reoperations in two different treatment protocols for trochanteric hip fractures - postoperative technical complications with dynamic hip screw, intramedullary nail and Medoff sliding plate.

    Science.gov (United States)

    Paulsson, Johnny; Stig, Josefine Corin; Olsson, Ola

    2017-08-24

    In treatment of unstable trochanteric fractures dynamic hip screw and Medoff sliding plate devices are designed to allow secondary fracture impaction, whereas intramedullary nails aim to maintain fracture alignment. Different treatment protocols are used by two similar Swedish regional emergency care hospitals. Dynamic hip screw is used for fractures considered as stable within the respective treatment protocol, whereas one treatment protocol (Medoff sliding plate/dynamic hip screw) uses biaxial Medoff sliding plate for unstable pertrochanteric fractures and uniaxial Medoff sliding plate for subtrochanteric fractures, the second (intramedullary nail/dynamic hip screw) uses intramedullary nail for subtrochanteric fractures and for pertrochanteric fractures with intertrochanteric comminution or subtrochanteric extension. All orthopedic surgeries are registered in a regional database. All consecutive trochanteric fracture operations during 2011-2012 (n = 856) and subsequent technical reoperations (n = 40) were derived from the database. Reoperations were analysed and classified into the categories adjustment (percutaneous removal of the locking screw of the Medoff sliding plate or the intramedullary nail, followed by fracture healing) or minor, intermediate (reosteosynthesis) or major (hip joint replacement, Girdlestone or persistent nonunion) technical complications. The relative risk of intermediate or major technical complications was 4.2 (1.2-14) times higher in unstable pertrochanteric fractures and 4.6 (1.1-19) times higher in subtrochanteric fractures with treatment protocol: intramedullary nail/dynamic hip screw, compared to treatment protocol: Medoff sliding plate/dynamic hip screw. Overall rates of intermediate and major technical complications in unstable pertrochanteric and subtrochanteric fractures were with biaxial Medoff sliding plate 0.68%, with uniaxial Medoff sliding plate 1.4%, with dynamic hip screw 3.4% and with intramedullary nail 7.2%. The

  19. Chronic Bilateral Tibial Stress Fractures with Valgus Treated with Bilateral Intramedullary Nailing: A Case Report

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    Steven K Dailey

    2014-01-01

    Full Text Available Introduction: Stress fractures are overuse injuries most commonly seen in athletes, military recruits, and individuals with endocrine abnormalities. It has been demonstrated that chronic cases of anterior tibial stress fractures refractory to conservative management respond well to intramedullary nailing. To our knowledge, only one report has been published concerning patients with bilateral tibial stress fractures treated with bilateral intramedullary nailing. All patients in the series were high-level athletes. We present the case of a non-athletic patient with chronic bilateral tibial stress fractures and associated deformity successfully treated with bilateral intramedullary nails. Case Report: A 23-year-old Caucasian female full-time student presented with chronic bilateral shin pain for approximately five years. She had failed an extensive regimen of conservative management. She was diagnosed with chronic bilateral tibial stress fractures based on history, physical examination, and radiologic findings. She subsequently underwent sequential intramedullary nailing of her tibiae. Both tibiae were in valgus alignment; however, this did not preclude nail placement. The nails deformed upon insertion into the sclerotic canals to conform to the deformation. Post operatively the tibiae united and patient was relieved of her symptoms. Conclusion: Bilateral intramedullary nailing of chronic bilateral tibial stress fractures should be considered as a treatment option for all patients, not just high-level athletes, who fail a trial of conservative management. Additionally, mild to moderate tibial malalignment does not necessarily preclude tibial nailing as the smaller nails placed in sclerotic canals will likely deform on insertion and conform to the canal. Keywords: Bilateral intramedullary nailing, bilateral tibial stress fractures, valgus

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

    Science.gov (United States)

    Xu, Wei-zhou; Guo, Xiao-dong; Zhao, Ju-cai; Wang, Yi-jin

    2006-06-01

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

  1. Comparison of the intramedullary nail and low-profile plate for unstable metacarpal neck fractures.

    Science.gov (United States)

    Fujitani, Ryotaro; Omokawa, Shohei; Shigematsu, Koji; Tanaka, Yasuhito

    2012-07-01

    There is no robust evidence for the best treatment practice for metacarpal neck fractures. The purpose of this comparative study was to investigate whether the intramedullary nail or low-profile plate allows for good clinical and radiological results for displaced metacarpal neck fractures. We prospectively reviewed 30 patients with a displaced metacarpal neck fracture who underwent surgery: 15 with intramedullary nails and 15 with low-profile plates. Radiographic and clinical outcomes of both groups were compared. Objective findings of range of finger motion and grip strength were assessed at 3, 6, and 12 months postoperatively. There was no non-union, and postoperative complications included extensor tendon rupture in one and transient ulnar nerve neuritis in two. Radiological parameters after the fracture healing were comparable between the two groups. Postoperative range of finger motion was better in patients with the intramedullary nail, and acquired grip strength in the low-profile plate group was superior to that in the intramedullary nail group. The current results indicate that both procedures are highly effective in maintaining fracture restorations. Plate fixation provides earlier recovery of powerful hand function, and intramedullary nailing allows a wide range of finger motion.

  2. Medial migration of the intramedullary Gamma 3 nail - a case report

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    Ana Costa Pinheiro

    Full Text Available ABSTRACT Intertrochanteric femur fractures are very common in patients over 65 years old, and are often associated with osteoporosis. Proximal femoral nails are preferred because of their biomechanical advantages in the treatment of these fractures, especially if the fracture is unstable. However, many complications associated with intramedullary fracture fixation have been described. The medial migration of the intramedullary gamma nail is a rare complication. The authors report an uncommon but potentially fatal complication, medial and intrapelvic migration of the intramedullary Gamma 3 nails, recorded after one month of osteosynthesis. This article aims to alert the orthopedic community to this rare complication, which may present a high risk of morbidity and mortality.

  3. Biomechanical analysis of a synthetic femoral spiral fracture model: Do end caps improve retrograde flexible intramedullary nail fixation?

    Science.gov (United States)

    Kaiser, Martin M; Zachert, Gregor; Wendlandt, Robert; Rapp, Marion; Eggert, Rebecca; Stratmann, Christine; Wessel, Lucas M; Schulz, Arndt P; Kienast, Benjamin J

    2011-09-18

    Elastic Stable intramedullary Nailing (ESIN) of dislocated diaphyseal femur fractures has become an accepted method for the treatment in children and adolescents with open physis. Studies focused on complications of this technique showed problems regarding stability, usually in complex fracture types such as spiral fractures and in older children weighing > 40 kg. Biomechanical in vitro testing was performed to evaluate the stability of simulated spiral femoral fractures after retrograde flexible titanium intramedullary nail fixation with and without End caps. Eight synthetic adolescent-size femoral bone models (Sawbones® with a medullar canal of 10 mm and a spiral fracture of 100 mm length identically sawn by the manufacturer) were used for each group. Both groups underwent retrograde fixation with two 3.5 mm Titanium C-shaped nails inserted from medial and lateral entry portals. In the End Cap group the ends of the nails of the eight specimens were covered with End Caps (Synthes Company, Oberdorf, Switzerland) at the distal entry. Beside posterior-anterior stress (4.11 Nm/mm vs. 1.78 Nm/mm, p Caps demonstrated no higher stability in 4-point bending compared to the group without End Caps (anterior-posterior bending 0.27 Nm/mm vs. 0.77 Nm/mm, p difference (0.37 Nm/° vs. 0.32 Nm/°, p = 0.13 and 1.29 mm vs. 2.18 mm, p = 0.20, respectively) compared to the "classic" 2-C-shaped osteosynthesis without End Caps. In this biomechanical study the use of End Caps did not improve the stability of the intramedullary flexible nail osteosynthesis.

  4. Primary Unreamed and Unlocked Intramedullary Nailing of Femoral Shaft Fractures

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    EJB Sié

    2012-07-01

    Full Text Available In this retrospective study, we present our experience using open Küntscher nailing (K-nailing which is still performed in developing countries for femoral fractures. Of 157 acute fractures treated between January 2003 and December 2009, 100 were stable (63.7% and 135 were located within the middle third of the shaft (86%. Comminution was absent or minimal in 135 (86% cases. Fracture union was achieved at an average of 14 weeks (range, 10 - 25. The duration of follow-up was 17 months (range, 6 - 36. Final evaluation showed that 129 (82.2% patients had a good result according to modified Kempf’s criteria. The predominant complications were infection (n=5; 3.2%, nonunion (n=9; 5.5%, implant failure (n=11; 7%, and malunion (n=27; 17.3%. Open reduction and fixation with a tight fitting K- nail can give good results in selected acute femoral shaft fractures but knowledge of potential complications is needed.

  5. Theoretical Investigation Of Plate Fixation And Intramedullary Nailing Methods On Radius Fractures

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    Halim Kovacı

    2012-06-01

    Full Text Available While forearm fractures are often treated with plate-screw osteosynthesis, intramedullary nailing gained importance recently. For this aim, radius bone model was obtained using CT images, a fracture was introduced to the model and the callus, which is a structure forms during healing, was added to the model. Plate and intramedullary nail models were implemented to radius model. Structural behaviors of obtained models and callus on treatments with various implants were investigated under axial loading. In the light of these analyses, stresses on bone-implant structure and callus movement were investigated from the angle of application and treatment, depending on implant selection.

  6. [Intramedullary nailing in diaphyseal clavicle fractures using minimally invasive percutaneous reduction].

    Science.gov (United States)

    Müller, M; Freude, T; Stöckle, U; Kraus, T M

    2017-02-01

    Closed reduction and intramedullary nailing is common in diaphyseal clavicle fractures. The aim of this report is to demonstrate a surgical method with minimally invasive percutaneous reduction in cases where closed reduction fails. The procedure is associated with good cosmetic results. Percutaneous reduction using two reduction forceps enables intramedullary nailing without an open procedure. Open, multifragmented or non-dislocated fractures, oblique fractures due to postoperative dislocation or shortening risk, fracture having potential to become compound fractures, neurovascular complications, pseudoarthroses. The patient is in beach-chair position. After an incision, the nail is entered from medial, two reduction forceps are mounted percutaneously at the lateral and medial fragment. After reduction the nail is pushed forward into the lateral fragment. Thereby, the fracture hematoma is not disturbed for the most part. Early functional rehabilitation with maximal abduction and anteversion of 90° for 6 weeks. Anatomic reduction can be achieved with mild cosmetic impairment.

  7. Screw elastic intramedullary nail for the management of adult forearm fractures

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    Wasudeo Gadegone

    2012-01-01

    Full Text Available Background: The failure of the conventional nailing of both forearm bones or isolated fractures of radius and ulna pose a potential problem of nail migration and rotational instability, despite the best reduction. The purpose of this paper is to evaluate the results of screw elastic intramedullary nail for the treatment of adult diaphyseal fractures of both forearm bones, which effectively addresses the problems associated with the conventional nailing systems for the forearm fractures. Materials and Methods: Seventy-six adults with forearm fractures (radius and ulna or isolated fracture of the single bone were retrospectively evaluated. Fifty males and 26 females with the mean age of 38 years (range, 18-70 years underwent closed reduction and screw intramedullary nail fixation. Ten patients required limited open reduction. The fractures were classified according to the AO/OTA system. The average followup was 12 months (range, 6 to 18 months. Results: The mean surgical time was 45 minutes (35 to 65 minutes. The meantime to union was 14 weeks (10-21 weeks. The results were graded as excellent in 50, good in 18 patients, and acceptable in eight patients, using the criteria of Grace and Eversman. We had superficial infection in three cases, one case of delayed infection, painful bursa in two cases, delayed union in two cases, malunion with dislocation of the DRUJ in two cases, injury to the extensor tendon of the thumb in one case, and one case of incomplete radioulnar synostosis. Conclusion: Closed reduction and internal fixation of forearm fractures by screw intramedullary nails reestablishes the near normal relationship of the fractured fragments. Screw intramedullary nail effectively controls both rotatory forces and the migration of the nail. It produces excellent clinical results in isolated fractures of either bones, as well as both bones of the forearm in adults.

  8. Talectomy and tibiocalcaneal arthrodesis with intramedullary nail fixation for treatment of equinus deformity in adults.

    Science.gov (United States)

    Gursu, Sarper; Bahar, Hakan; Camurcu, Yalkin; Yildirim, Timur; Buyuk, Fettah; Ozcan, Cagri; Sahin, Vedat

    2015-01-01

    Severe equinovarus foot deformity in adults is a challenging problem. Conservative treatment rarely is effective, and operative options are limited. The aim of this study was to evaluate the results of talectomy and tibiocalcaneal arthrodesis with intramedullary nail fixation for the treatment of severe equinovarus deformity in adults. Twelve patients (average age 39 years, range 15-70 years) with severe equinovarus deformities of the foot were treated with talectomy and tibiocalcaneal arthrodesis with intramedullary nail fixation between March 2010 and February 2013. Average follow-up was 20 months (range 10-37 months). Tibiocalcaneal fusion was achieved in all patients at an average of 12 weeks (range 8-17 weeks). Preoperatively, all patients had severe, irreducible equinovarus deformities; at last follow-up, almost all feet had mild residual deformity, but were plantigrade and did not require a brace or orthosis. The average AOFAS ankle score improved from 41.1 (range 8-66) preoperatively to 78.4 (range 67-86) postoperatively (P = .02). There was a similar improvement in the average VAS score from 6.3 (range 2-10) preoperatively to 0.8 (range 0-4) postoperatively (P = .02). The combination of talectomy and tibiocalcaneal arthrodesis was effective in correcting severe rigid equinovarus deformity in adults. Removal of the talus resulted in laxity of the soft tissues, making correction of the deformity easier. Tibiocalcaneal arthrodesis achieved a stable foot without the problems associated with talectomy alone. Level IV, case series. © The Author(s) 2014.

  9. Intramedullary nailing appears to be superior in pertrochanteric hip fractures with a detached greater trochanter

    DEFF Research Database (Denmark)

    Palm, Henrik; Lysén, Charlotte; Krasheninnikoff, Michael

    2011-01-01

    In recent years, intramedullary nails (INs) for the treatment of pertrochanteric hip fractures have gained prominence relative to conventional, sliding hip screws (SHSs). There is little empirical background for this development, however. A previous series of ours suggested that the use of SHS...

  10. Locked Intramedullary Nailing of Femur and Tibia in a Semi Urban ...

    African Journals Online (AJOL)

    Background: Long bone fractures of the extremities are increasingly becoming a common clinical presentation of the trauma patients to the emergency unit of most urban hospital in Nigeria due to increasing vehicular traffic on our roads. Locked intramedullary nailing is the gold standard for operative treatment of these ...

  11. Local and Widespread Hyperalgesia After Isolated Tibial Shaft Fractures Treated with Intramedullary Nailing

    DEFF Research Database (Denmark)

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

    2016-01-01

    postoperatively after intramedullary nailing of tibial shaft fracture. METHODS: A total of 39 patients were included in this 12-month follow-up study. After 6 weeks, 3, 6, and 12 months postoperatively the pain intensity was measured on a visual analog scale (VAS) and the pressure pain sensitivity was assessed...

  12. Comparison of Tibial Intramedullary Nailing Guided by Digital Technology Versus Conventional Method: A Prospective Study.

    Science.gov (United States)

    Liu, Lin; Xu, Xian; Li, Xu; Wu, Wei; Cai, Junfeng; Lu, Qingyou

    2017-06-12

    BACKGROUND This prospective study aimed to compare clinical effects of intramedullary nailing guided by digital and conventional technologies in treatment of tibial fractures. MATERIAL AND METHODS Thirty-two patients (mean age 43 years, 18 males and 14 females) who were treated for tibial fractures from October 2010 to October 2012 were enrolled. They were sequentially randomized to receive intramedullary nailing guided by either digital technology (digital group, n=16) or conventional technology (conventional group, n=16). The operation time, fluoroscopy times, fracture healing time, distance between the actual and planned insertion point, postoperative lower limb alignment, and functional recovery were recorded for all patients. RESULTS The mean operation time in the digital group was 43.1±6.2 min compared with 48.7±8.3 min for the conventional technology (P=0.039). The fluoroscopy times and distance between the actual and planned insertion point were significantly lower in the digital group than in the conventional group (both Pdigital technology. No difference was found in fracture healing time and good postoperative lower limb alignment between the digital and conventional groups (P=0.083 and P=0.310), as well as the effective rate (100% vs. 87.50%, P=0.144). CONCLUSIONS Intramedullary nailing guided by digital technology has many advantages in treatment of tibial fractures compared to conventional technology, including shorter operation time, reduced fluoroscopy times, and decreased distance between the actual and planned insertion point of the intramedullary nail.

  13. [Distal tibia peri-implant fracture with an intramedullary nail: a case report].

    Science.gov (United States)

    Reyes-Cabrera, J M; González-Alconada, R; García-Mota, M D

    2013-01-01

    Peri-implant fractures of the distal tibia after intramedullary nailing are rare. We present a case of a fracture of the distal tibia at the site of the distal interlocking screw. We found two cases reported in the world literature. There are no cases reported in the Spanish literature. © 2013 SECOT. Published by Elsevier Espana. All rights reserved.

  14. Prognostic factors for predicting outcomes after intramedullary nailing of the tibia

    NARCIS (Netherlands)

    Schemitsch, Emil H.; Bhandari, Mohit; Guyatt, Gordon; Sanders, David W.; Swiontkowski, Marc; Tornetta, Paul; Walter, Stephen D.; Zdero, Rad; Goslings, J. C.; Teague, David; Jeray, Kyle; McKee, Michael D.; Sprague, Sheila; Heels-Ansdell, Diane; Buckingham, Lisa; Leece, Pamela; Viveiros, Helena; Mignott, Tashay; Ansell, Natalie; Sidorkewicz, Natalie; Agel, Julie; Bombardier, Claire; Berlin, Jesse A.; Bosse, Michael; Browner, Bruce; Gillespie, Brenda; Jones, Alan; O'Brien, Peter; Poolman, Rudolf; Kreder, Hans J.; Stephen, David J. G.; Axelrod, Terry S.; Yee, Albert J. M.; Richards, Robin R.; Finkelstein, Joel; Gofton, Wade; Murnaghan, John; Schatztker, Joseph; Ford, Michael; Bulmer, Beverly; Conlan, Lisa; Laflamme, G. Yves; Berry, Gregory; Beaumont, Pierre; Ranger, Pierre; Laflamme, Georges-Henri; Gagnon, Sylvain; Malo, Michel; Fernandes, Julio; Poirier, Marie-France; Waddell, James P.; Bogoch, Earl R.; Daniels, Timothy R.; McBroom, Robert R.; Vicente, Milena R.; Storey, Wendy; Wild, Lisa M.; McCormack, Robert; Perey, Bertrand; Goetz, Thomas J.; Pate, Graham; Penner, Murray J.; Panagiotopoulos, Kostas; Pirani, Shafique; Dommisse, Ian G.; Loomer, Richard L.; Stone, Trevor; Moon, Karyn; Zomar, Mauri; Webb, Lawrence X.; Teasdall, Robert D.; Birkedal, John Peter; Martin, David Franklin; Ruch, David S.; Kilgus, Douglas J.; Pollock, David C.; Harris, Mitchel Brion; Wiesler, Ethan Ron; Ward, William G.; Shilt, Jeffrey Scott; Koman, Andrew L.; Poehling, Gary G.; Kulp, Brenda; Creevy, William R.; Stein, Andrew B.; Bono, Christopher T.; Einhorn, Thomas A.; Brown, Desmond; Pacicca, Donna; Sledge, John B.; Foster, Timothy E.; Voloshin, Ilva; Bolton, Jill; Carlisle, Hope; Shaughnessy, Lisa; Obremskey, William T.; LeCroy, C. Michael; Meinberg, Eric G.; Messer, Terry M.; Craig, William L.; Dirschl, Douglas R.; Caudle, Robert; Harris, Tim; Elhert, Kurt; Hage, William; Jones, Robert; Piedrahita, Luis; Schricker, Paul O.; Driver, Robin; Godwin, Jean; Kregor, Philip James; Tennent, Gregory; Truchan, Lisa M.; Sciadini, Marcus; Shuler, Franklin D.; Driver, Robin E.; Nading, Mary Alice; Neiderstadt, Jacky; Vap, Alexander R.; Vallier, Heather A.; Patterson, Brendan M.; Wilber, John H.; Wilber, Roger G.; Sontich, John K.; Moore, Timothy Alan; Brady, Drew; Cooperman, Daniel R.; Davis, John A.; Cureton, Beth Ann; Mandel, Scott; Orr, R. Douglas; Sadler, John T. S.; Hussain, Tousief; Rajaratnam, Krishan; Petrisor, Bradley; Drew, Brian; Bednar, Drew A.; Kwok, Desmond C. H.; Pettit, Shirley; Hancock, Jill; Cole, Peter A.; Smith, Joel J.; Brown, Gregory A.; Lange, Thomas A.; Stark, John G.; Levy, Bruce A.; Swiontkowski, Marc F.; Garaghty, Mary J.; Salzman, Joshua G.; Schutte, Carol A.; Tastad, Linda; Vang, Sandy; Seligson, David; Roberts, Craig S.; Malkani, Arthur L.; Sanders, Laura; Dyer, Carmen; Heinsen, Jessica; Smith, Langan; Madanagopal, Sudhakar; Frantz-Bush, Linda; Coupe, Kevin J.; Tucker, Jeffrey J.; Criswell, Allen R.; Buckle, Rosemary; Rechter, Alan Jeffrey; Sheth, Dhiren Shaskikant; Urquart, Brad; Trotscher, Thea; Anders, Mark J.; Kowalski, Joseph M.; Fineberg, Marc S.; Bone, Lawrence B.; Phillips, Matthew J.; Rohrbacher, Bernard; Stegemann, Philip; Mihalko, William M.; Buyea, Cathy; Augustine, Stephen J.; Jackson, William Thomas; Solis, Gregory; Ero, U.; Segina, Daniel N.; Berrey, Hudson B.; Agnew, Samuel G.; Fitzpatrick, Michael; Campbell, Lakina C.; Derting, Lynn; McAdams, June; Ponsen, Kees Jan; Kloen, Peter; Joosse, Pieter; Winkelhagen, Jasper; Duivenvoorden, Raphaël; Teague, David C.; Davey, Joseph; Sullivan, J. Andy; Ertl, William J. J.; Puckett, Timothy A.; Pasque, Charles B.; Tompkins, John F.; Gruel, Curtis R.; Kammerlocher, Paul; Lehman, Thomas P.; Puffinbarger, William R.; Carl, Kathy L.; Weber, Donald W.; Jomha, Nadr M.; Goplen, Gordon R.; Masson, Edward; A, Lauren; Schaump, Lori N.; Jeray, Kyle J.; Goetz, David R.; Westberry, David E.; Broderick, J. Scott; Moon, Bryan S.; Tanner, Stephanie L.; Powell, James N.; Buckley, Richard E.; Elves, Leslie; John, Saint; Connolly, Stephen; Abraham, Edward P.; Steele, Trudy; Ellis, Thomas; Herzberg, Alex; Brown, George A.; Crawford, Dennis E.; Hart, Robert; Hayden, James; Orfaly, Robert M.; Vigland, Theodore; Vivekaraj, Maharani; Bundy, Gina L.; Miclau, Theodore; Matityahu, Amir; Coughlin, R. Richard; Kandemir, Utku; McClellan, R. Trigg; Lin, Cindy Hsin-Hua; Karges, David; Cramer, Kathryn; Watson, J. Tracy; Moed, Berton; Scott, Barbara; Beck, Dennis J.; Orth, Carolyn; Puskas, David; Clark, Russell; Jones, Jennifer; Egol, Kenneth A.; Paksima, Nader; Wai, Eugene K.; Johnson, Garth; Wilkinson, Ross; Gruszczynski, Adam T.; Vexler, Liisa

    2012-01-01

    Prediction of negative postoperative outcomes after long-bone fracture treatment may help to optimize patient care. We recently completed the Study to Prospectively Evaluate Reamed Intramedullary Nails in Patients with Tibial Fractures (SPRINT), a large, multicenter trial of reamed and unreamed

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

    Directory of Open Access Journals (Sweden)

    L Bonifacio

    2014-03-01

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

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

    DEFF Research Database (Denmark)

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

    2015-01-01

    PURPOSE:To examine the long-term outcome after intramedullary nailing of femoral diaphysial fractures measured as disease-specific patient reported function, walking ability, muscle strength, pain and quality of life (QOL). METHODS:Cross-sectional study. Retrospective review and follow-up with cl......PURPOSE:To examine the long-term outcome after intramedullary nailing of femoral diaphysial fractures measured as disease-specific patient reported function, walking ability, muscle strength, pain and quality of life (QOL). METHODS:Cross-sectional study. Retrospective review and follow......-up with clinical examination of 48 patients treated with intramedullary nailing after femoral shaft fracture between 2007 and 2010. The patients underwent a clinical examination and assessment of walking ability, maximal muscle strength during knee flexion and extension and hip abduction. Hip disability......-specific questionnaire (HOOS) after intramedullary nailing of femoral shaft fracture....

  17. Comparative analysis of uniplanar external fixator and retrograde intramedullary nailing for ankle arthrodesis in diabetic Charcot′s neuroarthropathy

    Directory of Open Access Journals (Sweden)

    Nakul S Shah

    2011-01-01

    Results: All five (100% patients treated by intramedullary nailing achieved radiological union on an average follow-up of 16 weeks. The external fixation group had significantly higher rate of complications with one amputation, four non unions (66.7% and a delayed union which went on to full osseous union. Conclusion: The retrograde intramedullary nailing for tibio-talar arthrodesis in Charcot′s neuroarthropathy yielded significantly better outcomes as compared to the use of uniplanar external fixator.

  18. 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 treatment of long bone fractures.

  19. commonly asked questions on the practice of intramedullary nailing

    African Journals Online (AJOL)

    The principle biomechanical property of the IM nail is its rigidity, that is, its bending stiffness. The rigidity of a commentary. Q3) What are the advantages of IMN over conventional plating? A) Closed nailing has the advantage of preserving the fracture biology as opposed to plating. Even done open, IMN may be done with ...

  20. Fractures of the Proximal Third Tibia Treated With Intramedullary Interlocking Nails and Blocking Screws

    Directory of Open Access Journals (Sweden)

    Zanaty Mohamed Al-Toukhy

    2016-10-01

    Full Text Available BACKGROUND: Internal splintage of proximal metaphyseal tibial fractures has gained acceptance as a method of early stabilization of such injuries. Intramedullary nailing is a challenging procedure. This study tries to evaluate treatment outcomes of closed reduction and intramedullary nailing with the aid of blocking screws to maintain the reduction and stabilize theses injuries. METHOD: Thirty patients (23 males and 7 females with proximal metaphyseal tibial fractures were treated and followed from June 2010 and February 2014 (44 months with average 19 months. Age ranged between 23 to 55 years (average, 38 years. According to A.O. Classification 13 cases were Type A2.1, 9 cases were Type A2.1 (II, and 8 cases were Type A3.2. Seven cases were open fractures and according to Gustilo Anderson classification 4 cases were Grade (I, 3 cases were Grade (II. All cases were treated by interlocking intramedullary tibial nailing assisted by the use of blocking screws technique. RESULTS: The results had been evaluated through the following parameters: (pain, union, malunion, infection, range of motions, walking capacity, extension lag, knee stability and implant and technical failure. All cases had been united. Excellent alignment obtained in 27 fractures (90%. Knee and Ankle joints range of motions were equivalent to the unaffected side in 25 patients (82%. Two patients got superficial wound infection (2.7%. The final functional results were evaluated through modified Karlstrom-Olerud Score and we get: Excellent: 20 cases (66.7%, Good: 7 cases (23.3%, Satisfactory: 2 cases (6.7% and Poor: 1 case (3.3%. DISCUSSION: Intramedullary nailing of proximal tibial fracture is a load sharing procedure, sparing the extraosseous blood supply, avoiding additional soft-tissue dissection, thereby minimizing the risk of postoperative complications. Also, it reduces the length of hospital stay and costs, enables early mobilization and achieves satisfactory outcomes

  1. Controversies in the intramedullary nailing of proximal and distal tibia fractures.

    Science.gov (United States)

    Tejwani, Nirmal; Polonet, David; Wolinsky, Philip R

    2014-10-01

    Management of tibia fractures by internal fixation, particularly intramedullary nails, has become the standard for diaphyseal fractures. However, for metaphyseal fractures or those at the metaphyseal-diaphyseal junction, choice of fixation device and technique is controversial. For distal tibia fractures, nailing and plating techniques may be used, the primary goal of each being to achieve acceptable alignment with minimal complications. Different techniques for reduction of these fractures are available and can be applied with either fixation device. Overall outcomes appear to be nearly equivalent, with minor differences in complications. Proximal tibia fractures can be fixed using nailing, which is associated with deformity of the proximal short segment. A newer technique-suprapatellar nailing-may minimize these problems, and use of this method has been increasing in trauma centers. However, most of the data are still largely based on case series. Copyright 2014 by the American Academy of Orthopaedic Surgeons.

  2. Comparative study between reamed versus unreamed interlocking intramedullary nailing in compound fractures of shaft tibia

    Directory of Open Access Journals (Sweden)

    Subhash Puri

    2013-01-01

    Full Text Available Background: Tibia is the commonest bones to sustain open injury because of subcutaneous position. Treatment of open fractures requires simultaneous management of both skeletal and soft tissue injury. Intramedullary nailing with reaming is generally considered to be contraindicated for open fractures tibia, because it damages the endosteal blood supply which will lead to non-union, deep infection. However, recent studies with or without reaming in open fracture tibia shows no influence in healing of fracture. Purpose: To compare the clinical and radiological results of intramedullary interlocking nailing of open fractures of the tibial shaft after reaming versus unreamed medullary canal. Materials and Methods: Between 2008 and 2011, we have treated 40 patients with compound tibia fracture (type I, II, IIIA by simultaneous care of wound and skeletal injury. Primary fixation for fracture stabilization was done by closed intramedullary interlock nailing either reamed or unreamed; the allocation to the two groups made on alternating basis. Wound was managed by thorough debridement with primary/delayed primary closure by suturing, split thickness skin grafting or fasciocutaneous flap cover. Active, non-weight bearing exercises were started from next post-op day. Partial weight bearing after suture removal was started on 12 th day. Further follow-up was done at 6 weeks interval for union. Results: Open fractures of shaft of tibia treated with unreamed/reamed interlocking nailing gave excellent results. In present series, 19 fractures (95% treated by unreamed and 19 (95% fractures treated by reamed technique, united within 6 months of injury. Delay in union was noticed in one patient treated by unreamed technique who had segmental and extensive soft tissue injury and in reamed nailing there was one patient with deep infection, which was treated with antibiotic coated nail. Conclusion: Time to complete union was similar in both groups. Adequate

  3. THE RESULT OF INTRAMEDULLARY NAILING WITH BONE GRAFTING OF TIBIA'S PATHOLOGIC FRACTURE

    Directory of Open Access Journals (Sweden)

    V. M. Shapovalov

    2010-01-01

    Full Text Available The authors give the clinical case of successful surgical treatment of patient with tibia's pathologic fracture by intramedullary nailing with bone grafting. The disadvantages of such patients' treatment by plaster immobilization and by some invasive methods like vascular autografting by Ilizarov's method and bone plating were also discussed. The obvious benefits of proposed surgical treatment technique of observed patient category are shown.

  4. Treatment of tibial diaphysis fractures with reamed and locked intramedullary nailing

    Directory of Open Access Journals (Sweden)

    Yahya Coşar

    2011-06-01

    Full Text Available The aim of this study was to evaluate the results of reamed and locked intramedullary nailing for tibial diaphysis fractures.Materials and methods: The study included 38 patients (26 males, 12 females who were treated with reamed and locked intramedullary nailing for tibial diaphysis fractures. Fractures were classified according to Gustilo-Anderson classification and functional results were assessed using the Johner-Wrush criteria.Results: The mean age was 36 years (range 18-61. There were 21 AO/ASIF type A, 16 type B, and 1 type C fractures. Twenty-four fracture were closed (63.1% and 14 (36.9% were open fractures. According to the Gustilo-Anderson classification, 9 were grade I, 4 patients grade II, and one grade IIIA open fractures. Intramedullary nailing was performed following open reduction in 18 patients, and closed reduction in 20. The mean time to surgery was 9.4 days and the mean follow-up was 29 months. Union was achieved in all patients within a mean of 17.6 weeks. Anterior knee pain developed in 18 patients and infection developed in three patients. Angular deformity less than 10º was developed 12 patients (31.6%. There were screw breakacge and synostosis in four and two patients respectively. According to the Johner-Wrush criteria, functional results were very good in 23 patients (60.5%, good in 12 patients (31.6% and fair in 3 (7.9% patients.Conclusion: Treatment of tibial diaphysis fractures with reamed and locked intramedullary nailing gives satisfactory results. It should be considered as first choice in the treatment of these fractures. J Clin Exp Invest 2011;2(2:168-74

  5. Skeletal metastatic disease of the femur: results by management with intramedullary nailing.

    Science.gov (United States)

    Märdian, S; Schaser, K-D; Ruppert, M; Melcher, I; Haas, N P; Schwabe, P

    2015-01-01

    PURPOSE OF THE STUDY This study aimed to analyse the outcome following intramedullary nailing for metastases of the femur in a large cohort with special regard to mechanical, implant associated complications and patient survival. Furthermore, we aimed to identify factors influencing the overall survival. MATERIAL AND METHODS All patients (n = 74) that underwent intramedullary nailing for metastatic disease of the femur between 2004 and 2008 and were retrospectively reviewed. Data were recorded from the patients' medical record and the outpatients' clinics files. Details about the tumour biology, the surgery performed as well as the postoperative care were documented. Survival data were extracted from patient records or obtained via communication with outpatient oncologists or the community registration office. RESULTS 74 (28 (37.8%) male, 46 (62.2%) female; p = 0.048) patients with a mean age of 64.4 ± 11.7 years were included. Breast (25, 33.8%), lung (18, 24.3%), bone marrow (7, 9.5%) and kidney (6, 8.1%) were the primary tumours in more than 75% of all patients. The mean overall survival was 17.5 (95% CI: 9.6 - 25.5) months. Patients with osseous metastases had a significant longer survival than patients with visceral and/or cerebral metastases (p = 0.025 and p = 0.032). CONCLUSION Intramedullary nailing represents a valuable fixation method for pathologic fractures or impending fractures of the femur in patients with an advanced stage of metastatic disease. It provides adequate stability to outlast the patient s remaining life-span. However, the balance must be found between therapeutic resignation and surgical overtreatment since operative treatment may be accompanied with serious complications. Key words: bone metastases, intramedullary nailing, metastatic disease, cement augmentation, osteolytic defect.

  6. Elastic Intramedullary Nailing of a Medial Clavicle Fracture in a Pediatric Patient

    Directory of Open Access Journals (Sweden)

    Michael J. Stark

    2017-01-01

    Full Text Available Introduction. Injuries to the medial clavicle in pediatric patients typically involve the physis and/or sternoclavicular joint. Clavicle fractures are one of the most common injuries in children, but ones at its medial end are rare. Most medial clavicle fractures are treated nonoperatively, but surgery is indicated in some cases. This original case report is unique in describing the use of an elastic intramedullary nail for fixation of a completely displaced medial clavicle fracture in a pediatric patient. Case Presentation. A pediatric patient sustained a completely displaced fracture of the medial clavicle. The fracture was lateral to the medial physis of the clavicle and did not involve the sternoclavicular joint. Internal fixation was achieved in an anatomic position with an elastic intramedullary nail. The postoperative course was unremarkable and resulted in complete healing of the fracture in an anatomic position. The patient returned to full activities without any pain or dysfunction. Conclusion. The use of elastic intramedullary nails is a viable option for internal fixation of displaced medial clavicle fractures. Knowledge of the surgical anatomy, potential implant complications, and rehabilitation principles is essential to a successful outcome.

  7. The intramedullary nailing using a single knee incision for treatment of extraarticular floating knee (nine cases

    Directory of Open Access Journals (Sweden)

    Omar Dahmani

    2014-01-01

    Full Text Available Context: Floating knee injuries are uncommon and complex injuries. Management of this injury has been variously described in the literature. Aims: We present the outcome of the intramedullary nailing using a single knee incision for treatment of extraarticular floating knee. Materials and Methods: We report a retrospective series of nine patients with extraarticular floating knee. Results: There were seven men and two women with an average age of 35 years. At least one of the fractures was open in three cases. The average Injury Severity Score was 17. According to Fraser′s classification, 100% of the cases are type I. All our patients were treated by the intramedullary nailing using a single knee incision. The mean operating time was 146 min. The mean follow-up is 19 months. According to the Karlstrφm criteria, the end results were excellent in two cases, good in four, acceptable in two, and poor in one. Bone union was achieved in eight cases with an average period of 93 days. Conclusions: The intramedullary nailing using a single knee incision has shown in this series better results.

  8. Architecture of the femoral medullary canal and working length for intramedullary nailing. Biomechanic indications for dynamic nailing.

    Science.gov (United States)

    Steriopoulos, K; Psarakis, S A; Savakis, C; Papakitsou, E; Christakis, D; Velivasakis, E

    1997-10-01

    We classified human femoral intramedullary architecture into 3 types. The cortex in the first type is thick and the medullary canal narrow with an even and smooth translation towards the metaphysis. In the second type, the cortex is thin and the canal wider, also evenly distributed along the entire length, while in the third type the canal narrows just distal to the subtrochanteric region and similarly a few centimeters distally. Some medullary canals of the second type do not allow dynamic nailing, while canals of the third type presents some difficulties for unreamed nails. Most medullary canals belong to the first and second type and only few belong to type three. We performed comparative experimental loading in 11 pairs of cadaveric fractured femora fixed with static and dynamic nailing. Dynamic nailing was found to behave as safely as static ones in the presence of a sound femoral shaft central and peripheral to the fracture with a length twice the diameter of the femur at the fracture level. This could be checked intraoperatively with gentle rotation under image intensifier. In a clinical series, dynamic nailing was performed in about one quarter of the patients with femoral shaft fractures (18 of 72 patients) with excellent results.

  9. Distal Femoral Complications Following Antegrade Intramedullary Nail Placement

    OpenAIRE

    Fantry, Amanda J.; Gregory Elia; Brian G. Vopat; Daniels, Alan H.

    2015-01-01

    While antegrade nailing for proximal and diaphyseal femur fractures is a commonly utilized fixation method with benefits including early mobilization and high rates of fracture union, both intraoperative and postoperative complications may occur. Intraoperative errors include leg length discrepancy, anterior cortical perforation, malreduction of the fracture, and neurovascular injury, and postoperative complications include nonunion, malunion, infection, and hardware failure. This case series...

  10. Intramedullary fixation of forearm fractures with new locked nail

    Directory of Open Access Journals (Sweden)

    Himanshu Bansal

    2011-01-01

    Conclusion: This new interlocking nail may be considered as an alternative to plate osteosynthesis for fractures of the forearm in adults. The advantages are benefit of closed reduction, smaller residual scar, reduced cost and early union with allowance of immediate movements.

  11. Intramedullary Nailing and External Ring Fixation for Tibiotalocalcaneal Arthrodesis in Charcot Arthropathy.

    Science.gov (United States)

    Richman, James; Cota, Adam; Weinfeld, Steven

    2017-02-01

    Surgical strategies to address deformities of the ankle and hindfoot in patients with Charcot arthropathy include the use of retrograde intramedullary nails and ring fixators. The literature has not shown superiority of one technique over the other. This study presents a single surgeon's case series of Charcot arthropathy patients treated with either a ring fixator or retrograde intramedullary nail to achieve tibiotalocalcaneal arthrodesis. We performed a retrospective analysis of 27 consecutive patients with Charcot arthropathy who underwent a tibiotalocalcaneal arthrodesis using either a retrograde intramedullary (IM) nail (n = 16 patients) or a ring fixator (RF) (n = 11 patients) by a single surgeon. We report the rates of limb salvage complications requiring secondary surgery and fusion in both groups. The patient demographics and presence of medical comorbidities known to increase the risk of surgical complications were similar between groups. The mean duration of follow-up for the retrograde nail group was 3.6 years and 2.2 years for the ring fixator group. The mean time to discharge from the hospital after the index surgical procedure was 2.7 days for the IM group and 4.6 days for the RF group. For the patients treated with a ring fixator, the mean time to removal of the frame after the initial application was 13.3 ± 1.8 weeks. The limb salvage rate for the RF group was 9 of 11 patients whereas it was 15 of 16 in the IM group. Complications including deep infection, hardware failure, and symptomatic nonunion requiring revision surgery were common in the IM group, with 11 of 16 patients requiring further surgery. Seven patients in the IM group required removal of the implant at a mean of 117.2 weeks after the index procedure because of the development of deep infection or nail cutout. In the RF group, only 1 patient required revision surgery. Fusion rates were similar between both groups, with 10 of 16 patients fusing in the IM group and 7 of 11 in the RF

  12. In Vivo Caprine Model for Osteomyelitis and Evaluation of Biofilm-Resistant Intramedullary Nails

    Directory of Open Access Journals (Sweden)

    Nhiem Tran

    2013-01-01

    Full Text Available Bone infection remains a formidable challenge to the medical field. The goal of the current study is to evaluate antibacterial coatings in vitro and to develop a large animal model to assess coated bone implants. A novel coating consisting of titanium oxide and siloxane polymer doped with silver was created by metal-organic methods. The coating was tested in vitro using rapid screening techniques to determine compositions which inhibited Staphylococcus aureus growth, while not affecting osteoblast viability. The coating was then applied to intramedullary nails and evaluated in vivo in a caprine model. In this pilot study, a fracture was created in the tibia of the goat, and Staphylococcus aureus was inoculated directly into the bone canal. The fractures were fixed by either coated (treated or non-coated intramedullary nails (control for 5 weeks. Clinical observations as well as microbiology, mechanical, radiology, and histology testing were used to compare the animals. The treated goat was able to walk using all four limbs after 5 weeks, while the control was unwilling to bear weight on the fixed leg. These results suggest the antimicrobial potential of the hybrid coating and the feasibility of the goat model for antimicrobial coated intramedullary implant evaluation.

  13. 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

    2017-11-18

    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

  14. Efficacy comparison of intramedullary nails, locking plates and conservative treatment for displaced proximal humeral fractures in the elderly

    Directory of Open Access Journals (Sweden)

    Ge W

    2017-11-01

    Full Text Available Wei Ge,* Qi Sun,* Gen Li, Guanghua Lu, Ming Cai, ShaoHua Li Department of Orthopedics, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China *These authors contributed equally to this work Purpose: The incidence of proximal humeral fractures is high in the elderly, and the superior management of these fractures remains a controversy. The study aims to compare clinical outcomes of intramedullary nails, locking plates and conservative treatment for the management of displaced proximal humeral fractures in the elderly. Patients and methods: In this prospective study, a total of 198 patients with 2- or 3-part proximal humeral fractures who received fixation of locking plates or intramedullary nails or conservative treatment were included. The primary outcome was the 24-month Constant–Murley score. The secondary outcomes included the American Shoulder and Elbow Surgeons (ASES scores, the visual analog scale (VAS pain scores, shoulder range of motion and complication rate. Results: There were no statistically significant differences in the Constant–Murley scores and ASES scores among the plate group, the nail group and the conservative group for 2-part fractures. For 3-part fractures, Constant–Murley scores and ASES scores were lower in the conservative group compared with those in the plate group and the nail group. Besides, the conservative group showed a significantly lower external rotation during follow-ups. The complication rate was comparable among the plate group, the nail group and the conservative group for both 2-part and 3-part fractures. Conclusion: Similar satisfactory functional outcomes can be achieved with the locking plates, intramedullary nails or conservative treatment for 2-part proximal humeral fractures in the elderly. The advantages in functional outcomes favor locking plates and intramedullary nails in the management of 3-part proximal humeral fractures. Keywords

  15. Biocompatibility of sol-gel-derived titania-silica coated intramedullary NiTi nails.

    Science.gov (United States)

    Muhonen, V; Kujala, S; Vuotikka, A; Aäritalo, V; Peltola, T; Areva, S; Närhi, T; Tuukkanen, J

    2009-02-01

    We investigated bone response to sol-gel-derived titania-silica coated functional intramedullary NiTi nails that applied a continuous bending force. Nails 26 mm in length, either straight or with a radius of curvature of 28 or 15 mm, were implanted in the cooled martensite form from a proximal to distal direction into the medullary cavity of the right femur in 40 Sprague-Dawley rats. Body temperature restored the austenite form, causing the curved implants to generate a bending force on the bone. The femurs were examined after 24 weeks. Bone length measurements did not reveal any bowing or shortening of the bone in the experimental groups. The results from histomorphometry demonstrated that the stronger bending force, together with sol-gel surface treatment, resulted in more bone deposition around the implant and the formation of significantly less fibrous tissue. Straight intramedullary nails, even those with a titania-silica coating, were poorly attached when compared to the implants with a curved austenite structure.

  16. Fluoroscopic freehand and electromagnetic-guided targeting system for distal locking screws of humeral intramedullary nail.

    Science.gov (United States)

    Persiani, P; Gurzi, M; Moreschini, O; Di Giacomo, G; Villani, C

    2017-04-01

    The current techniques used to lock distal screws for the nailing of long bone fractures expose the surgeons, radiologists and patients to a hearty dose of ionizing radiation. The Sureshot™ Distal Targeting System is a new technique that, with the same results, allows for shorter surgery times and, consequently, less exposure to radiation. The study was performed on 59 patients (34 males and 25 females) with a simple humerus fracture diagnosis, type 1.2.A according to the AO classification, who were divided into two groups. Group 1 was treated with ante-grade intramedullary nailing with distal locking screws inserted with a freehand technique. Group 2 was treated with the intramedullary nail using the Sureshot™ Distal Targeting System. Two intra-operative time parameters were evaluated in both groups: the time needed for the positioning of the distal locking screws and the time of exposure to ionizing radiations during this procedure. Group 2 showed a lower average distal locking time compared to group 1 (645.48″ vs. 1023.57″) and also a lower average time of exposure to ionizing radiation than in group 1 (4.35″ vs. 28.96″). The Sureshot™ Distal Targeting System has proven to be equally effective when compared to the traditional techniques, with the added benefits of a significant reduction in both surgical time and risk factors related to the exposure to ionizing radiation for all the operating room staff and the patient.

  17. Retrograde intramedullary nailing of the femur using a tibial nail--the adjunctive use of an existing implant: a case report.

    Science.gov (United States)

    Rodgers, W B; Kennedy, J G; Coran, D L; Goodman, L J; Lhowe, D W

    1996-01-01

    A 74-year-old male involved in a pedestrian-automobile collision sustained a comminuted supracondylar-diaphyseal femur fracture. The fracture was stabilized by retrograde intramedullary fixation with a Synthes unreamed tibial nail. Knee motion reached 0 degree-120 degrees by the sixth postoperative day and the fracture healed within twelve weeks. Twelve months after his injury, his knee motion was symmetric to his uninjured side and he had resumed full preinjury activities, including martial arts training. Although antegrade intramedullary nailing remains the treatment of choice for fractures of the femur, this case highlights the usefulness of retrograde nailing and demonstrates the adjunctive application of an existing implant, the tibial nail, in certain special trauma situations.

  18. Treatment of Gustilo grade III tibial fractures with unreamed intramedullary nailing versus external fixator: a meta-analysis.

    Science.gov (United States)

    Fang, Xiao; Jiang, Lei; Wang, Ying; Zhao, Liangyu

    2012-04-01

    Unreamed Intramedullary nailing and external fixation are 2 major treatments widely used in Gustilo grade III open tibial fractures, but the difference in effectiveness and complication remains controversial. We retrieved original publications of comparative studies from medical literature databases and selected 9 of them for a meta-analysis. Observation items include malunion and deep infection rate, non-union and comparison of time to union. The analysis showed a lower malunion rate using unreamed intramedullary nailing than external fixation. No significant differences were revealed in deep infection/nonunion rate and time to union. More studies of larger scale and better design are needed to reach an ultimate and definite conclusion.

  19. Flexible Intramedullary Nailing of Unstable and/or Open Tibia Shaft Fractures in the Pediatric Population.

    Science.gov (United States)

    Pandya, Nirav K

    2016-06-01

    Tibial shaft fractures are common injuries in the pediatric population, and can be treated conservatively the vast majority of the time. Yet, it is important to recognize that open and/or unstable tibial shaft fractures represent a different entity. Rigid intramedullary devices are generally contraindicated because of the skeletal immaturity of these patients, and external fixation is associated with a high complication rate. As a result, flexible nailing is being utilized with increasing frequency. It is essential for the clinician to understand the pearls and pitfalls associated with the utilization of these flexible nails; particularly in regards to their immediate use in the context of open fractures and the risk of compartment syndrome postoperatively after fixation.

  20. A CLINICAL STUDY OF SURGICAL MANAGEMENT OF FRACTURE SHAFT FEMUR IN ADULTS WITH INTRAMEDULLARY INTERLOCKING NAIL

    Directory of Open Access Journals (Sweden)

    A. M. Ilias Basha

    2017-07-01

    Full Text Available BACKGROUND Orthopaedic surgeons often encounter diaphyseal femur fractures, because these fracture most often result from high-energy trauma, one must have high index of suspicion for complications. Currently surgery is indicated for most femur fractures because of high rate of union, low rate of complications and advantage of early stabilization which decreases the morbidity and mortality rate in patients. The main stay of the treatment has been reamed interlocking intramedullary nailing, one of the frequently performed procedure for diaphyseal fracture of femur. MATERIALS AND METHODS We studied a total of 40 patients of fracture shaft of femur admitted in the Orthopaedic Department of Government General Hospital, Kurnool, treated with reamed femur intramedullary interlocking nailing. The common age group was ranging from 20 to 71 yrs. with average age group of 36 yrs. 32 patients were males, 8 were females. 26 patients had closed fracture, 10 had Gustillo Anderson Grade I compound and 4 had Grade II compound fracture. In 22 patients fracture was at M/3rd, in 10 patients it was at L/3rd level and in 8 patients it was at U/3rd level. 4 patients were operated by open interlocking nail and other 36 by closed technique using C-arm. RESULTS Injury surgery interval was 6.20 days on an average. Mean time for union was more in patients treated by open procedure (20 weeks as compared to closed technique (18.35 weeks. We found 2 patients developed superficial infection, which healed completely and 2 had deep infection with nonunion. In our series of 40 patients, 24 patients had excellent results, 12 patients had good results, 2 fair results and 2 poor results, and functional evaluation was done using Thoresen et al classification system. CONCLUSION Interlocking intramedullary nailing is a very effective and successful method of definitive treatment in most types of fractures of the shaft of the femur. It is effective in controlling rotational and

  1. Decreased QOL and muscle strength are persistent 1 year after intramedullary nailing of a tibial shaft fracture

    DEFF Research Database (Denmark)

    Larsen, Peter; Elsoe, Rasmus; Laessoe, Uffe

    2016-01-01

    INTRODUCTION:To evaluate the development in patient-reported quality of life (QOL) and muscle strength in the period from surgery to 12 months postoperatively after intramedullary nailing of a tibial shaft fracture. MATERIALS AND METHODS:The design was a prospective, follow-up cohort study. QOL w...

  2. Character, Incidence, and Predictors of Knee Pain and Activity After Infrapatellar Intramedullary Nailing of an Isolated Tibia Fracture

    NARCIS (Netherlands)

    Obremskey, William; Agel, Julie; Archer, Kristin; To, Philip; Tornetta, Paul; Bhandari, Mohit; Guyatt, Gordon; Sanders, David W.; Schemitsch, Emil H.; Swiontkowski, Marc; Walter, Stephen; Sprague, Sheila; Heels-Ansdell, Diane; Buckingham, Lisa; Leece, Pamela; Viveiros, Helena; Mignott, Tashay; Ansell, Natalie; Sidorkewicz, Natalie; Bombardier, Claire; Berlin, Jesse A.; Bosse, Michael; Browner, Bruce; Gillespie, Brenda; Jones, Alan; O'Brien, Peter; Poolman, Rudolf; Macleod, Mark D.; Carey, Timothy; Leitch, Kellie; Bailey, Stuart; Gurr, Kevin; Konito, Ken; Bartha, Charlene; Low, Isolina; MacBean, Leila V.; Ramu, Mala; Reiber, Susan; Strapp, Ruth; Tieszer, Christina; Kreder, Hans J.; Stephen, David J. G.; Axelrod, Terry S.; Yee, Albert J. M.; Richards, Robin R.; Finkelstein, Joel; Gofton, Wade; Murnaghan, John; Schatztker, Joseph; Ford, Michael; Bulmer, Beverly; Conlan, Lisa; Laflamme, G. Yves; Berry, Gregory; Beaumont, Pierre; Ranger, Pierre; Laflamme, Georges-Henri; Gagnon, Sylvain; Malo, Michel; Fernandes, Julio; Poirier, Marie-France; McKee, Michael D.; Waddell, James P.; Bogoch, Earl R.; Daniels, Timothy R.; McBroom, Robert R.; Vicente, Milena R.; Storey, Wendy; Wild, Lisa M.; McCormack, Robert; Perey, Bertrand; Goetz, Thomas J.; Pate, Graham; Penner, Murray J.; Panagiotopoulos, Kostas; Pirani, Shafique; Dommisse, Ian G.; Loomer, Richard L.; Stone, Trevor; Moon, Karyn; Zomar, Mauri; Webb, Lawrence X.; Teasdall, Robert D.; Birkedal, John Peter; Martin, David Franklin; Ruch, David S.; Kilgus, Douglas J.; Pollock, David C.; Harris, Mitchel Brion; Wiesler, Ethan Ron; Ward, William G.; Shilt, Jeffrey Scott; Koman, Andrew L.; Poehling, Gary G.; Kulp, Brenda; Creevy, William R.; Stein, Andrew B.; Bono, Christopher T.; Einhorn, Thomas A.; Brown, T. Desmond; Pacicca, Donna; Sledge, John B.; Foster, Timothy E.; Voloshin, Ilva; Bolton, Jill; Carlisle, Hope; Shaughnessy, Lisa; Obremskey, William T.; LeCroy, C. Michael; Meinberg, Eric G.; Messer, Terry M.; Craig, William L.; Dirschl, Douglas R.; Caudle, Robert; Harris, Tim; Elhert, Kurt; Hage, William; Jones, Robert; Piedrahita, Luis; Schricker, Paul O.; Driver, Robin; Godwin, Jean; Kregor, Philip James; Tennent, Gregory; Truchan, Lisa M.; Sciadini, Marcus; Shuler, Franklin D.; Driver, Robin E.; Nading, Mary Alice; Neiderstadt, Jacky; Vap, Alexander R.; Vallier, Heather A.; Patterson, Brendan M.; Wilber, John H.; Wilber, Roger G.; Sontich, John K.; Moore, Timothy Alan; Brady, Drew; Cooperman, Daniel R.; Davis, John A.; Cureton, Beth Ann; Mandel, Scott; Orr, R. Douglas; Sadler, John T. S.; Hussain, Tousief; Rajaratnam, Krishan; Petrisor, Bradley; Drew, Brian; Bednar, Drew A.; Kwok, Desmond C. H.; Pettit, Shirley; Hancock, Jill; Cole, Peter A.; Smith, Joel J.; Brown, Gregory A.; Lange, Thomas A.; Stark, John G.; Levy, Bruce A.; Swiontkowski, Marc F.; Garaghty, Mary J.; Salzman, Joshua G.; Schutte, Carol A.; Tastad, Linda; Vang, Sandy; Seligson, David; Roberts, Craig S.; Malkani, Arthur L.; Sanders, Laura; Dyer, Carmen; Heinsen, Jessica; Smith, Langan; Madanagopal, Sudhakar; Frantz-Bush, Linda; Coupe, Kevin J.; Tucker, Jeffrey J.; Criswell, Allen R.; Buckle, Rosemary; Rechter, Alan Jeffrey; Sheth, Dhiren Shaskikant; Urquart, Brad; Trotscher, Thea; Anders, Mark J.; Kowalski, Joseph M.; Fineberg, Marc S.; Bone, Lawrence B.; Phillips, Matthew J.; Rohrbacher, Bernard; Stegemann, Philip; Mihalko, William M.; Buyea, Cathy; Augustine, Stephen J.; Jackson, William Thomas; Solis, Gregory; Ero, Sunday U.; Segina, Daniel N.; Berrey, Hudson B.; Agnew, Samuel G.; Fitzpatrick, Michael; Campbell, Lakina C.; Derting, Lynn; McAdams, June; Goslings, J. Carel; Ponsen, Kees Jan; Luitse, Jan; Kloen, Peter; Joosse, Pieter; Winkelhagen, Jasper; Duivenvoorden, Raphaël; Teague, David C.; Davey, Joseph; Sullivan, J. Andy; Ertl, William J. J.; Puckett, Timothy A.; Pasque, Charles B.; Tompkins, John F.; Gruel, Curtis R.; Kammerlocher, Paul; Lehman, Thomas P.; Puffinbarger, William R.; Carl, Kathy L.; Weber, Donald W.; Jomha, Nadr M.; Goplen, Gordon R.; Masson, Edward; Beaupre, Lauren A.; Greaves, Karen E.; Schaump, Lori N.; Jeray, Kyle J.; Goetz, David R.; Westberry, David E.; Broderick, J. Scott; Moon, Bryan S.; Tanner, Stephanie L.; Powell, James N.; Buckley, Richard E.; Elves, Leslie; Connolly, Stephen; Abraham, Edward P.; Steele, Trudy; Ellis, Thomas; Herzberg, Alex; Brown, George A.; Crawford, Dennis E.; Hart, Robert; Hayden, James; Orfaly, Robert M.; Vigland, Theodore; Vivekaraj, Maharani; Bundy, Gina L.; Miclau, Theodore; Matityahu, Amir; Coughlin, R. Richard; Kandemir, Utku; McClellan, R. Trigg; Lin, Cindy Hsin-Hua; Karges, David; Cramer, Kathryn; Watson, J. Tracy; Moed, Berton; Scott, Barbara; Beck, Dennis J.; Orth, Carolyn; Puskas, David; Clark, Russell; Jones, Jennifer; Egol, Kenneth A.; Paksima, Nader; France, Monet; Wai, Eugene K.; Johnson, Garth; Wilkinson, Ross; Gruszczynski, Adam T.; Vexler, Liisa

    2016-01-01

    To study the activity and incidence of knee pain after sustaining an isolated tibia fracture treated with an infrapatellar intramedullary nail at 1 year. Retrospective review of prospective cohort. Multicenter Academic and Community hospitals. Four hundred thirty-seven patients with an isolated

  3. Efficacy comparison of intramedullary nails, locking plates and conservative treatment for displaced proximal humeral fractures in the elderly

    Science.gov (United States)

    Li, Gen; Lu, Guanghua; Cai, Ming; Li, ShaoHua

    2017-01-01

    Purpose The incidence of proximal humeral fractures is high in the elderly, and the superior management of these fractures remains a controversy. The study aims to compare clinical outcomes of intramedullary nails, locking plates and conservative treatment for the management of displaced proximal humeral fractures in the elderly. Patients and methods In this prospective study, a total of 198 patients with 2- or 3-part proximal humeral fractures who received fixation of locking plates or intramedullary nails or conservative treatment were included. The primary outcome was the 24-month Constant–Murley score. The secondary outcomes included the American Shoulder and Elbow Surgeons (ASES) scores, the visual analog scale (VAS) pain scores, shoulder range of motion and complication rate. Results There were no statistically significant differences in the Constant–Murley scores and ASES scores among the plate group, the nail group and the conservative group for 2-part fractures. For 3-part fractures, Constant–Murley scores and ASES scores were lower in the conservative group compared with those in the plate group and the nail group. Besides, the conservative group showed a significantly lower external rotation during follow-ups. The complication rate was comparable among the plate group, the nail group and the conservative group for both 2-part and 3-part fractures. Conclusion Similar satisfactory functional outcomes can be achieved with the locking plates, intramedullary nails or conservative treatment for 2-part proximal humeral fractures in the elderly. The advantages in functional outcomes favor locking plates and intramedullary nails in the management of 3-part proximal humeral fractures. PMID:29238180

  4. Restrictions in Quality of Life after Intramedullary Nailing of Tibial Shaft Fracture. A retrospective follow-up study of 223 cases

    DEFF Research Database (Denmark)

    Larsen, Peter; Lund, Hans; Læssøe, Uffe

    2014-01-01

    OBJECTIVE: To evaluate the long term outcome after intramedullary nailing of tibial shaft fracture. DESIGN: Retrospective, Cross sectional study. SETTING: Level I, Trauma Center. METHODS: Retrospective review of 294 patients treated with intramedullary nailing after tibial shaft fracture from 1998......-2008. The participants completed Knee Injury and Osteoarthritis Outcome Score (KOOS) and these data were compared with published reference population. INTERVENTION: Intramedullary nailing of tibial shaft fracture. MAIN OUTCOME MEASURES: KOOS RESULTS:A total of 223 patients agreed to participate (76%). Mean time...

  5. Open tibial shaft fractures. Treatment with intramedullary nailing after provisional stabilization with non penetrating external fixator

    Directory of Open Access Journals (Sweden)

    Jose Octavio Soares Hungri

    2013-12-01

    Full Text Available Objective: To evaluate the incidence of union, nonunion, deep infection and factors influencing the time of bone healing in the treatment of open tibial shaft fractures Gustilo and Anderson types I and II initially treated with a non penetrating external fixator (Pinless(r followed by an unreamed intramedullary locked nail (UTN(r. Methods: It is a prospective study of 39 open tibial shaft fractures. According to the AO classification, 16 patients (41.0% were type A, 17 (43.6% were type B and six (15.4% were type C. According to the Gustilo and Anderson classification, 14 patients (35.9% were type I and 25 (64.1% were type II. For the definitive stabilization of the fracture were used an unreamed intramedulary locked nail (UTN(r. Results: Bone healing was achieved in 97.4% of the cases, with a mean time of 21.2 weeks, ranging from 12 to 104 weeks. Deep infection was seen in 2.6% patients and malunion were seen in 5.1%. Only the presence of complications were statistically significant to the time of bone healing, with a risk of faster healing in patients without complications of 4.29 times (CI 95%: 1.25 -14.71 comparing to patients with complications. Conclusion: The treatment of open tibial shaft fractures with unreamed intramedullary locked nail allows high rates of bone healing, low rates of nonunion and deep infection, and only the presence of complications is statistically significant to the time of bone healing.

  6. Plate Versus Intramedullary Nail Fixation of Anterior Tibial Stress Fractures: A Biomechanical Study.

    Science.gov (United States)

    Markolf, Keith L; Cheung, Edward; Joshi, Nirav B; Boguszewski, Daniel V; Petrigliano, Frank A; McAllister, David R

    2016-06-01

    Anterior midtibial stress fractures are an important clinical problem for patients engaged in high-intensity military activities or athletic training activities. When nonoperative treatment has failed, intramedullary (IM) nail and plate fixation are 2 surgical options used to arrest the progression of a fatigue fracture and allow bone healing. A plate will be more effective than an IM nail in preventing the opening of a simulated anterior midtibial stress fracture from tibial bending. Controlled laboratory study. Fresh-frozen human tibias were loaded by applying a pure bending moment in the sagittal plane. Thin transverse saw cuts, 50% and 75% of the depth of the anterior tibial cortex, were created at the midtibia to simulate a fatigue fracture. An extensometer spanning the defect was used to measure the fracture opening displacement (FOD) before and after the application of IM nail and plate fixation constructs. IM nails were tested without locking screws, with a proximal screw only, and with proximal and distal screws. Plates were tested with unlocked bicortical screws (standard compression plate) and locked bicortical screws; both plate constructs were tested with the plate edge placed 1 mm from the anterior tibial crest (anterior location) and 5 mm posterior to the crest. For the 75% saw cut depth, the mean FOD values for all IM nail constructs were 13% to 17% less than those for the saw cut alone; the use of locking screws had no significant effect on the FOD. The mean FOD values for all plate constructs were significantly less than those for all IM nail constructs. The mean FOD values for all plates were 28% to 46% less than those for the saw cut alone. Anterior plate placement significantly decreased mean FOD values for both compression and locked plate constructs, but the mean percentage reductions for locked and unlocked plates were not significantly different from each other for either plate placement. The percentage FOD reductions for all plate

  7. A newly designed intramedullary nail for the treatment of diaphyseal forearm fractures in adults

    Directory of Open Access Journals (Sweden)

    Ibrahim Azboy

    2017-01-01

    Full Text Available Background: The treatment of diaphyseal forearm fractures using open reduction and plate fixation is generally accepted as the best choice in many studies. However, periosteal stripping, haematoma evacuation may result in delayed union, nonunion and infection. Refracture after plate removal is another concern. To overcome these problems intramedullary nails (IM with different designs have been used with various outcomes. However previous IM nails have some shortcomings such is rotational instability and interlocking difficulties. We evaluated the results of newly designed IM nail in the treatment of diaphyseal forearm fractures in adults. Materials and Methods: 32 patients who had been treated with the interlocking IM nail for forearm fractures between 2011 and 2014 were included in this study. There were 23 males and 9 females with mean age of 36 years (range 18-68 years. 22 patients (68.8% had both bone fractures. Nine patients (28.1% had open fractures. The remaining ten patients (31.2% had radius or ulna fractures. Grace and Eversmann rating system was used to assess functional evaluation. Patient reported outcomes were assessed using the Disabilities of the Arm, Shoulder and Hand (DASH questionnaire scores. Results: Union was achieved in all patients. The mean followup was 17 months (range 13 – 28 months. According to the Grace-Eversmann criteria, 27 patients (87.5% had excellent or good results. The mean DASH score was 14 (range 5-36. Overall complication rate was 12.5%. Superficial infection was encountered in two patients. One patient had delayed union, however fracture healed without any additional surgical procedure. One patient who had open grade 3A, comminuted proximal third radius fracture developed radioulnar synostosis. Conclusions: The new design IM interlocking forearm nail provides satisfactory functional and radiological outcomes in the treatment of adult diaphyseal forearm fractures.

  8. Comparison between Intramedullary Nailing and Percutaneous K-Wire Fixation for Fractures in the Distal Third of the Metacarpal Bone

    Directory of Open Access Journals (Sweden)

    Sung Jun Moon

    2014-11-01

    Full Text Available BackgroundTo compare clinical and radiographic outcomes between intramedullary nail fixation and percutaneous K-wire fixation for fractures in the distal third portion of the metacarpal bone.MethodsA single-institutional retrospective review identified 41 consecutive cases of metacarpal fractures between September 2009 and August 2013. Each of the cases met the inclusion criteria for closed, extra-articular fractures of the distal third of the metacarpal bone. The patients were divided by the method of fixation (intramedullary nailing or K-wire. Outcomes were compared for mean and median total active motion of the digit, radiographic parameters, and period until return to work. Complications and symptoms were determined by a questionnaire.ResultsDuring the period under review, 41 patients met the inclusion criteria, and the fractures were managed with either intramedullary nailing (n=19 or percutaneous K-wire fixation (n=22. The mean and median total active range of motion and radiographic healing showed no statistically significant difference between the two groups. No union failures were observed in either group. The mean operation time was shorter by an average of 14 minutes for the percutaneous K-wire fixation group. However, the intramedullary nailing group returned to work earlier by an average of 2.3 weeks. Complications were reported only in the K-wire fixation group.ConclusionsIntramedullary nailing fixation is advisable for fractures in the distal third of the metacarpal bone. It provides early recovery of the range of motion, an earlier return to work, and lower complication rates, despite potentially requiring a wire removal procedure at the patient's request.

  9. Comparison between Intramedullary Nailing and Percutaneous K-Wire Fixation for Fractures in the Distal Third of the Metacarpal Bone

    Science.gov (United States)

    Moon, Sung Jun; Roh, Si Young; Lee, Dong Chul; Kim, Jin Soo

    2014-01-01

    Background To compare clinical and radiographic outcomes between intramedullary nail fixation and percutaneous K-wire fixation for fractures in the distal third portion of the metacarpal bone. Methods A single-institutional retrospective review identified 41 consecutive cases of metacarpal fractures between September 2009 and August 2013. Each of the cases met the inclusion criteria for closed, extra-articular fractures of the distal third of the metacarpal bone. The patients were divided by the method of fixation (intramedullary nailing or K-wire). Outcomes were compared for mean and median total active motion of the digit, radiographic parameters, and period until return to work. Complications and symptoms were determined by a questionnaire. Results During the period under review, 41 patients met the inclusion criteria, and the fractures were managed with either intramedullary nailing (n=19) or percutaneous K-wire fixation (n=22). The mean and median total active range of motion and radiographic healing showed no statistically significant difference between the two groups. No union failures were observed in either group. The mean operation time was shorter by an average of 14 minutes for the percutaneous K-wire fixation group. However, the intramedullary nailing group returned to work earlier by an average of 2.3 weeks. Complications were reported only in the K-wire fixation group. Conclusions Intramedullary nailing fixation is advisable for fractures in the distal third of the metacarpal bone. It provides early recovery of the range of motion, an earlier return to work, and lower complication rates, despite potentially requiring a wire removal procedure at the patient's request. PMID:25396193

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

    Directory of Open Access Journals (Sweden)

    Olasunkanmi M Babalola

    2016-01-01

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

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

    Directory of Open Access Journals (Sweden)

    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.

  12. A Novel Closed Method to Retrieve Broken Teflon Tube During Intramedullary Nailing in Proximal Humeral Fracture

    Directory of Open Access Journals (Sweden)

    Yuk Fai Lau

    2017-12-01

    Full Text Available Broken medullary tubes have been used for intramedullary (IM nailing of femoral and tibial fractures. In these reported cases, fragments of the medullary tube were retrieved by opening the fracture sites or left in situ, which might jeopardize periosteal blood supply. We herein present the case of a 58-year-old woman who underwent IM nailing for proximal humeral fracture, which was complicated by breakage of the medullary tube intraoperatively. Different instruments including guide rods, straight forceps, and cement extract hook were used to retrieve the retained fragments from the medullary canal, but these attempts were unsuccessful. Finally, the fragments were successfully removed using an anterior cruciate ligament (ACL ENDOBUTTON depth gauge. This case highlights that medullary tubes can break during humeral IM nailing, which could be minimized by ensuring integrity of the medullary tube prior to surgery and disposing medullary tubes with more than 100 exposures. A novel method of using ACL ENDOBUTTON depth gauge to retrieve retained tube fragments is recommended because of its long and slim design.

  13. [Comparison of clinical effects between locking intramedullary nail fixation and skeletal traction in treating tibiofibula fractures].

    Science.gov (United States)

    Liu, Wei-jia; Mai, Min-jun; Liu, Yong-kun; Gao, Gen-ping

    2010-01-01

    To compare and evaluate clinical effects between locking intramedullary nail fixation and skeletal traction in order to provide the best therapeutic choice for tibiofibula fractures. From November 1989 to December 2000, 108 patients with tibiofibula fractures (group A) were treated with skeletal traction, there was 76 males and 32 females; the age was from 29 to 66 years with an average of (40.3 +/- 9.6) years; according to AO classification standard,48 cases were type A, 46 type B, 14 type C, of which the standard typing Gustio, type I in 15 cases, type II in 13, type III A in 2. And from January 2001 to July 2007, 57 patients with tibiofibula fractures (group B) were treated with locking intramedullary nail fixation,there was 40 males and 17 females,the age was from 21 to 69 years with an average of (38.1 +/- 8.9) years; according to AO classification standard, 27 cases were type A, 22 type B, 8 type C, of which the standard typing Gustio, type I in 7 cases, type II in 6, type III A in 1. Four indexes were compared, including the time of fracture healing, the time of achieved 90 degrees genuflection, the time of off-bed weight-bearing and complication. Comparison of fracture healing time: group A was (19.0 +/- 0.6) weeks and group B was (14.0 +/- 0.5) weeks; the time of achieved 90 degrees genuflection in group A was (92.0 +/- 8.2) d and in group B was (39.0 +/- 6.1) d; the time of off-bed weight-bearing in group A was (96.0 +/- 6.3) d and in group B was (38.0 +/- 6.5) d. Complication occurred in 42 cases in group A and 6 in group B. There was significantly difference in 4 items between two groups (P skeletal traction in treating tibiofibula fractures. Treatment of tibiaofibula fractures with locking intramedullary nail fixation can obtain satisfactory effect, which has less complication, the fracture heals and weigh-loading can be achieved early.

  14. A new technique of closed intramedullary nailing in fractures of the proximal humerus with varus deformity

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    A. N. Chelnokov

    2015-01-01

    Full Text Available Introduction. Varus displacement is common in fractures of the proximal humerus. Development of new low invasive surgical modalities providing anatomy restoration and non-traumatic fracture fixation is actual. Purpose of the study was development of the low invasive technique of closed interlocking nailing providing reduction of the typical varus displacement in fractures and posttraumatic deformities of the proximal humerus. Material and methods. A new technique of correction of the proximal humerus in fractures and posttraumatic deformities was applied in 12 patients - 7 with two-part fractures and 5 with posttraumatic varus deformities. The surgical technique includes application of a small wire circular external frame. Its proximal part is secured to the humeral head to reduce varus displacement along with connection to the distal part of the frame, and the reached alignment is fixed by an intramedullary nail. Results. In all 12 cases we succeeded to reduce the varus deformity. At 1 year follow-up healing was reached in 11 patients, and in one patient exchange compression nailing was performed. Constant score in 1 year was 76±17 after fracture treament, and 70±16 in posttraumatic deformities, which corresponeded to good results. Conclusion. The presented technique allows to reach 40-50° angular correction without open approach and significant soft tissue damage. The obtained results confirm efficacy of the new technique and pertinence of its use in patients with fractures and posttraumatic deformities of this localization. The introduced technique of closed nailing appears to be a promising approach in reconstructive surgery of the proximal humerus.

  15. Lengthening With Monolateral External Fixation Versus Magnetically Motorized Intramedullary Nail in Congenital Femoral Deficiency.

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    Szymczuk, Vivian L; Hammouda, Ahmed I; Gesheff, Martin G; Standard, Shawn C; Herzenberg, John E

    2017-07-28

    Limb lengthening for congenital femoral deficiency (CFD) with or without fibular hemimelia can be performed with both external and internal devices. The purpose of this study is to compare clinical outcomes of femoral lengthening utilizing monolateral external fixation versus a magnetically motorized intramedullary nail in patients with CFD with or without fibular hemimelia. This retrospective review included 62 patients with femoral lengthening, 32 patients had monolateral external fixation (group A), 30 patients had internal lengthening nail (group B). Mean age in years was 9.4±3.8 and 15.4±4.9 for groups A and B, respectively. Mean follow-up in years was 4.47±2.7 and 1.86±0.7 years for groups A and B, respectively. Mean lengthening achieved was 5.6±1.7 and 4.8±1.4 cm for group A and group B, respectively (P=0.052). Mean distraction index was 0.7±0.2 mm/d for group A and 0.7±0.2 mm/d for the group B (P=0.99). Mean consolidation index for group A was 29.3±12.7 and 34.8±11.2 d/cm for group B (P=0.08). Mean arc of motion before surgery and at final follow-up were similar between groups (P=0.35). Group A had significantly less range of motion at the end of distraction (P=0.0007) and at consolidation (P<0.0001). Both groups had similar rates of obstacles and complications. A significant difference between groups was found in the total problems (P<0.001) specifically with pin site/superficial infection (P<0.0001). The intramedullary nail had superior range of motion during the lengthening phase and at consolidation and an overall lower problem complication rate, while maintaining similar distraction and healing indices to monolateral external fixation. Internal lengthening nails represent a significant advance in technology for CFD lengthening. Level IV-therapeutic.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share

  16. Use of oral anticoagulants after intramedullary nailing of femur and tibial fractures in trauma department

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    A. K. Dulaev

    2014-01-01

    Full Text Available The authors evaluated of the effectiveness of new oral anticoagulants in patients with diaphyseal fractures of the femur and tibia.We analyzed the effectiveness of thromboprophylaxis in 85 patients with diaphyseal fractures of the femur and tibia in the early postoperative period. Patients were divided into 3 groups: group 1 - patients, who was taking enoxaparin, group 2 - dabigatran etexilate, group 3 - rivaroxaban. We evaluated the frequency of thromboembolic complications and bleeding for 4 weeks after intramedullary nailing of femur and tibia.The lowest frequency of postoperative bleeding was observed in patients treated with dabigatran etexilate. In addition, the minimum frequency of complications was observed among patients of the second group of the study (9.7% in the group receiving dabigatran etexilati compared with 27.8% for the combined group I and III.Statistically significant differences between groups of patients taking oral or parenteral anticoagulants was not obtained.

  17. The treatment of open tibial shaft fractures using an interlocked intramedullary nail without reaming.

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    Sanders, R; Jersinovich, I; Anglen, J; DiPasquale, T; Herscovici, D

    1994-12-01

    Between January 1989 and September 1991, 117 consecutive open tibial shaft fractures were treated at our institution. Of these, 64 (55%) met the inclusion criteria and were prospectively treated according to protocol using unreamed interlocking intramedullary nails as definitive fixation. Wounds were classified according to the method of Gustilo et al., and included 10 type I, 16 type II, and 38 type III (17 type IIIA, 21 type IIIB) wounds. Contraindications to intramedullary nailing included (a) fractures involving the proximal or distal one fifth of the tibia, (b) patients with open physes, and (c) an associated vascular injury (type IIIC). Proximal locking was routinely performed, whereas distal locking was used as needed for axial and/or rotational stability. Soft-tissue coverage was obtained after adequate debridement within 7 days: 26 of 64 fractures (41%) required a soft-tissue procedure (17 split-thickness skin grafts, eight free-tissue transfers, one rotational muscle flap). Patients were encouraged to bear full weight in a short leg cast or Sarmiento brace as soon as other injuries or pain permitted. Average follow-up time was 24.8 months (range 12-44) and was possible in 46 fractures (71.875%; nine of 10 type I, 12 of 16 type II, 10 of 17 type IIIA, and 15 of 21 type IIIB). Mean time to healing was as follows: type I, 4.8 months; type II, 4.7 months; type IIIA, 8.28 months; and type IIIB, 9.30 months. Twenty fractures exhibited a delay in healing (> 6 months). This included two of 12 type II (16%), six of 10 type IIIA (60%), and 12 of 15 type IIIB fractures (80%).(ABSTRACT TRUNCATED AT 250 WORDS)

  18. Multiple flexible intramedullary nailing for the treatment of humeral bone cysts

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    Guity M

    2007-06-01

    Full Text Available Background: Simple bone cyst is a common benign lesion in the proximal humerus, especially in prepubertal children. Up to 75 percent of patients with the bone cyst have a pathologic fracture and the most significant complication is recurrent pathologic fracture. Since the process of spontaneous healing of these fractures is rare, treatment is required. Ideal treatment for simple bone cyst should stabilize pathologic fractures, assist healing and provide a quick return to normal activity with reduced complication and recurrence. Methods: In this descriptive case series study, 24 patients with simple bone cysts of the humerus were selected for retrograde flexible intramedullary nailing from the lateral cortex of the distal humerus, since 2000 to 2005 at Imam Khomeini Hospital, Tehran. The mean age of the patients was 14.4 years, ranging from 6-39 years. Results were evaluated by plain radiography using the classification system of Capanna et al. Results: The mean duration of follow up for 23 of the patients was 31 (9-51 months. One patient with short-term of follow-up was excluded. Of these patients, 91.3% were healed either completely (65.2% or with residual minor defect (26.1%. Only one cyst (4.3% persisted with no response to treatment and one patient (4.3% had a recurrence of the cyst. However, there was no instance of recurrent pathologic fracture among these patients. Conclusion: This study shows that flexible intramedullary nailing is an effective treatment for humeral simple bone cysts that reduces the chance of complication, recurrence of cyst or pathologic fracture. This technique provides sufficient stability for quick return to normal activity.

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

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

    2014-01-01

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

  20. A novel smart navigation system for intramedullary nailing in orthopedic surgery.

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    Jaesuk Choi

    Full Text Available This paper proposes a novel smart surgical navigation system for intramedullary nailing in orthopedic surgery. Using a handle-integrated laser guidance module, the system can target a drill insertion point onto skin, indicating an accurate target position to perpendicularly access an invisible distal hole. The proposed handle-integration-based fixation of the laser guidance module precisely defines the relative position of the module with respect to the distal hole. Consequently, unlike conventional systems, the proposed system can indicate the target insertion point without any help from bulky and costly external position-tracking equipment that is usually required for compensating disturbances generated by external impacts. After insertion, a correct drilling direction toward the distal hole is guided by real-time drilling angle measurement modules-one integrated with the nail handle and the other with the drill body. Each module contains a 9-axis inertial sensor and a Bluetooth communication device. These two modules work together to provide real-time drilling angle data, allowing calculation of the directional error toward the center of the distal hole in real time. The proposed system removes the need for fluoroscopy and provides a compact and cost-effective solution compared with conventional systems.

  1. A novel smart navigation system for intramedullary nailing in orthopedic surgery.

    Science.gov (United States)

    Choi, Jaesuk; Kim, Jihun; Hwang, Jae Youn; Je, Minkyu; Kim, Jun-Young; Kim, Shin-Yoon

    2017-01-01

    This paper proposes a novel smart surgical navigation system for intramedullary nailing in orthopedic surgery. Using a handle-integrated laser guidance module, the system can target a drill insertion point onto skin, indicating an accurate target position to perpendicularly access an invisible distal hole. The proposed handle-integration-based fixation of the laser guidance module precisely defines the relative position of the module with respect to the distal hole. Consequently, unlike conventional systems, the proposed system can indicate the target insertion point without any help from bulky and costly external position-tracking equipment that is usually required for compensating disturbances generated by external impacts. After insertion, a correct drilling direction toward the distal hole is guided by real-time drilling angle measurement modules-one integrated with the nail handle and the other with the drill body. Each module contains a 9-axis inertial sensor and a Bluetooth communication device. These two modules work together to provide real-time drilling angle data, allowing calculation of the directional error toward the center of the distal hole in real time. The proposed system removes the need for fluoroscopy and provides a compact and cost-effective solution compared with conventional systems.

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

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

    2013-11-01

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

  3. Retrograde tibial nailing: a minimally invasive and biomechanically superior alternative to angle-stable plate osteosynthesis in distal tibia fractures.

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    Kuhn, Sebastian; Appelmann, Philipp; Mehler, Dorothea; Pairon, Philip; Rommens, Pol M

    2014-05-13

    Currently, antegrade intramedullary nailing and minimally invasive plate osteosynthesis (MIPO) represent the main surgical alternatives in distal tibial fractures. However, neither choice is optimal for all bony and soft tissue injuries. The Retrograde Tibial Nail (RTN) is a small-caliber prototype implant, which is introduced through a 2-cm-long incision at the tip of the medial malleolus with stab incisions sufficient for interlocking. During this project, we investigated the feasibility of retrograde tibial nailing in a cadaver model and conducted biomechanical testing. Anatomical implantations of the RTN were carried out in AO/OTA 43 A1-3 fracture types in three cadaveric lower limbs. Biomechanical testing was conducted in an AO/OTA 43 A3 fracture model for extra-axial compression, torsion, and destructive extra-axial compression. Sixteen composite tibiae were used to compare the RTN against an angle-stable plate osteosynthesis (Medial Distal Tibial Plate, Synthes®). Statistical analysis was performed by Student's t test. Retrograde intramedullary nailing is feasible in simple fracture types by closed manual reduction and percutaneous reduction forceps, while in highly comminuted fractures, the use of a large distractor can aid the reduction. Biomechanical testing shows a statistically superior stability (p maximum soft tissue protection by a minimally invasive surgical approach with the ability of secure fracture fixation by multiple locking options. Retrograde tibial nailing with the RTN is a promising concept in the treatment of distal tibia fractures.

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

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

    2007-09-01

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

  5. Management of a Tibial Plafond Lung Cancer Metastasis Using an Intramedullary Hindfoot Fusion Nail.

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    Hsu, Andrew R; Lindsay, Adam D

    2017-09-01

    Metastatic disease to the tibial plafond is rare with few reports in the literature. No consensus exists regarding surgical reconstruction of large structural defects of the ankle due to these lesions, as each treatment must be tailored to the individual patient's goals and prognosis. Cancer metastases pose a unique challenge to limb salvage as there is often bone loss and poor soft tissue quality combined with the need for postoperative adjuvant therapy. The goal of surgery is to obtain early weightbearing, pain relief, and a durable reconstruction that will outlive the patient. In this report, we present the case of an intraarticular fracture of the tibial plafond with severe bone loss due to a lung carcinoma metastasis. The patient was successfully treated with en bloc tumor excision, curettage, argon beam coagulation, tibiotalocalcaneal arthrodesis using an intramedullary hindfoot fusion nail, and bone cementation with postoperative chemotherapy and radiation. One year after surgery, the patient was able to bear full weight on the extremity without a brace or assistive device and had no pain in the ankle with no local tumor recurrence. Level V: Expert opinion.

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

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    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.

  7. [Effect of intramedullary reaming and nailing on the production of growth factors in the femur fracture callus in rats].

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    Mingo-Robinet, J; Valle-Cruz, J A; Ortega-Medina, L; Fuentes-Ferrer, M; López-Durán Stern, L

    2013-01-01

    Many studies have been conducted to determine the different effects that reaming or intramedullary nailing have on fracture healing, but there is no evidence in the literature of the effect of intramedullary reaming on osteogenesis. We performed a prospective study to analyse the effect of intramedullary reaming and nailing on the production of growth factors during the process of fracture healing in the femur of rats. A transverse mid-shaft non-comminuted femur fracture was produced in 64 rats; 34 rats did not receive any treatment, and a standardized surgical procedure was performed on 30 rats, by exposing the left knee, reaming the medullary canal from distal to proximal, and then fixing the fracture with a steel pin. The rats were sacrificed at the 24th hour, 4th, 7th and 15th days after the fracture. The amount of growth factors that appeared in the callus fracture was measured using histopathology studies. The primary categorical variables analysed were PDGFA, TGF2 and TGFβ-R2. These variables were analysed in each group at the different sacrifice times. The results of the primary variables of the study, stratified by the time until sacrifice, showed no statistically significant differences. Even if the presence of an intramedullary wire facilitates the fracture repair and the stabilising the bridge of bone between both edges of the fracture site, no evidence was found that reaming changes the expression of the growth factors studied (PDGFA, TGFβ-R2 and TGFβ2) during the callus formation in rats. © 2013 SECOT. Published by Elsevier Espana. All rights reserved.

  8. Incidence of infection after early intramedullary nailing of open tibial shaft fractures stabilized with pinless external fixators

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    Kulshrestha Vikas

    2008-01-01

    Full Text Available Background: A major drawback of conventional fixator system is the penetration of fixator pins into the medullary canal. The pins create a direct link between the medullary cavity and outer environment, leading to higher infection rates on conversion to intramedullary nailing. This disadvantage is overcome by the AO pinless fixator, in which the trocar points are clamped onto the outer cortex without penetrating it. This study was designed to evaluate the role of AO pinless fixators in primary stabilization of open diaphyseal tibial fractures that received staged treatment because of delayed presentation or poor general condition. We also analyzed the rate of infection on early conversion to intramedullary nail. Materials and Methods: This study is a retrospective review of 30 open diaphyseal fractures of tibia, which were managed with primary stabilization with pinless fixator and early exchange nailing. Outcome was evaluated in terms of fracture union and rate of residual infection. The data were compared with that available in the literature. Results: All the cases were followed up for a period of 2 years. The study includes Gustilo type 1 (n=10, 14 Gustilo type 2 (n=14, and type3 (n=6 cases. 6 cases (20% had clamp site infection, 2 cases (6.7% had deep infection, and in 28 cases (93% the fracture healed and consolidated well. Conclusion: This study has highlighted the valuable role of pinless external fixator in the management of open tibial fractures in terms of safety and ease of application as well as the advantage of early conversion to intramedullary implant without the risk of deep infection.

  9. Comparison of hybrid fixation versus dual intramedullary nailing fixation for forearm fractures in older children: Case-control study.

    Science.gov (United States)

    Feng, Yongzeng; Shui, Xiaolong; Wang, Jianshun; Cai, Leyi; Wang, Gang; Hong, Jianjun

    2016-06-01

    The aim of the present study was to compare the clinical outcomes of hybrid fixation using elastic stable intramedullary nailing (ESIN) for the radius and plate screw fixation for the ulna (Hybrid group) with dual ESIN fixation (D-ESIN group) for both-bone forearm fractures in children between 10 and 16 years of age. Fifty patients with both-bone forearm fractures (28 patients in the Hybrid group and 22 patients in the D-ESIN group) were reviewed. Functional outcomes were evaluated according to the criteria of Price et al. Radiological results were assessed by fracture union at three and six months and bone union time. Postoperative complications were also recorded. The times of fluoroscopy intraoperatively and duration of immobilization postoperatively were significantly lower in the Hybrid group (P < 0.05). The union rate of the ulna at three months postoperatively in the hybrid group was significantly higher than that in the D-ESIN group (P < 0.05). The average time of bone union was significantly shorter in the hybrid group than that in the D-ESIN group (P < 0.05). There were no differences according to the satisfactory rate and degree, the major and minor complications between the groups. Hybrid fixation is superior in terms of the times of fluoroscopy intraoperatively, duration of immobilization postoperatively, delayed union rate of the ulna and the average time of bone union. Therefore, hybrid fixation is an alternative treatment for both-bone forearm fractures in children between 10 and 16 years of age. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  10. Comparison of Posterior Approach With Intramedullary Nailing Versus Lateral Transfibular Approach With Fixed-Angle Plating for Tibiotalocalcaneal Arthrodesis.

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    Mulligan, Ryan P; Adams, Samuel B; Easley, Mark E; DeOrio, James K; Nunley, James A

    2017-12-01

    A variety of operative approaches and fixation techniques have been described for tibiotalocalcaneal (TTC) arthrodesis. The intramedullary (IM) nail and lateral, fixed-angle plating are commonly used because of ease of use and favorable biomechanical properties. A lateral, transfibular (LTF) approach allows for direct access to the tibiotalar and subtalar joints, but the posterior, Achilles tendon-splitting (PATS) approach offers a robust soft tissue envelope. The purpose of this study was to compare the results of TTC arthrodesis with either a PATS approach with IM nailing or LTF approach with fixed-angle plating. A retrospective review was performed on all patients who underwent simultaneous TTC arthrodesis with minimum 1 year clinical and radiographic follow up. Patients were excluded if they underwent TTC arthrodesis through an approach other than PATS or LTF, and received fixation without an IM nail or fixed-angle plate. Primary outcomes examined were union rate, revisions, and complications. Thirty-eight patients underwent TTC arthrodesis with a PATS approach and IM nailing, and 28 with a LTF approach and lateral plating. The overall union rate was 71%; 76% (29 of 38 patients) for the PATS/IM nail group, and 64% (18 of 28) for LTF/plating group ( P = .41). Symptomatic nonunion requiring revision arthrodesis occurred in 16% (6 of 38) of the PATS/IM nail group versus 7% (2 of 28) in the LTF/lateral plating group ( P = .45). There were no significant differences in individual tibiotalar or subtalar union rates, superficial wound problems, infection, symptomatic hardware, stress fractures, or nerve irritations. Union, revision, and complication rates were similar for TTC arthrodesis performed with a PATS approach and IM nail compared with an LTF approach and fixed-angle plate in a complex patient population. Both techniques were adequate, especially when prior incisions, preexisting hardware, or deformity preclude options. Level III, retrospective comparative

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

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    Sushil Thapa

    2016-08-01

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

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

    Science.gov (United States)

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

    2017-07-01

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

  13. Retrograde ankle arthrodesis using an intramedullary nail: a comparison of patients with and without diabetes mellitus.

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    Wukich, Dane K; Shen, James Y C; Ramirez, Claudia P; Irrgang, James J

    2011-01-01

    Tibiotalocalcaneal arthrodesis (TTCA) has been used for the salvage of severe deformity involving the ankle and hindfoot. The purpose of this study was to evaluate the results of retrograde intramedullary nailing (IMN) for severe ankle/hindfoot pathology in a group of patients with diabetic neuropathy and compare them with a cohort of nondiabetic patients. Our working hypothesis was that patients with diabetes mellitus (DM) and neuropathy would experience inferior outcomes and more postoperative complications than patients who did not have DM. Forty consecutive patients (17 with DM and 23 without DM) who had a minimum follow-up of 1 year were retrospectively reviewed. The mean follow-up was 33 months and the mean AOFAS Ankle Hindfoot Score significantly improved form 19 to 55. Patients with DM improved on average from 24 to 55 and patients without DM improved from 16 to 55. Although a postoperative complication was experienced in 59% of patients with DM compared with 44% of patients without DM, this difference did not reach statistical significance with the numbers available. More patients with DM used a brace at final follow-up than patients without DM. Those patients who had a history of preoperative skin ulceration had higher rates of infection than those patients who did not have skin ulcers. We did not find any significant postoperative differences in AOFAS Ankle Hindfoot Scores between those patients with DM versus patients without DM. On average, patients with DM demonstrated an improvement of 129% and patients without diabetes improved by 243%. With the numbers available, we were not able to confirm our hypothesis that patients with DM experienced significantly lower clinical outcomes than patients without DM. A study of 100 patients in each group would be necessary to achieve adequate power to conclusively state that DM had no impact on the final outcome. Copyright © 2011 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights

  14. Shanz Screws for Closed Reduction of Femoral Shaft Fractures during Intramedullary Nailing

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    A. Sedighy

    2008-01-01

    Full Text Available Introduction & Objective: Closed intramedullary nailing has become the standard treatment for femoral shaft fractures, but because the existing closed reduction methods are difficult and demanding, in the most trauma centers these fractures usually are treated by open reduction method. Our objective was close reduction of these difficult fractures by a simple but effective method using Schanz screws for manipulating fracture fragments on a radiolucent table.Materials & Methods: In this prospective study, 30 patients whose femoral shaft fractures required reduction were operated on a radiolucent table in the lateral position and their fractures reduced closed by Schanz pins and fixed with IM Rod. The patients were followed-up 1 year. Results: We obtained reduction in 93% of patients. Average time of reduction in the first 48 hours was 9.23minutes and after 48 hours it was 19.7minutes (p<0.05. Also time to reduction was dependent on amount of preoperative traction .When the amount of preoperative traction was 5kg, that time was 19.16minutes but in maximal amount of traction it was 10.29minutes. Time to reduction also was shorter in Winquist-Hansen type III and IV fractures than in type I and II fractures. There was 13% valgus deformity (5-10 o, 33% external malrotation (5-15 o and 37% shortening (up to 1-3 cm. But we had no infection and no need for blood transfusion or bone grafting.Conclusion: Schanz screws provide a very effective method for close reduction of femoral shaft fractures. Complications of this method are the same or even in some parts are less than other close reduction methods. The method is more successful if performed in the first 48 hours, or if the weight of preoperative skeletal traction is near to the maximum (15% of body weight.

  15. Locking plate versus retrograde intramedullary nail fixation for tibiotalocalcaneal arthrodesis A retrospective analysis

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    Chi Zhang

    2015-01-01

    Full Text Available Background: Tibiotalocalcaneal arthrodesis (TTCA surgery is indicated for the end-stage disease of the tibiotalar and subtalar joints.Although different fixation technique of TTCA has been proposed to achieve high fusion rate and low complication rate, there is still no consensus upon this point. The purpose of this study is to compare the clinical efficacy of retrograde intramedullary nail fixation (RINF and locking plate fixation (LPF for TTCA. Materials and Methods: Fifty four patients who underwent TTCA through the lateral approach with lateral fibular osteotomy using RINF (32 patients, 18 male/14 female, mean age: 48 or LPF (22 patients, 12 male/10 female, mean age: 51 between January 2007 and January 2010 were retrospectively analyzed. Demographic and clinical characteristics, surgery (operation time, blood loss outcomes (postoperative fusion rates, visual analog scale and foot and ankle surgery score and complications were compared. Results: The LPF group had a shorter operation time (72.3 ± 9.2 vs. 102.8 ± 11.1 min, P < 0.001, less blood loss (75.9 ± 20.2 vs. 140.0 ± 23.8 ml, P < 0.001 and less intraoperative fluoroscopy sessions (3.6 ± 0.9 vs. 8.4 ± 1.3, P < 0.001 than the RINF group. Patients were followed up for 12-24 months (mean of 16.2 months. Both groups had similar postoperative fusion rates (90.6% and 95.4% and the LPF group showed a nonsignificant lower complication rate (18.2% vs. 28.1% respectively. Patients at higher risk on nonunion due to rheumatoid diseases may have a lower nonunion rate with LPF than RINF (one out of eight vs. three out of nine, P < 0.001. Conclusions: The LPF for TTCA was simpler to perform compared with RINF, but with similar postoperative outcomes and complication rates.

  16. A comparison of compressive force generation by plating and intramedullary nailing techniques in a transverse diaphyseal humerus fracture model.

    Science.gov (United States)

    Virkus, Walter V; Goldberg, Steven H; Lorenz, Eric P

    2008-07-01

    The null hypothesis to be tested in this study is that the compression forces generated with a novel compressible intramedullary nail are not different from compression plating techniques. A custom sensor was used to measure the compressive force at a transverse midshaft humeral sawbone osteotomy (OTA 12-A3.2) in four groups. The groups included: standard compression plating using a limited contact dynamic compression plate (LCDC) with eccentric screw placement (ED-LCDC), compression plating using an LCDC plate with an articulated tensioner and eccentric compression screw (AT-LCDC), locked humeral nail compressed using the manufacturer's long stainless steel screwdriver (T2-IMN), and locked humeral nail compressed using a short stainless steel AO screwdriver (SF-IMN). From continuous measurements recorded during osteotomy compression, the maximum force (CMax) and force at 60 seconds after the peak measurement (CMax +60) were analyzed. The mean CMax was 2043 N for SF-IMN, 1109 N for AT-LCDC, 799 N for T2-IMN, and 365 N for ED-LCDC. Mean CMax +60 was 1648 N for SF-IMN, 944 N for AT-LCDC, 650 N for T2-IMN, and 319 N for ED-LCDC. The difference in both CMax and CMax +60 was statistically significant between all groups (p tensioner when used with a short stainless steel screwdriver shaft. Clinical studies are needed to analyze whether this compression could improve the union rate of humeral fractures and nonunions beyond those of standard nails.

  17. Early effect of Ti-24Nb-4Zr-7.9Sn intramedullary nails on fractured bone

    Energy Technology Data Exchange (ETDEWEB)

    Guo, Z., E-mail: guozheng@fmmu.edu.cn [Institute of Orthopaedics, Xijing Hospital, The Fourth Military Medical University, Xi' an 710032 (China); Fu, J.; Zhang, Y.Q.; Hu, Y.Y.; Wu, Z.G.; Shi, L.; Sha, M. [Institute of Orthopaedics, Xijing Hospital, The Fourth Military Medical University, Xi' an 710032 (China); Li, S.J. [Shenyang National Laboratory for Materials Science, Institute of Metal Research, Chinese Academy of Sciences, 72 Wenhua Road, Shenyang 110016 (China); Hao, Y.L., E-mail: ylhao@imr.ac.cn [Shenyang National Laboratory for Materials Science, Institute of Metal Research, Chinese Academy of Sciences, 72 Wenhua Road, Shenyang 110016 (China); Yang, R. [Shenyang National Laboratory for Materials Science, Institute of Metal Research, Chinese Academy of Sciences, 72 Wenhua Road, Shenyang 110016 (China)

    2009-04-30

    A multifunctional titanium Ti-24Nb-4Zr-7.9Sn alloy (abbreviated as Ti2448) with ultra-low elastic modulus and high strength has been developed recently for potential biomedical applications. In this study, the bone healing and stability of implants in a rabbit tibial fracture model were investigated using intramedullary nails made of both the Ti2448 and Ti-6Al-4V ELI alloys. X-ray radiographic analysis showed that the volume fractions of new calluses formed around the fractured tibia increased with implantation times up to 4 weeks in both groups but no obvious difference was found between the alloys at the same time point. The micro-CT analysis revealed that, in the distal end of the tibia, there were many new calluses around nails made of the Ti2448 alloy that were confirmed by histological observations. The above analysis was consistent with tensile testing results performed 4 weeks after implantation. The mean maximum tensile force to failure of the newly formed calluses was similar between both groups whereas the mean maximum pull-out forces of the implanted nails were larger in the group of the Ti2448 alloy. Four weeks after fixation, no obvious difference in the degree of fracture healing was found between both groups. These results suggested that, in the early stage of fixation, the nails with ultra-low elastic modulus improved the new bone formation in the marrow cavity.

  18. A COMPARATIVE STUDY OF REAMED AND UNREAMED INTRAMEDULLARY INTERLOCKING NAILING IN COMPOUND FRACTURES OF SHAFT OF TIBIA

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    Ravindra Gunaki

    2015-02-01

    Full Text Available INTRODUCTION : Whether to ream the compound tibia fr actures witle intramedullary interlocking nailing or not has been an eternal debate. So we have conducted a study to compare the functional outcomes, rate of infection and time needed for union in reamed and unreamed interlocking nailing on open tibia frac tures. METHODOLOGY: This study was carried out as a prospective, comparative study. 100 patients with open fractures of tibial shaft admitted in our hospital between J une 2011 and January 2013 were enrolled in the study. Patients outside the age group of 20 - 50years of age, severely ommuniated fractures and fractures classified under Gustilo Anderson type III b and IIIc were excluded. 100 fractures were divided into two groups (reamed nailing and unreamed nailing n=50 in each with simple randomization techn ique. Evaluation in the form of radiological union was done with serial x - rays and functional grading according to Klemm & Borner’s criteria for tibial shaft fractures was done at the end of 6 months. RESULTS: A verage fracture healing time was 16 - 20 weeks in both in undreamed nailing radiologically. Also, differences in rates of clinical union, clinical outcome, time for weight bearing and complication in both groups were not significant. Post - operative infection was found in 5 cases in reamed group and 3 c ases in unreamed group. CONCLUSION: There are no clear indications or contraindications or advantage/disadvantage to favour either reamed or unreamed nailing over each other. Fracture union, functional outcome and rate of complications are similar in both groups

  19. Plate versus intramedullary nail fixation in the treatment of humeral shaft fractures: an updated meta-analysis.

    Science.gov (United States)

    Ouyang, Hanbin; Xiong, Jun; Xiang, Peng; Cui, Zhuang; Chen, Liguang; Yu, Bin

    2013-03-01

    Regarding the treatment of humeral shaft fractures, the choice of plating or intramedullary nailing remains controversial. Previous randomized controlled trials and meta-analyses failed to draw a unanimous conclusion. To guide clinical decision making, we conducted an updated meta-analysis on the optimal treatment of humeral shaft fractures. We identified eligible studies published from 1969 to July 2011 using the Cochrane Library; Cochrane Bone, Joint and Muscle Trauma Group; MEDLINE; Embase; OVID; and Google Scholar and manually searched the references of relevant studies. Randomized controlled trials that compared nailing and plating in the treatment of humeral shaft fractures were included. After the methodologic assessment, available data were extracted and statistically reviewed. The primary outcomes were nonunion, delayed union, postoperative infection, reoperation, and radial nerve palsy. The secondary outcomes were restriction of shoulder motion, shoulder impingement, iatrogenic fracture comminution, and implant failure. We included 10 studies comparing plating and nailing in patients with humeral shaft fractures, comprising 439 participants. Plating reduced the risk of shoulder impingement and shoulder restriction in comparison with nailing. Regarding reoperation risk, a secondary sensitivity analysis showed the finding favoring plating over nailing remained unstable. Otherwise, no significant differences were found in postoperative infection, nonunion, delayed union, radial nerve palsy, iatrogenic fracture comminution, and implant failure between groups. On the basis of current evidence, both plating and nailing can achieve a similar treatment effect on humeral shaft fractures, but plating may reduce the occurrence of shoulder problems. Randomized controlled trials with larger sample sizes using appropriate blinding methods are needed to confirm these findings. Level II, Meta-analysis of prospective comparative trials. Copyright © 2013 Journal of

  20. (Sample) size matters! An examination of sample size from the SPRINT trial study to prospectively evaluate reamed intramedullary nails in patients with tibial fractures

    NARCIS (Netherlands)

    Bhandari, Mohit; Tornetta, Paul; Rampersad, Shelly-Ann; Sprague, Sheila; Heels-Ansdell, Diane; Sanders, David W.; Schemitsch, Emil H.; Swiontkowski, Marc; Walter, Stephen; Guyatt, Gordon; Buckingham, Lisa; Leece, Pamela; Viveiros, Helena; Mignott, Tashay; Ansell, Natalie; Sidorkewicz, Natalie; Agel, Julie; Bombardier, Claire; Berlin, Jesse A.; Bosse, Michael; Browner, Bruce; Gillespie, Brenda; O'Brien, Peter; Poolman, Rudolf; Macleod, Mark D.; Carey, Timothy; Leitch, Kellie; Bailey, Stuart; Gurr, Kevin; Konito, Ken; Bartha, Charlene; Low, Isolina; MacBean, Leila V.; Ramu, Mala; Reiber, Susan; Strapp, Ruth; Tieszer, Christina; Kreder, Hans; Stephen, David J. G.; Axelrod, Terry S.; Yee, Albert J. M.; Richards, Robin R.; Finkelstein, Joel; Holtby, Richard M.; Cameron, Hugh; Cameron, John; Gofton, Wade; Murnaghan, John; Schatztker, Joseph; Bulmer, Beverly; Conlan, Lisa; Laflamme, Yves; Berry, Gregory; Beaumont, Pierre; Ranger, Pierre; Laflamme, Georges-Henri; Jodoin, Alain; Renaud, Eric; Gagnon, Sylvain; Maurais, Gilles; Malo, Michel; Fernandes, Julio; Latendresse, Kim; Poirier, Marie-France; Daigneault, Gina; McKee, Michael M.; Waddell, James P.; Bogoch, Earl R.; Daniels, Timothy R.; McBroom, Robert R.; Vicente, Milena R.; Storey, Wendy; Wild, Lisa M.; McCormack, Robert; Perey, Bertrand; Goetz, Thomas J.; Pate, Graham; Penner, Murray J.; Panagiotopoulos, Kostas; Pirani, Shafique; Dommisse, Ian G.; Loomer, Richard L.; Stone, Trevor; Moon, Karyn; Zomar, Mauri; Webb, Lawrence X.; Teasdall, Robert D.; Birkedal, John Peter; Martin, David Franklin; Ruch, David S.; Kilgus, Douglas J.; Pollock, David C.; Harris, Mitchel Brion; Wiesler, Ethan Ron; Ward, William G.; Shilt, Jeffrey Scott; Koman, Andrew L.; Poehling, Gary G.; Kulp, Brenda; Creevy, William R.; Stein, Andrew B.; Bono, Christopher T.; Einhorn, Thomas A.; Brown, T. Desmond; Pacicca, Donna; Sledge, John B.; Foster, Timothy E.; Voloshin, Ilva; Bolton, Jill; Carlisle, Hope; Shaughnessy, Lisa; Ombremsky, William T.; LeCroy, C. Michael; Meinberg, Eric G.; Messer, Terry M.; Craig, William L.; Dirschl, Douglas R.; Caudle, Robert; Harris, Tim; Elhert, Kurt; Hage, William; Jones, Robert; Piedrahita, Luis; Schricker, Paul O.; Driver, Robin; Godwin, Jean; Hansley, Gloria; Obremskey, William Todd; Kregor, Philip James; Tennent, Gregory; Truchan, Lisa M.; Sciadini, Marcus; Shuler, Franklin D.; Driver, Robin E.; Nading, Mary Alice; Neiderstadt, Jacky; Vap, Alexander R.; Vallier, Heather A.; Patterson, Brendan M.; Wilber, John H.; Wilber, Roger G.; Sontich, John K.; Moore, Timothy Alan; Brady, Drew; Cooperman, Daniel R.; Davis, John A.; Cureton, Beth Ann; Mandel, Scott; Orr, R. Douglas; Sadler, John T. S.; Hussain, Tousief; Rajaratnam, Krishan; Petrisor, Bradley; Drew, Brian; Bednar, Drew A.; Kwok, Desmond C. H.; Pettit, Shirley; Hancock, Jill; Cole, Peter A.; Smith, Joel J.; Brown, Gregory A.; Lange, Thomas A.; Stark, John G.; Levy, Bruce; Swiontkowski, Marc F.; Garaghty, Mary J.; Salzman, Joshua G.; Schutte, Carol A.; Tastad, Linda Toddie; Vang, Sandy; Seligson, David; Roberts, Craig S.; Malkani, Arthur L.; Sanders, Laura; Gregory, Sharon Allen; Dyer, Carmen; Heinsen, Jessica; Smith, Langan; Madanagopal, Sudhakar; Coupe, Kevin J.; Tucker, Jeffrey J.; Criswell, Allen R.; Buckle, Rosemary; Rechter, Alan Jeffrey; Sheth, Dhiren Shaskikant; Urquart, Brad; Trotscher, Thea; Anders, Mark J.; Kowalski, Joseph M.; Fineberg, Marc S.; Bone, Lawrence B.; Phillips, Matthew J.; Rohrbacher, Bernard; Stegemann, Philip; Mihalko, William M.; Buyea, Cathy; Augustine, Stephen J.; Jackson, William Thomas; Solis, Gregory; Ero, Sunday U.; Segina, Daniel N.; Berrey, Hudson B.; Agnew, Samuel G.; Fitzpatrick, Michael; Campbell, Lakina C.; Derting, Lynn; McAdams, June; Goslings, J. Carel; Ponsen, Kees Jan; Luitse, Jan; Kloen, Peter; Joosse, Pieter; Winkelhagen, Jasper; Duivenvoorden, Raphaël; Teague, David C.; Davey, Joseph; Sullivan, J. Andy; Ertl, William J. J.; Puckett, Timothy A.; Pasque, Charles B.; Tompkins, John F.; Gruel, Curtis R.; Kammerlocher, Paul; Lehman, Thomas P.; Puffinbarger, William R.; Carl, Kathy L.; Weber, Donald W.; Jomha, Nadr M.; Goplen, Gordon R.; Masson, Edward; Beaupre, Lauren A.; Greaves, Karen E.; Schaump, Lori N.; Jeray, Kyle J.; Goetz, David R.; Westberry, Davd E.; Broderick, J. Scott; Moon, Bryan S.; Tanner, Stephanie L.; Powell, James N.; Buckley, Richard E.; Elves, Leslie; Connolly, Stephen; Abraham, Edward P.; Eastwood, Donna; Steele, Trudy; Ellis, Thomas; Herzberg, Alex; Brown, George A.; Crawford, Dennis E.; Hart, Robert; Hayden, James; Orfaly, Robert M.; Vigland, Theodore; Vivekaraj, Maharani; Bundy, Gina L.; Miclau, Theodore; Matityahu, Amir; Coughlin, R. Richard; Kandemir, Utku; McClellan, R. Trigg; Lin, Cindy Hsin-Hua; Karges, David; Cramer, Kathryn; Watson, J. Tracy; Moed, Berton; Scott, Barbara; Beck, Dennis J.; Orth, Carolyn; Puskas, David; Clark, Russell; Jones, Jennifer; Egol, Kenneth A.; Paksima, Nader; France, Monet; Wai, Eugene K.; Johnson, Garth; Wilkinson, Ross; Gruszczynski, Adam T.; Vexler, Liisa

    2013-01-01

    Inadequate sample size and power in randomized trials can result in misleading findings. This study demonstrates the effect of sample size in a large clinical trial by evaluating the results of the Study to Prospectively evaluate Reamed Intramedullary Nails in Patients with Tibial fractures (SPRINT)

  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. [Minimal invasive elastic intramedullary nails and external fixation for treatment of comminuted closed fracture of tibia-fibula shaft].

    Science.gov (United States)

    Yu, Yang; Chen, Wei-kai; Cui, Wei; Zhou, Yi-fei; Chen, Hua; Yang, Lei

    2015-05-01

    To investigate the clinical results of external fixation and AO titanium elastic intramedullary nailing for treatment of tibia-fibula comminuted closed fractures. From June 2010 to June 2012,58 patients with tibia-fibula comminuted closed fractures were treated with external fixation and AO titanium elastic intramedullary nailing, including 31 males and 27 females with an average age of 38.5 years old ranging from 21 to 57 years old. According to the system of AO Classification, the fractures were classified as type B1 in 9 cases,type B2 in 7 cases, type B3 in 10 cases, type Cl in 14 cases, type C2 in 12 cases,and type C3 in 6 cases. According to the system of Winquist-Hanson,the fractures' comminuted were classified as grade 1 in 23 cases, grade 2 in 17 cases, grade 3 in 12 cases, and grade 4 in 6 cases. According to the system of Johner-Wruhs, clinical results were compared between different type and grade groups by the time of last followed-up. All 58 patients were followed up with an average time of 6.8 months (ranged from 18 to 36 weeks). All fractures had clinical healing with an average time of 28 weeks (ranged from 24 to 32 weeks). The total rate of good to excellent results was 91.4%. The rate of good to excellent in the group of grade 1 was higher than that of other grades. The complication rates and fracture healing time would increase respectively with higher Winquist-Hanson's grade. The complication rates in the group of type C3 was higher than that of other types, but the rate of good to excellent was lower than that of other types. The complication rates in the group of type B1 was lower than that of other types,but the rate of good to excellent was higher than that of other types. Minimal invasiveusing AO titanium elastic intramedullary nailing combined with external fixation for treatment of tibia-fibula fractures especially for the multiple-segment,long spiral mild-to-moderate comminuted with hidden fracture can get satisfactory reduction and

  3. Anatomical and biomechanical evaluation of an intramedullary nail for fractures of proximal humerus fractures based on tuberosity fixation.

    Science.gov (United States)

    Clavert, Ph; Hatzidakis, A; Boileau, P

    2016-02-01

    For unstable proximal humerus fractures, both plates and nails may be recommended. We introduce an anterograde nail designed for the treatment of 3- and 4-parts proximal humerus fractures. The aim of this study is to compare the biomechanics of this nail versus a plate and then to analyze the relationships of the screws with the axillary nerve. Our working hypotheses are as follows: (1) this nail is biomechanically equal or better to the reference plate and (2) it does not endanger the axillary nerve. Biomechanical study: using 40 sawbones, a reproducible 4-part fracture was created and fixed first with an angle-stable plate for proximal humeral fracture, then fixed with the nail using 2 posterior screws. All specimens were mounted in a custom testing apparatus. Two trails were performed needing each time 5 "normal" and 5 "osteoporotic" bones. On 20 unpaired shoulders, a nail was inserted with all screws through a superior approach (deltoid split approach). Dissection of all shoulders was done to identify the axillary nerve. The distance between each screw and the axillary nerve or its branches was measured. The proximal humerus nail demonstrated higher values than locking plate for both stiffness and load to failure. The failure mode differs in function of the type of osteosynthesis. The lowest distance between a screw and the axillary nerve was 20.13 mm. We introduce a biomechanically efficient nail without increased neurological risks to improve the pullout strength of the screws to provide more secure fixation of proximal humeral fractures. Basic Science Study, Anatomic Cadaver Study. Copyright © 2015 Elsevier Ltd. All rights reserved.

  4. Use of antibiotic cement-impregnated intramedullary nail in treatment of infected non-union of long bone

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    Shyam Ashok

    2009-01-01

    Full Text Available Background: In cases with infected non-union, the primary step is eradication of the infection before attempting to achieve union. Release of antibiotics from the bone cement at a high concentration and its penetration to the surrounding tissues, including cortical and cancellous bone, prompted the use of antibiotic cement in the control of bone infection. The aim of this study is to summarize our experience with the use of antibiotic cement-impregnated intramedullary nail (ACIIN for control of infection in cases of infected non-union with bone defect. Materials and Methods: We prospectively studied 25 cases of infected non-union (23 femora and two tibiae. There were 24 males and one female, with the mean age being 33 years (range, 21-58 years. All patients had high-velocity road traffic accidents except one patient who had farmland injury. There were seven closed fractures, one grade I compound, two grade II compound fractures, five grade IIIA compound fractures, and 10 grade IIIB compound fractures. ACIIN was used in all cases after adequate debridement. Patients were classified according to the amount of bone defect present after debridement: group 1 with bone defect < 4 cm (n=13, group 2 with bone defect ≥4-< 6 cm (n=7, and group 3 with bone defect ≥6 cm (n=5. Infection control was judged on the basis of discharge through the wound and laboratory parameters. All patients were followed-up, with an average follow-up time of 29 months (range, 18-40 months. The mean duration of retention of the intramedullary rod was 8 weeks (range, 6-12 weeks. Results: In group 1, all cases achieved infection control, with three patients achieving bone union without any need of secondary procedure. In group 2, all cases achieved infection control but the time taken was significantly longer than for group 1 (p-value 0.0002. All the cases required a secondary procedure in the form of either interlocking intramedullary nailing with iliac crest bone graft or

  5. Use of intra-medullary stacked nailing in the reduction of proximal plastic deformity in a pediatric Monteggia fracture: a case report

    Directory of Open Access Journals (Sweden)

    Huntley James S

    2011-04-01

    Full Text Available Abstract Introduction In a Monteggia fracture dislocation, it is important to reduce the ulnar fracture completely. Extensive plastic deformation of the proximal ulna may make reduction by closed manipulation impossible. Case presentation We report the case of a four-year-old Caucasian boy in whom the plastic deformation of the proximal ulna was reduced, and this reduction was maintained, using intra-medullary stacked nailing. Conclusion The technique of stacked nailing is a useful addition to the armamentarium in the management of the potentially awkward Monteggia fracture.

  6. Diaphyseal Fractures of the Forearm in Adults, Plating Or Intramedullary Nailing Is a Better Option for the Treatment?

    Directory of Open Access Journals (Sweden)

    Tabet A. Al-Sadek

    2016-11-01

    Full Text Available BACKGROUND: Fractures of the radius and ulna occupy a large field of the modern traumatology. Therefore, these fractures are a major subject in modern orthopaedics and traumatology. The study of the mechanisms of the trauma, and the pathophysiological changes that occur are of great importance for the development of ever more efficient and varied ways of the treatment and prophylactics of this type of fracture. AIM: The aim of this paper was to study the pattern of the diaphyseal fractures of the forearm in adults, to decide the modalities of surgical management, to observe the period of fracture healing clinically and radiologically, as well to study the rehabilitation of the patients. MATERIAL AND METHODS: The present study included 45 cases of diaphyseal fractures of both bones forearm in adults presenting to the orthopaedic outpatient department. For all the patients a detailed history was taken. A thorough clinical examination was carried out, required X-rays were taken, and initial treatment was given and admitted as in all patients. After careful pre-operative planning and evaluation for anaesthetic fitness, patients were operated for the fractures of both bone forearms. Twenty-three cases with 46 fractures were treated by open reduction and rigid fixation with DCP & Semi-tubular plates and 22 cases with 44 fractures were treated by closed reduction and fixation with “Talwarkar” intramedullary square nails. RESULTS: United results were found in 100% of plating group vs. 86% in the nailing group. Delayed and non-union results were found in 9% of the nailing group only. Average time to union in weeks was 9.4 weeks in the plating group vs. 10.2 weeks in the nailing group. CONCLUSION: Open reduction and internal fixation with compression plates with strict adherence to surgical technique is the gold standard method of treatment in both bones forearm fractures with excellent results than closed reduction, internal fixation with

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

    OpenAIRE

    Lakhwani, O. P.

    2012-01-01

    Background. Selection of entry point for nail insertion is controversial and lack firm anatomical basis. The study is done to analyze the proximal anthropometry of femur and measure the Trochanter-Shaft Angle to find its relation and significance in selection of entry point for antegrade uniplanar femoral nail. Materials and Methods. Study involves the measurement of trochanter-shaft angle and other anthropometric measurements on 50 dry femora and on digital radiogram. Results. Trochanter-Sha...

  8. 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.

  9. Unreamed Intramedullary Nailing is a better alternative than External Fixator for Gustilo grade IIIB Tibial Fractures based on a meta-analysis.

    Science.gov (United States)

    Zhang, F; Zhu, Y; Li, W; Chen, W; Tian, Y; Zhang, Y

    2016-06-01

    There remains a controversy between unreamed intramedullary nailing and external fixation to treat Gustilo grade IIIB tibial fractures. To evaluate the comparative effectiveness and safeness of both methods for this type of fracture, we performed this meta-analysis. Relevant original studies were searched in MEDLINE, EMBASE, China National Knowledge Infrastructure, and Cochrane Central Database (all through February 2014). Studies included in this meta-analysis had to compare the effectiveness or complications and provided sufficient data of interest. The patients treated by both methods were similar statistically in demography and injury mechanism. The Stata 11.0 was used to analyze all data. Six studies involving 163 participants were included. Unreamed intramedullary nailing was associated with reduced time to union (standardized mean difference, -1.14; 95% confidence interval, -2.04 to -0.24) and lower rates of superficial infection (odds ratio: 0.39; 95% confidence interval: 0.17-0.87) and malunion (odds ratio: 0.27; 95% confidence interval: 0.09-0.78). However, there were no significant differences in other adverse events including delayed union, non-union, deep infection, and fixation failure. The existing evidence supports unreamed intramedullary nailing to be a better method for treating Gustilo grade IIIB tibial fractures, and this might aid in the management of this sever injury. © The Finnish Surgical Society 2015.

  10. Intramedullary compressive nail fixation for the treatment of severe Charcot deformity of the ankle and rear foot.

    Science.gov (United States)

    Caravaggi, Carlo; Cimmino, Marzio; Caruso, Sebastiano; Dalla Noce, Sergio

    2006-01-01

    Involvement of the ankle joint in Charcot osteoarthropathy may be associated with severe instability and fracture or collapse of the talus. Recalcitrant ulceration may result over the lateral malleolus, increasing the risk of major amputation. This study evaluated ankle arthrodesis with a compressive intramedullary nail in 14 patients with diabetes affected by Charcot of the ankle. The mean patient age was 58 +/- 12 years, and the mean duration of diabetes was 17 +/- 5 years. Transcutaneous oxygen pressures were > or = 50 mm Hg in all patients, indicating a good distal blood supply. A below-knee amputation had previously been suggested because of severe ankle joint instability. None of the patients were able to walk without a brace. Four patients had an ulceration that had healed before the index procedure. All procedures were performed in the quiescent phase of the disease. After a mean follow-up of 18 +/- 4 months, 10 patients (71.4%) achieved a solid arthrodesis, returning to walking with protective shoes. Three patients (21.4%) developed breakage of the calcaneus screws, necessitating removal of the screws in 2 cases and removal of the entire nail in 2 cases. These 3 patients went on to fibrous union that allowed walking with a brace. One patient (7.2%) required a below-knee amputation because of postoperative osteomyelitis of the distal tibia. The data from our study demonstrate a high rate of limb salvage (92.8%), suggesting that this device is safe and effective in the treatment of Charcot arthropathy of the ankle.

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

    Science.gov (United States)

    Grimwood, Darren; Harvey-Lloyd, Jane

    2016-12-01

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

  12. Systematic review: functional outcomes and complications of intramedullary nailing versus plate fixation for both-bone diaphyseal forearm fractures in children.

    Science.gov (United States)

    Patel, Akash; Li, Lily; Anand, Amarjit

    2014-08-01

    Both-bone diaphyseal forearm fractures constitute up to 5.4% of all fractures in children in the United Kingdom. Most can be managed with closed reduction and cast immobilisation. Surgical fixation options include flexible intramedullary nailing and plating. However, the optimal method is controversial. The main purpose of this study was to systematically search for and critically appraise articles comparing functional outcomes, radiographic outcomes and complications of nailing and plating for both-bone diaphyseal forearm fractures in children under 18 years. A comprehensive search of Medline, Embase and Cochrane databases using specific search terms and limits was conducted. Articles identified were thoroughly screened using strict eligibility criteria and eight retrospective non-randomised comparative studies were identified and reviewed. There were no statistically significant differences in functional outcome or time to fracture union between plating and IM nailing. No consistent difference was found in complication rate, fracture angulation, shortening or rotation. Better cosmesis and shorter duration of surgery was noted in the IM nailing group. Post-operative radial bow was significantly abnormal in the IM nailing groups, but did not affect forearm movement. Based on similar functional and radiographic outcomes, nailing seems to be a safe and effective option when compared to plating for paediatric forearm fractures. However, critical appraisal of the studies in this review identified some methodological deficiencies and further prospective, randomised trials are recommended. Copyright © 2014 Elsevier Ltd. All rights reserved.

  13. Causes and treatments of lag screw's cut out after intramedullary nailing osteosinthesis for trochanteric fractures.

    Science.gov (United States)

    Gazzotti, Gabriele; Matino, Giovanni; Tsatsis, Christos; Sacchetti, GianLuigi; Baudi, Paolo; Catani, Fabio

    2014-08-20

    Background. Superior cut-out of a lag screw remains a serious complication in the treatment of trochanteric or subtrochanteric fractures and it is related to many factors: the type of fracture, osteoporosis and the stability of fracture reduction. Little is known about the outcome after revision surgery for complications of the gamma nail. We assessed the outcome in patients who had revision surgery because of lag screw's cut out after gamma nailing for a trochanteric fracture.Material and Method. We present a study of 20 consecutive patients who underwent treatment after 20 cut-out of the lag screw fixation of a trochanteric fracture with Gamma Locking Nail from September 2004 to November 2010. In 16 patients hip prothesis was performed, in 1 the removal of the implant and in 3 the reosteosynthesis. We reviewed 13 patients: 10 total hip arthroplasty, 2 endoprothesis and 1 reosteosynthesis of nail and lag screw (mean follow up: 26 months, mean age: 73 years old), 7 patients died. Patients were reviewed retrospectively by an independent observer. Clinical evaluation was performed, Oxford score and Harris Hip score were measured. X-Ray examination was performed after a minimum of 12 months of follow up.Results. Mean Harris Hip Score mean was 67 and mean Oxford score was 32 in hip prothesis group (12 patients). We had several complications, Implant-related complications were: 2 ipometria > 2cm, 2 recurrent hip arthroplasty dislocations (1 reoperated), 4 persistent thigh pain. In only 4 patients none complications were observed. Another patient,  who had been subjected to reosteosinthesis, obtained better results (HHS:95, Oxford score:45) but with a 2 cm ipometria and occasional pain in the thigh.Conclusion. Cut out after gamma nail is consequent to biological or mechanical causes. Treatment of this complication is hip prosthesis (parzial or total hip arthroplasty), reosteosynthesis of the lag screw and/or the nail and the removal of the implant. Conversion to total

  14. Osteossínteses com hastes intramedulares em crianças Osteosynthesis with intramedullary nails on children

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    Helio Jorge Alvachian Fernandes

    2009-10-01

    Full Text Available Os autores fazem uma ampla revisão da literatura destacando o emprego de hastes intramedulares flexíveis no tratamento de fraturas em crianças. Destacam o tratamento das fraturas diafisárias do fêmur e dos ossos do antebraço e enfatizam também a importância da abordagem não cirúrgica. A idade e o peso limite das crianças ainda não estão bem definidos para o emprego do método. A retirada de implantes tem destaque controverso na literatura, com tendência da permanência dos implantes.The authors present a comprehensive review of the literature emphasizing the use of flexible intramedullary nails in the treatment of fractures in children, focusing the treatment of femoral shaft and forearm fractures and emphasizing the importance of the non-surgical approach. Children's age and weight threshold are not well defined for the use of the method. The removal of implants is a controversial matter in the literature, with a trend towards keeping the implants.

  15. ANALYSIS OF FAILURES AND COMPLICATIONS FOLLOWING TREATMENT OF DIAPHYSEAL FOREARM FRACTURES IN CHILDREN USING FLEXIBLE INTRAMEDULLARY NAILING

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    A. A. Korobeinikov

    2016-01-01

    Full Text Available Introduction. Currently flexible intramedullary nailing (FIN is the method of choice for treatment of diaphyseal forearm fractures in children.Purpose of the study: to perform a quantitative and qualitative analysis of failures and complications encountered in treatment of children with diaphyseal forearm fractures using FIN fixation.Materials and methods. The study included 55 consecutive continuous cases of diaphyseal forearm fractures in children operated by FIN fixation from October 2011 till October 2014. Follow up period covered timeframe from admission until implant removal but no less than 6 months. The authors studied age, gender, fracture pattern, surgical technique features, length of hospital stay, frequency of outpatient examinations, healing period, x-ray data and all complications.Results. Complications during treatment were reported in 10 patients. Two patients demonstrated two complications. In two cases a surgical procedure was required to address the complications. Early postoperative complications were observed in two cases (neuropathy of superficial branch of radial nerve. In other cases patients developed complications at outpatient stage starting one to six months after the surgery which did not impact the final outcome.Conclusion. Despite various complications observed following FIN fixation of diaphyseal forearm fractures in children, their severity and frequency had no impact on the final outcome in the authors’ case series. Majority of issues were related to violations in surgical technique and adverse fracture pattern.

  16. Fixator-Assisted Lengthening and Deformity Correction Over an Intramedullary Nail in a Patient with Achondroplasia

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    Erdal Uzun

    2014-12-01

    Full Text Available Achondroplasia is the most frequently encountered form of nonlethal skeletal dysplasia and a type of rhizomelic dwarfism. It results in considerable physical and psychologic handicaps owing to the disproportionate stature of the body and difficulty in performing routine activities of daily living. They also have major musculoskeletal problems including symptomatic malalignment of the lower limbs. Limb lengthening has been used in patients with achondroplasia by different techniques (Intramedullar nailing, monolateral or circular external fixator. We report our treatment of a patient 17 years of age with achondroplasia for bilateral lower limb length discrepancy and bilateral tibial varus deformity.

  17. Use of the suprapatellar approach in intramedullary nailing of a multi-fragmentary dislocated tibia fracture with a hypermobile intermediate fragment in a young patient

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    Patrick Haubruck

    2017-01-01

    Full Text Available A case of an adolescent female patient who suffered from first grade open multi-fragment fracture of the tibia (AO42-C2 with a large hypermobile intermediate fragment is presented in this case report. Intramedullary nailing of the tibia remains the treatment of choice despite a high risk of malformation and anterior knee pain especially in multi-fragment fractures. Here the suprapatellar approach as a semiextended nailing technique seems favorable. The specialty in our case was an early change of procedures necessary due to persistent swelling during external fixation based on the hypermobile intermediate fragment. Decision in favor of this surgical technique was conducted in order to achieve beneficial alignment and union while protecting the softtissue despite the hypermobile intermediate fragment and decrease the risk of anterior knee pain. In our case we achieved successful alignment and proper bone healing without any signs of anterior knee pain or limitations in the range of motion of the knee. With this report we would like to recommend the suprapatellar approach as a favorable alternative in intramedullary nailing in this type of fracture also in young patients.

  18. Treatment of femur fractures in young children: a multicenter comparison of flexible intramedullary nails to spica casting in young children aged 2 to 6 years.

    Science.gov (United States)

    Heffernan, Michael J; Gordon, J Eric; Sabatini, Coleen S; Keeler, Kathryn A; Lehmann, Charles L; O'Donnell, June C; Seehausen, Derek A; Luhmann, Scott J; Arkader, Alexandre

    2015-03-01

    Spica casting is the standard of care for femur fractures in children up to 6 years of age. The indications for surgery are controversial. We sought to compare immediate spica casting (Spica) and flexible intramedullary nailing [titanium elastic nailing (TEN)] in a group of children ages 2 to 6 years. We hypothesized that young children can be successfully treated with flexible nails, resulting in faster return to ambulation and an equivalent complication rate when compared with spica casting. This was a multicenter retrospective review of 215 patients, 141 treated with immediate spica casting, and 74 treated with elastic nails. Patient demographics, fracture characteristics, mechanism of injury, associated injuries, outcomes, and complications were recorded and compared between the 2 groups. Patients in the elastic nailing group were more likely to be injured as a pedestrian struck by an automobile (Spica 8% vs. TEN 26%, P=0.001), and had increased rates of associated injuries (Pcasting with shorter time to independent ambulation and full activities. Fractures associated with a high-energy mechanism are especially appropriate for consideration of treatment with TEN. Level III, this was a retrospective comparative study.

  19. [Proximal femoral intramedullary nail versus DHS plate for the treatment of intertrochanteric fractures. A prospective analysis].

    Science.gov (United States)

    Calderón, A; Ramos, T; Vilchez, F; Mendoza-Lemus, O; Peña, V; Cárdenas-Estrada, E; Acosta-Olivo, C

    2013-01-01

    To show that patients with intertrochanteric fractures treated with a proximal femoral nail have a better postoperative course than those treated with a DHS plate (dynamic hip screw). Patients with a Boyd & Griffin type II intertrochanteric fracture were randomly divided into two groups: a group of patients treated with a PFN and another one treated with a DHS plate. All patients were assessed at 2, 4, 8 and 16 weeks using the Harris scale and the visual analog scale pre- and postoperatively, as well as the operative time, incision size, intraoperative bleeding, onset of partial and/or total weight bearing, healing time, time to attain prior physical activity level, and radiographic result. 32 patients met our criteria. The variables that had a significant reduction were: incision, operative time, postoperative pain according to the visual analog scale, onset of mobility, partial weight bearing and pain at 2 weeks. The proximal femoral nail has better short-term outcomes than the DHS plate; however, in the medium term both implants have the same outcomes.

  20. Femoral bone transport by a monolateral external fixator with or without the use of intramedullary nail: a single-department retrospective study.

    Science.gov (United States)

    Wan, Jun; Ling, Lin; Zhang, Xiang-sheng; Li, Zhi-hong

    2013-05-01

    Treatment for bone defect remains a challenge for orthopedists. Bone transport gives an effective alternative, which can be performed with an external fixator alone or combined with an intramedullary nail. Each has its advantages and disadvantages. We present a retrospective study to find out the optimal choice by evaluating the outcomes of treatment for femoral bone defect with two methods. Two groups of patients, the monolateral external fixator alone (group A, n = 13) and the monolateral external fixator combined with intramedullary nail (group B, n = 15), were compared. Duration of the external fixator, external fixator index, radiographic consolidation index, complication, and total cost for treatment was also recorded. A modified classification of the Association for the Study and Application of the Method of Ilizarov (ASAMI) was used to assess results in two groups of patients; another SF-36 health survey questionnaire was used to assess the life qualities patients of two groups. Healing was achieved in 13/13 and 13/15 of the two groups, respectively. The rates of complications were significantly higher in the group A. Two patients performed amputations because of persistent deep infections in group B. Statistically significant difference was found when comparing ASAMI scores and categories of the SF-36 health survey. Bone transport by monolateral external fixator with the use of intramedullary nail reduces the incidence of complication and the duration of external fixator time that give patients a better life quality in both physical and emotional. However, if chronic osteitis exists, bone transport should be treated with monolateral external fixator alone due to a lower rate of amputations.

  1. A Fast, Accurate and Easy to Implement Method for Pose Recognition of an Intramedullary Nail using a Tracked C-arm

    Science.gov (United States)

    Esfandiari, H.; Amiri, S.; Lichti, D. D.; Anglin, C.

    2014-06-01

    A C-arm is a mobile X-ray device that is frequently used during orthopaedic surgeries. It consists of a semi-circular, arc-shaped arm that holds an X-ray transmitter at one end and an X-ray detector at the other. Intramedullary nail (IM nail) fixation is a popular orthopaedic surgery in which a metallic rod is placed into the patient's fractured bone (femur or tibia) and fixed using metal screws. The main challenge of IM-nail fixation surgery is to achieve the X-ray shot in which the distal holes of the IM nail appear as circles (desired view) so that the surgeon can easily insert the screws. Although C-arm X-ray devices are routinely used in IM-nail fixation surgeries, the surgeons or radiation technologists (rad-techs) usually use it in a trial-and-error manner. This method raises both radiation exposure and surgery time. In this study, we have designed and developed an IM-nail distal locking navigation technique that leads to more accurate and faster screw placement with a lower radiation dose and a minimum number of added steps to the operation to make it more accepted within the orthopaedic community. The specific purpose of this study was to develop and validate an automated technique for identifying the current pose of the IM nail relative to the C-arm. An accuracy assessment was performed to test the reliability of the navigation results. Translational accuracy was demonstrated to be better than 1 mm, roll and pitch rotations better than 2° and yaw rotational accuracy better than 2-5° depending on the separate angle. Computation time was less than 3.5 seconds.

  2. A Fast, Accurate and Easy to Implement Method for Pose Recognition of an Intramedullary Nail using a Tracked C-arm

    Directory of Open Access Journals (Sweden)

    H. Esfandiari

    2014-06-01

    Full Text Available A C-arm is a mobile X-ray device that is frequently used during orthopaedic surgeries. It consists of a semi-circular, arc-shaped arm that holds an X-ray transmitter at one end and an X-ray detector at the other. Intramedullary nail (IM nail fixation is a popular orthopaedic surgery in which a metallic rod is placed into the patient's fractured bone (femur or tibia and fixed using metal screws. The main challenge of IM-nail fixation surgery is to achieve the X-ray shot in which the distal holes of the IM nail appear as circles (desired view so that the surgeon can easily insert the screws. Although C-arm X-ray devices are routinely used in IM-nail fixation surgeries, the surgeons or radiation technologists (rad-techs usually use it in a trial-and-error manner. This method raises both radiation exposure and surgery time. In this study, we have designed and developed an IM-nail distal locking navigation technique that leads to more accurate and faster screw placement with a lower radiation dose and a minimum number of added steps to the operation to make it more accepted within the orthopaedic community. The specific purpose of this study was to develop and validate an automated technique for identifying the current pose of the IM nail relative to the C-arm. An accuracy assessment was performed to test the reliability of the navigation results. Translational accuracy was demonstrated to be better than 1 mm, roll and pitch rotations better than 2° and yaw rotational accuracy better than 2–5° depending on the separate angle. Computation time was less than 3.5 seconds.

  3. Open unstable metaphyseo-diaphyseal fractures of the tibia in adolescents: treatment by flexible intramedullary nails augmented by external fixator.

    Science.gov (United States)

    Atef, Ashraf; El Tantawy, Ahmad

    2015-05-01

    The treatment of open and unstable metaphyseo-diaphyseal fractures of the tibia in adolescents is challenging. It is important to choose a fixation method that can maintain alignment, allow wound care and not violate the growth plate. The aim of this work was to evaluate the efficacy of using flexible intramedullary nails (FIN) augmented by external fixator (EF) in the management of such fractures. A total of 26 males, with a mean age of 14.08 years and average body weight of 49.8 kg, presented with open metaphyseo-diaphyseal tibial fractures. All cases were treated using FIN augmented by mono-lateral EF. The fractures were located at the upper third in 17 cases and at the lower third in nine cases. The fracture pattern was spiral in eight cases, oblique in seven and multi-fragmentary in 11. The results were evaluated according to the scoring system for femoral TENs. All fractures united primarily after an average eight to 12 weeks with no evident angular deformity or limb-length discrepancy. None of the cases required cast immobilization or revision procedure. Twenty patients had excellent results, six patients showed good results and none had poor results. Fracture characteristics as well as patients' characteristics had no statistically significant effect (p > 0.005) on the final end results. The use of FIN augmented by EF is a good alternative in the management of open metaphyseo-diaphyseal tibial fractures in adolescents. This fixation provides more stability, allows easy access to the wound and early patients' ambulation.

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

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    A. A. Emanov

    2015-01-01

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

  5. Complications and outcomes of diaphyseal forearm fracture intramedullary nailing: a comparison of pediatric and adolescent age groups.

    Science.gov (United States)

    Martus, Jeffrey E; Preston, Ryan K; Schoenecker, Jonathan G; Lovejoy, Steven A; Green, Neil E; Mencio, Gregory A

    2013-09-01

    Flexible intramedullary nailing (IMN) has become a popular technique for the management of unstable or open forearm fractures. Recent publications have suggested an increased incidence of delayed union and poor outcomes in older children and adolescents. The objective of this study was to review forearm fractures treated with IMN, comparing the rate of complications and outcomes between the 2 age groups. Our hypothesis was that IMN is an effective technique with a similar rate of complications in both age groups. An Institutional Review Board-approved retrospective review was conducted of pediatric forearm fractures treated from 1998 to 2008 at a single institution. Over the study time period, 4161 pediatric forearm fractures were managed nonoperatively (92%) and 353 were treated operatively with plate, cross-pin, or intramedullary fixation (8%). Patients with inadequate follow-up, cross-pin, or plate fixation were excluded. Medical records were reviewed for indications and complications. Complications were graded with a modification of the Clavien-Dindo classification. Outcomes were judged by a new grading system. A total of 205 forearm fractures treated with IMN in 203 patients were identified. The mean age was 9.7 years (range, 1.7 to 16.2 y) and mean follow-up was 42 weeks. Operative indications were failure of closed treatment in 165 (80%) and open fracture in 40 (20%). Mean time from injury to IMN was 5.9 days (range, 0 to 25 d). Single bone IMN was performed in 40 of 185 both bone fractures (26%); there were 20 single-bone forearm fractures treated with IMN. Open reduction was required in 61/165 (37%) of closed fractures. Asymptomatic delayed union (grade 1 complication) was observed in 9 fractures (4%). More severe complications were noted in 17% (grade 2 to 4 complications). Postoperative compartment syndrome occurred in 3 isolated forearm fractures with a significant younger mean age (6.0 vs. 10 y, P=0.031). Overall, complications were significantly more

  6. Effectiveness and complications of SIGN intramedullary interlocking ...

    African Journals Online (AJOL)

    Effectiveness and complications of SIGN intramedullary interlocking nailing in the management of femoral and tibial fractures at Moi Teaching and Referral Hospital, Eldoret- Kenya: A retrospective study.

  7. Histopathological examination of bone debris from reaming of interlocking intra-medullary nail fixation of long bone fractures with concomitant head injury.

    Science.gov (United States)

    Khallaf, Fathy G; Kehinde, Elijah O

    2015-12-01

    The aim of study was to test, for the presence of osteoblasts in the reaming debris of intramedullary nailing of femoral and tibial fracture in patients with and without severe head injury. Two groups of patients were studied. Group A (n = 32) had long bone fractures in addition to having head injuries. Group B (n = 35) had only long bone fractures. The fractures in the 2 groups of patients was treated by inter medullary nailing. Osteoblasts in the debris of the inter medullary nailing was compared between the 2 groups of patients. The results demonstrated that histopathological specimens from reaming debris of fractured femur and tibia in patients with head injury showed osteoblasts in (82.9%) and in (27.5%) of patients with isolated long bone fractures (p fractures and concomitant head injury confirm fast and adequate healing in these patients and the presence of plenty of osteoblasts in their reaming debris may reflect a proof of accelerated fracture healing environment.

  8. “Internal fixation of proximal humeral fractures using the Polarus intramedullary nail: our institutional experience and review of the literature”

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    Giannoudis Peter V

    2012-12-01

    Full Text Available Abstract Background The purpose of this study is to evaluate the functional outcome, union and complication rates after surgical treatment of unstable or displaced proximal humeral fractures using the Polarus intramedullary nail, by reviewing our institutional experience and the relevant current literature. Methods Twenty-seven patients were treated operatively for proximal humeral fracture using the Polarus nail. Fractures were classified according to Neer’s classification. A number of parameters including patient demographics, mechanism of injury, operative time, time to union and complications were recorded. Functional outcome was evaluated using the Constant Shoulder Score. A comparison among functional outcomes in patients >60 years in relation to the younger ones was performed. Moreover, a review of the literature was carried out to evaluate the overall union and complication rates. Results Two patients lost to follow-up were excluded from the analysis. For the twenty-five patients (mean age: 61 years, the mean follow-up was 36 months. There were 7 complications (28%, including one fixation failure, four protruded screws, one superficial infection and one case of impingement. The union rate was 96% (mean time to union: 4.2 months. The mean Constant score was 74.5 (range: 48–89. Patients under the age of 60 had a better functional outcome compared to patients >60 years of age (p0.05. From the literature review and from a total of 215 patients treated with a Polarus nail, the mean union rate was 95.8%, the overall reported complication rate, including both minor and major complications, ranged widely from 9.3% up to 70%. Conclusions The Polarus nail was found to be an effective implant for stabilisation of proximal humeral fractures. Functional outcome is for the vast majority of the cases excellent or good, but in elderly patients a lower Constant score can be expected.

  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

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    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. Locked intramedullary total wrist arthrodesis.

    Science.gov (United States)

    Orbay, Jorge L; Feliciano, Eric; Orbay, Carolina

    2012-11-01

    Total wrist arthrodesis is commonly performed using fixation plates, which can produce soft tissue irritation, often require removal, and limit the ability to position the hand in space. The Skeletal Dynamics IMPLATE is an intramedullary total wrist fusion device designed to provide stable fixation while avoiding the problems associated with plates. Radial and metacarpal locked intramedullary nails are inserted and joined by a connector. Desired hand placement is achieved by selecting the proper connector length and angle, then orienting it appropriately. Fusion mass compression is obtained by virtue of longitudinal threads on the radial nail that allow for length adjustment. Seven wrists in three men and four women were treated with this device and followed for a minimum of 24 weeks. In all cases, local cancellous bone graft was used and the third carpometacarpal (CMC) joint incorporated into the fusion. The median age was 49 (range, 28-71) years. Indications for fusion were two posttraumatic arthritides, three rheumatoid arthritides, one spastic deformity, and one infection. Patients were evaluated before surgery and at final follow-up using the Fernandez pain score and grip strength measurements using a hand-held dynamometer. All patients improved their grip strength and decreased their pain scores. All fusions united, and none of the patients presented dorsal soft tissue problems or required implant removal. One rheumatoid patient required secondary surgery for removal of a retained palmar osteophyte. This device delivers stable fixation, facilitates hand placement, and does not require removal.

  11. [Retrograde intramedullary nailing in proximal fracture of the humerus in the elderly patient. Results of a minimally invasive management concept].

    Science.gov (United States)

    Hoffmann, R; Khodadadyan, C; Raschke, M; Melcher, I; Maitino, P D; Haas, N P

    1998-01-01

    Retrograde intramedullary fixation of proximal humerus fractures with flexible wires was evaluated in a prospectively documented study. Seventy-four fractures in 73 patients with unstable proximal humerus shaft or neck fractures were fixed with 3-11 flexible intramedullary wires. The age of the patients averaged 72 years (42 females, 31 males). In nine fractures additional implants (screws, cerclages) were used to fix dislocated fragments through an anterior approach to the shoulder. Complications associated with the procedure especially in osteoporotic bone were secondary loss of reduction (16%) and wire migration (21%) which lead to revision surgery in 14% of patients within 6 weeks. A minimum follow-up of 12 months (average 16.5 months) could be obtained in 61 patients (84%). According to the Neer- and Constant-scores 60% showed good or excellent results, 30% had a satisfactory and 10% had an unsatisfactory or poor result.--Retrograde intramedullary, flexible wire fixation can provide an overall satisfactory outcome in unstable proximal humerus fractures of the elderly. However, the high incidence of secondary wire dislocations especially in marked osteoporosis appears to be an unsolved problem of this treatment modality.

  12. Comparison of novel intramedullary nailing with mini-invasive plating in surgical fixation of displaced midshaft clavicle fractures.

    Science.gov (United States)

    Zehir, Sinan; Zehir, Regayip; Şahin, Ercan; Çalbıyık, Murat

    2015-03-01

    This prospective randomized pilot study sought to determine whether fixation with Sonoma CRx intramedullary pin is a comparable alternative to minimally invasive plating fixation in patients with displaced clavicle fractures. A total of 45 consecutive patients (Robinson class B1 or B2) were randomly allocated into two groups; intramedullary pin (IMP) group (n = 24, mean age; 33.17 ± 8.60 years, 14 males 58.3 %) received Sonoma CRx Collarbone pin (Sonoma, USA) whereas locking midshaft superior plating (MIPPO) group (n = 21, 32.38 ± 8.41 years, 12 males) patients received minimally invasive locking midshaft superior plating (Acumed, USA). Patients were followed up with a mean time of 11.82 ± 4.22 and 14.45 ± 6.43 months, respectively. Functional status, as the primary outcome measure, was assessed using quick disability of the arm, shoulder and hand (DASH) scores. Mean time of operation and mean time of fluoroscopy were significantly shorter in the IMP group than those in MIPPO group (p < 0.001 and p = 0.03, respectively). Time of hospital stay was significantly shorter in IMP group (p < 0.001). Complications were rare in the early postoperative period. Time until bony union was significantly shorter in IMP group. Mean quick DASH scores were not significantly different between two groups. Implant failure occurred in one patient from each group. Cosmetic dissatisfaction was more common in MIPPO group. Given the shorter operative times and better cosmetic appearance, Sonoma CRx intramedullary pin may be an alternative to minimally invasive plating. Further safety studies are warranted.

  13. Decreased QOL and muscle strength are persistent 1 year after intramedullary nailing of a tibial shaft fracture: a prospective 1-year follow-up cohort study.

    Science.gov (United States)

    Larsen, Peter; Elsoe, Rasmus; Laessoe, Uffe; Graven-Nielsen, Thomas; Eriksen, Christian Berre; Rasmussen, Sten

    2016-10-01

    To evaluate the development in patient-reported quality of life (QOL) and muscle strength in the period from surgery to 12 months postoperatively after intramedullary nailing of a tibial shaft fracture. The design was a prospective, follow-up cohort study. QOL was measured with the questionnaire Eq5D-5L and compared to norm data from a reference population. Recordings of pain and contralateral muscle strength (isometric maximal voluntary contraction (MVC) for knee flexion and extension were collected at 6 weeks, 3, 6, and 12 months postoperatively. Ipsilateral MVCs were recorded at 6 and 12 months. Forty-nine patients were included. The mean age at the time of fracture was 43.1 years (18-79 years). Twelve months postoperatively, the mean Eq5D-5L index was 0.792 (95 % CI 0.747-0.837). Throughout the 12 months postoperatively, patients reported worse QOL compared to the reference population. Six and 12 months after surgery patients demonstrated decreased muscle strength in the injured leg compared to the non-injured leg for knee extension and flexion (P muscle strength during knee extension show a fair correlation to worse QOL (R = 0.541, P Muscle strength in the non-injured leg improved over time and was higher after 6 and 12 months compared with the injured leg.

  14. Intramedullary nailing versus external fixation in Gustilo type III open tibial shaft fractures: a meta-analysis of randomised controlled trials.

    Science.gov (United States)

    Giovannini, Francesca; de Palma, Luigi; Panfighi, Andrea; Marinelli, Mario

    2016-04-01

    Open tibial shaft fractures are the most common of long-bone open fractures. Management of the fracture is either by intramedullary nailing (IMN) or by external fixation (EF). Since the literature does not indicate clearly which is more effective, a meta-analysis was conducted to establish which approach is more suitable to treat Gustilo type III fractures. MEDLINE, the Cochrane Central Register of Controlled Trials, EMBASE and CINAHL databases were searched for randomised controlled trials (RCT) describing IMN and EF treatment of Gustilo type III fractures. As of 15 November 2012, five RCT involving 239 patients had been published; the outcomes examined in this study are their surgical complications. Data analysis led complications to be grouped into infection, fracture healing problems (non-union, malunion) and "other complications" (vascular injury, revision surgery, soft tissue damage, mechanical failure and tibial malalignment). IMN was associated with lower rates of infection and fracture healing problems; the differences between the two approaches for "other complications" were not significant. The data indicate that IMN is the treatment of choice for Gustilo type III fractures.

  15. Effect of Locking Plate Fixation vs Intramedullary Nail Fixation on 6-Month Disability Among Adults With Displaced Fracture of the Distal Tibia: The UK FixDT Randomized Clinical Trial.

    Science.gov (United States)

    Costa, Matthew L; Achten, Juul; Griffin, James; Petrou, Stavros; Pallister, Ian; Lamb, Sarah E; Parsons, Nick R

    2017-11-14

    The best treatment for fractures of the distal tibia remains controversial. Most such fractures require surgical fixation but outcomes are unpredictable and complications are common. To assess disability, quality of life, and complications in patients with displaced tibial fracture treated with intramedullary nail fixation vs locking plate fixation. A multicenter randomized trial recruiting 321 patients 16 years or older with an acute, displaced, extra-articular fracture of the distal tibia from April 2013 through April 2016 with final follow-up in February 2017. Exclusion criteria included open fractures, fractures involving the ankle joint, contraindication to nailing, or inability to complete questionnaires. Intramedullary nail fixation (nail group; n = 161), a metal rod inserted into the hollow center of the tibia, vs locking plate fixation (plate group; n = 160), a plate attached to the surface of the tibia with fixed-angle screws. Disability Rating Index (DRI; score range, 0 [no disability] to 100 [complete disability]) at 6 months was the primary outcome measure, with a minimal clinically important difference of 8 points. DRI measurement was also collected at 3 and 12 months. Secondary outcomes were the Olerud-Molander Ankle Score (OMAS), quality of life, and complications (such as infection and further surgery). Among 321 randomized patients (mean age, 45 years [SD, 16.2]; men, 197 [61%]; had experienced traumatic injury after a fall, 223 [69%]), 258 completed the study. There was no statistically significant difference in the DRI score at 6 months between groups (mean score, 29.8 in the nail group vs 33.8 in the plate group; adjusted difference, 4.0 [95% CI, -1.0 to 9.0], P = .11). There was a statistically significant difference in the DRI score at 3 months in favor of nail fixation (mean score, 44.2 in the nail group and 52.6 in the plate group; adjusted difference, 8.8 [95% CI, 4.3 to 13.2], P fracture of the distal tibia, neither nail

  16. Immediate versus delayed intramedullary nailing for open fractures of the tibial shaft: a multivariate analysis of factors affecting deep infection and fracture healing.

    Science.gov (United States)

    Yokoyama, Kazuhiko; Itoman, Moritoshi; Uchino, Masataka; Fukushima, Kensuke; Nitta, Hiroshi; Kojima, Yoshiaki

    2008-10-01

    The purpose of this study was to evaluate contributing factors affecting deep infection and fracture healing of open tibia fractures treated with locked intramedullary nailing (IMN) by multivariate analysis. We examined 99 open tibial fractures (98 patients) treated with immediate or delayed locked IMN in static fashion from 1991 to 2002. Multivariate analyses following univariate analyses were derived to determine predictors of deep infection, nonunion, and healing time to union. The following predictive variables of deep infection were selected for analysis: age, sex, Gustilo type, fracture grade by AO type, fracture location, timing or method of IMN, reamed or unreamed nailing, debridement time (6 h), method of soft-tissue management, skin closure time (1 week), existence of polytrauma (ISS or =18), existence of floating knee injury, and existence of superficial/pin site infection. The predictive variables of nonunion selected for analysis was the same as those for deep infection, with the addition of deep infection for exchange of pin site infection. The predictive variables of union time selected for analysis was the same as those for nonunion, excluding of location, debridement time, and existence of floating knee and superficial infection. Six (6.1%; type II Gustilo n=1, type IIIB Gustilo n=5) of the 99 open tibial fractures developed deep infections. Multivariate analysis revealed that timing or method of IMN, debridement time, method of soft-tissue management, and existence of superficial or pin site infection significantly correlated with the occurrence of deep infection (PGustilo type, skin closure time, and existence of deep infection significantly correlated with occurrence of nonunion (P Gustilo type and existence of deep infection were significantly correlated with healing time to union on multivariate analysis (r(2) = 0.263, P = 0.0001). Multivariate analyses for open tibial fractures treated with IMN showed that IMN after EF (especially in

  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. Immediate versus delayed intramedullary nailing for open fractures of the tibial shaft: A multivariate analysis of factors affecting deep infection and fracture healing

    Directory of Open Access Journals (Sweden)

    Yokoyama Kazuhiko

    2008-01-01

    Full Text Available Background: The purpose of this study was to evaluate contributing factors affecting deep infection and fracture healing of open tibia fractures treated with locked intramedullary nailing (IMN by multivariate analysis. Materials and Methods: We examined 99 open tibial fractures (98 patients treated with immediate or delayed locked IMN in static fashion from 1991 to 2002. Multivariate analyses following univariate analyses were derived to determine predictors of deep infection, nonunion, and healing time to union. The following predictive variables of deep infection were selected for analysis: age, sex, Gustilo type, fracture grade by AO type, fracture location, timing or method of IMN, reamed or unreamed nailing, debridement time (≤6 h or> 6 h, method of soft-tissue management, skin closure time (≤1 week or> 1 week, existence of polytrauma (ISS< 18 or ISS≥18, existence of floating knee injury, and existence of superficial/pin site infection. The predictive variables of nonunion selected for analysis was the same as those for deep infection, with the addition of deep infection for exchange of pin site infection. The predictive variables of union time selected for analysis was the same as those for nonunion, excluding of location, debridement time, and existence of floating knee and superficial infection. Results: Six (6.1%; type II Gustilo n=1, type IIIB Gustilo n=5 of the 99 open tibial fractures developed deep infections. Multivariate analysis revealed that timing or method of IMN, debridement time, method of soft-tissue management, and existence of superficial or pin site infection significantly correlated with the occurrence of deep infection ( P < 0.0001. In the immediate nailing group alone, the deep infection rate in type IIIB + IIIC was significantly higher than those in type I + II and IIIA ( P = 0.016. Nonunion occurred in 17 fractures (20.3%, 17/84. Multivariate analysis revealed that Gustilo type, skin closure time, and

  19. Use of Titanium Elastic Nails in the Adult Diaphyseal Humerus Fractures

    OpenAIRE

    Upadhyay AS; Lil NA

    2017-01-01

    INTRODUCTION: Humerus shaft fractures in adults can be managed conservatively with functional braces or operatively with plate osteosynthesis or with intramedullary nailing. Conventionally humerus intramedullary nailing is done either using humerus interlocking nails or Enders nails. In this study we analyse the outcome of humerus shaft fractures (upper and middle third) managed with closed ante- grade intramedullary titanium elastic nailing in terms of union rates, union time, functional res...

  20. Cost-effectiveness of replacing skeletal traction by interlocked intramedullary nailing for femoral shaft fractures in a provincial trauma hospital in Cambodia.

    Science.gov (United States)

    Gosselin, Richard A; Heitto, Merja; Zirkle, Lew

    2009-10-01

    In this article the costs and effectiveness of introducing the SIGN nailing system for femoral shaft fractures in a provincial trauma hospital in Cambodia are compared to those of Perkin's traction treatment. At an average cost per patient of $1,107 in the traction group and $888 in the nail group (p < 0.01), and with better clinical outcomes in the nail group, internal fixation is more cost-effective than conservative treatment.

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

    Directory of Open Access Journals (Sweden)

    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.

  2. UK Fixation of Distal Tibia Fractures (UK FixDT): protocol for a randomised controlled trial of 'locking' plate fixation versus intramedullary nail fixation in the treatment of adult patients with a displaced fracture of the distal tibia.

    Science.gov (United States)

    Achten, Juul; Parsons, Nicholas R; McGuinness, Katie R; Petrou, Stavros; Lamb, Sarah E; Costa, Matthew L

    2015-09-18

    The treatment of displaced, extra-articular fractures of the distal tibia remains controversial. These injuries are difficult to manage due to limited soft tissue cover, poor vascularity of the area and proximity to the ankle joint. Surgical treatment options are expanding and include locked intramedullary nails, plate and screw fixation and external fixator systems. The nail and plate options are most commonly used in the UK, but controversy exists over which treatment is most clinically and cost-effective. In this multicentre randomised controlled trial we aim to assess ratings of disability 6 months postinjury in patients who have sustained a distal tibia fracture treated with either an intramedullary nail or plate and locking screw fixation. Adult patients presenting at trial centres with an acute fracture of the distal tibia will be considered for inclusion. A total of 320 patients will provide 90% power to detect a difference of 8 points in Disability Rating Index (DRI) score at 6 months at the 5% level. The randomisation sequence is stratified by trial centre and age, and administered via web-based service with 1:1 treatment allocation. Baseline demographic and pre-injury functional data and radiographs will be collected using the DRI, Olerud and Molander, and EuroQol EQ-5D questionnaire. Clinical assessment, early complications and radiographs will be recorded at 6-8 weeks. Functional outcome, health-related quality of life and resource use will be collected at 3, 6 and 12 months postoperatively. The main analysis will investigate differences in DRI 6 months postsurgery, between the two treatment groups, on an intention-to-treat basis. Tests will be two-sided and considered to provide evidence for a significant difference if p values are <0.05. NRES Committee West-Midlands, 6/11/2012 (ref:12/WM/0340). The results of the trial will be disseminated via peer-reviewed publications and presentations at relevant conferences. ISRCTN99771224. Published by

  3. 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.

  4. Cost-effectiveness of replacing skeletal traction by interlocked intramedullary nailing for femoral shaft fractures in a provincial trauma hospital in Cambodia

    National Research Council Canada - National Science Library

    Gosselin, Richard A; Heitto, Merja; Zirkle, Lew

    2009-01-01

    In this article the costs and effectiveness of introducing the SIGN nailing system for femoral shaft fractures in a provincial trauma hospital in Cambodia are compared to those of Perkin's traction treatment...

  5. Displaced 3- and 4-part proximal humeral fractures: Evaluation and management with an intramedullary nail within 48 h, in the emergency department

    Directory of Open Access Journals (Sweden)

    Francesco Nobile

    2016-03-01

    Conclusions: The nail utilized is provided with locking and multiplanar proximal screws and could be applied through a mini-invasive anterolateral approach. This enables the reduction of the fracture fragments, while preserving vascularization of the scapulo-humeral joint. Our results confirm that the indication of endomedullary nail could be extended to the treatment of complex proximal humeral fractures with 3 and 4 fragments (level of evidence IV, according to the Oxford Centre for Evidence Based Medicine Levels of Evidence Working Group.

  6. Comparision of the expandable nail with locked nail in the treatment ...

    African Journals Online (AJOL)

    Background: Expandable nails achieve stability only by hydraulic expansion; therefore suggest less radiation exposure and operation time. In this study, we aimed to compare the results of expandable femoral nails with locked intramedullary nails in the treatment of diaphyseal fractures of femur. Materials and Methods: ...

  7. Carbon-fiber reinforced intramedullary nailing in musculoskeletal tumor surgery: a national multicentric experience of the Italian Orthopaedic Society (SIOT) Bone Metastasis Study Group.

    Science.gov (United States)

    Piccioli, Andrea; Piana, Raimondo; Lisanti, Michele; Di Martino, Alberto; Rossi, Barbara; Camnasio, Francesco; Gatti, Marco; Maniscalco, Pietro; Gherlinzoni, Franco; Spinelli, Maria Silvia; Donati, Davide Maria; Biagini, Roberto; Capanna, Rodolfo; Denaro, Vincenzo

    2017-10-01

    Carbon fiber reinforced (CFR) implants have been proposed for the treatment of fractures or impending fractures of the long bones in the oncology patient. Aim of this study is to present the largest cohort of oncology patients operated by CFR nailing by the Italian Orthopaedic Society (SIOT) Bone Metastasis Study Group. 53 adult oncology patients were operated on with a CFR-PEEK nail. All the data from adjuvants therapies were collected. Bone callus formation, response to radiotherapy, relapse or progression of the osteolysis were recorded. Hardware survival and failure, breakage and need for implant revision were also analysed. Anatomical implantation of nails include humerus (n = 35), femur (n =11) and tibia (n = 7). The most frequent tumors affecting the bone were myeloma (n = 13), breast (n = 11), lung (n = 8), and renal cell cancer (n = 7). Acrylic cement reinforcement was used in 2 patients. One patient was subjected to electrochemotherapy after nail insertion. Intraoperative and early postoperative complications occurred in 13.2% and 7.54% of patients respectively. Eight patients had local progression and one developed a stress fracture proximally to the distal static screw. Radiographic union occurred in 14 patients; one screw loosening was recorded. There is currently a lack of solid evidence on the clinical use of CFR nails in oncologic patients. This is the first and largest study of CFR nailing, with the longest available follow up. Implant related complications and surgery-related morbidity should be taken into account in the decision-making process for the surgical management of these patients. These data can improve the surgeon-patient communication and guide further studies on patients' survival and complications with respect to surgery. © 2017 Elsevier Ltd. All rights reserved.

  8. Treatment of fractures of the tibial diaphysis using external fixator compared with locked intramedullary nails Tratamento das fraturas diafisárias da tíbia com fixador externo comparado com a haste intramedular bloqueada

    Directory of Open Access Journals (Sweden)

    Rodrigo Tavares Cardozo

    2013-04-01

    Full Text Available OBJECTIVE: To compare efficiency of external fixator in modular form with unilateral and uniplanar intramedullary locked seeking definitive treatment of fractures of the tibia diaphysis. METHODS: Orthopedic surgical treatments were compared to 50 patients with definite diafisária fracture of the tibia, through the use of the external fixator, modular and intramedullary locked. The fractures were treated at emergency hospital school of Orthopedics and Traumatology service in the period from January 2007 to January 2011, with a variation of 15 to 48 weeks. RESULTS: this study has proven functional results and excellent consolidation when locked intramedullary rods were used and the versatility and speed of application of external fixator reaching the necessary stabilization of bony fragments. Consolidation of fractures was obtained in 95 cases when using the intramedullary locked and 90 cases undergoing external fixation. CONCLUSIONS: the definitive treatment of tibial diaphysis fractures by external fixator modular presented themselves as valid alternative treatment in patients who could not be submitted for early conversion to internal osteosynthesis or when the intramedullary nails are not available to the surgeon. OBJETIVO: Comparar a eficiência de fixador externo modular na forma uniplanar e unilateral com haste intramedular bloqueada (HIB buscando tratamento definitivo das fraturas diafisárias da tíbia. MÉTODOS: Foram comparados os tratamentos cirúrgicos ortopédicos definitivos de 50 pacientes com fratura diafisária da tíbia, por meio do uso do fixador externo modular e da haste intramedular bloqueada. As fraturas foram tratadas no setor de emergência de um hospital-escola pelo serviço de ortopedia e traumatologia de janeiro de 2007 a janeiro de 2011, com variação de 15 a 48 semanas. RESULTADOS: Este estudo comprovou resultados funcionais e de consolidação excelentes quando usada a haste intramedular bloqueada e a

  9. The Retrograde Tibial Nail: presentation and biomechanical evaluation of a new concept in the treatment of distal tibia fractures.

    Science.gov (United States)

    Kuhn, Sebastian; Appelmann, Philipp; Pairon, Philip; Mehler, Dorothea; Rommens, Pol M

    2014-01-01

    Displaced distal tibia fractures require stable fixation while minimizing secondary damage to the soft tissues by the surgical approach and implants. Antegrade intramedullary nailing has become an alternative to plate osteosynthesis for the treatment of distal metaphyseal fractures over the past two decades. While retrograde intramedullary nailing is a standard procedure in other long bone fractures, only few attempts have been made on retrograde nailing of tibial fractures. The main reasons are difficulties of finding an ideal entry portal and the lack of an ideal implant for retrograde insertion. The Retrograde Tibial Nail (RTN) is a prototype intramedullary implant developed by our group. The implant offers double proximal and triple distal interlocking with an end cap leading to an angle-stable screw-nail construct of the most distal interlocking screw. Its design meets the requirements of a minimally invasive surgical approach, with a stable fracture fixation by multiple locking options. The 8mm diameter curved nail, with a length of 120 mm, is introduced through an entry portal at the medial malleolus. We see possible indications for the RTN in far distal tibial shaft fractures, distal extraarticular metaphyseal tibial fractures and in distal tibia fractures with simple extension into the ankle joint when the nail is combined lag screw fixation. A biomechanical comparison of the current RTN prototype against antegrade nailing (Expert Tibial Nail, Synthes(®), ETN) was performed. Both implants were fixed with double proximal and triple distal interlocking. Seven biomechanical composite tibiae were treated with either osteosynthesis techniques. A 10mm defect osteotomy 40 mm proximal to the joint line served as an AO 43-A3 type distal tibial fracture model. The stiffness of the implant-bone constructs was measured under low and high extra-axial compression (350 and 600 N) and under torsional load (8 Nm). Results show a comparable stability during axial loading

  10. Tibiocalcaneal Arthrodesis With a Porous Tantalum Spacer and Locked Intramedullary Nail for Post-Traumatic Global Avascular Necrosis of the Talus.

    Science.gov (United States)

    Cohen, Michael M; Kazak, Marat

    2015-01-01

    Global avascular necrosis of the talus is a devastating complication that usually occurs as a result of a post-traumatic or metabolic etiology. When conservative options fail, tibiocalcaneal arthrodesis is generally indicated in conjunction with massive bone grafting to maintain the functional length of the extremity. Several bone grafting options are available, including the use of a freeze-dried or fresh-frozen femoral head allograft or autograft obtained from the iliac crest or fibula, all of which pose their own inherent risks. The noted complications with massive bone grafting techniques have included graft collapse, infection, immune response, donor site morbidity, and nonunion. In an effort to avoid many of these complications, we present a case report involving post-traumatic talar avascular necrosis in a 59-year-old male who was successfully treated with the use of a porous tantalum spacer, an autogenic morselized fibular bone graft, and 30 mL of bone marrow aspirate in conjunction with a retrograde tibiocalcaneal nail. Porous tantalum is an attractive substitute for bone grafting because of its structural integrity, biocompatibility, avoidance of donor site complications, and lack of an immune response. The successful use of porous tantalum has been well-documented in hip and knee surgery. We present a practical surgical approach to tibiotalocalcaneal arthrodesis with a large segmental deficit. To our knowledge, this is the first published report describing an alternative surgical technique to address global avascular necrosis of the talus that could have additional applications in salvaging the ankle with a large bone deficiency. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

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

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    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.

  12. Comparative study of the locked intramedullary nail and Ender pins in the treatment of tibial diaphyseal fractures Estudo comparativo entre a haste intramedular bloqueada e os pinos de Ender no tratamento das fraturas diafisárias da tíbia

    Directory of Open Access Journals (Sweden)

    Marcos Hideyo Sakaki

    2007-01-01

    Full Text Available OBJECTIVE: To compare the locked, unreamed intramedullary nail with Ender pins in the treatment of open Gustilo grade I or II or closed tibial diaphyseal fractures of type A, B, or C2 of the AO classification. MATERIALS AND METHODS: Forty-four patients with unilateral tibial diaphyseal fractures were treated with intramedullary nails or Ender pins. Twenty patients were treated with an unreamed intramedullary nail with access via the patellar tendon with static locking. Twenty-four patients were treated with Ender pins introduced medially and laterally with respect to the tuberosity of the tibia. The main parameters analyzed were type of reduction, complications, union rate, deformities, joint mobility, pain, gait, effort capacity, presence of neurovascular disorders, and complaints related to the synthesis material. RESULTS: During 1 year of follow-up, the fractures of 90.0% of the patients with intramedullary nails and 95.7% of patients with Ender pins healed within an average of 21.5 weeks and 20.9 weeks, respectively. The significant findings were as follows: patients treated with Ender pins had less mobility of the subtalar joint; patients treated with intramedullary nails were more likely to have pain in the knee; both groups showed shortening of the tibia at the end of 1 year of treatment. CONCLUSIONS: The two methods are similar in the treatment of type A, B, and C2 tibial diaphyseal fractures.OBJETIVO: Comparar a haste intramedular bloqueada não-fresada com os pinos de Ender no tratamento das fraturas da diáfise da tíbia tipos A, B ou C2 da classificação AO, fechadas ou expostas graus I ou II de Gustilo. MATERIAIS E MÉTODOS: 44 pacientes com fratura unilateral da diáfise da tíbia, tratados com HIB ou com pinos de Ender. Vinte pacientes foram tratados com uma haste intramedular bloqueada não fresada por acesso através do tendão patelar e com bloqueio estático; vinte e quatro pacientes com pinos de Ender introduzidos medial e

  13. [Compression osteosyntheses with the new AO universal nail. Functional principle and biomechanical prerequisites].

    Science.gov (United States)

    Ritter, G

    1991-01-01

    The new AO universal nail, with its special construction, allows extremely stable compression osteosynthesis in correctly selected fractures. Compression osteosynthesis with an intramedullary brace has definite advantages for fracture healing and biomechanics. The basic requirement, especially for the long-term maintenance of pressure, is truly stable anchorage of the locking bolts in the bone. Previous investigations by the author have shown that this is only possible in the shaft of the bone. Anchoring stability is not sufficient in the cancellous juxta-articular bone. Five years of clinical experience fully confirm the theoretical expectations.

  14. Comparison of intramedullary nailing and minimal invasive plate osteosynthesis in the treatment of simple intra-articular fractures of the distal tibia (AO-OTA type 43 C1-C2).

    Science.gov (United States)

    Beytemür, Ozan; Barış, Alican; Albay, Cem; Yüksel, Serdar; Çağlar, Sever; Alagöz, Ender

    2017-01-01

    The aim of this study was to compare midterm functional and radiographic results of minimal invasive plate osteosynthesis (MIPO) with intramedullary nailing (IMN) of simple intra-articular distal tibial fractures (AO-OTA type 43 C1-C2). Seventy-three simple intra-articular distal tibial fracture patients were evaluated retrospectively. All were treated between 2009 and 2014. The average age of the patients was 40.3 years. Thirty-seven patients were treated with IMN and 36 patients were treated with MIPO. Fibular plate osteosynthesis was applied in 5 cases (13.5%) in the IMN group and in 23 patients (63.9%) in the MIPO group. Functional results and complications of IMN and MIPO methods were assessed in 73 patients. The average union time was 16.4 ± 2.7 weeks in the IMN group and 15.2 ± 1.8 weeks in the MIPO group (p = 0.079). The average Olerud-Molander Ankle Score was 87.8 ± 8.1 in the IMN group and 81.5 ± 11.8 in the MIPO group (p = 0.013). Four patients in the IMN group experienced valgus malunion, while it was not observed in any patients in the MIPO group (p = 0.042). Recurvatum malunion was detected in 10 patients in the MIPO group and not seen in the IMN group (p = 0.001). Ankle dorsiflexion angle was 25.8 ± 4.5° in the IMN group and 33.3 ± 8.9° in the MIPO group (p = 0.000). Simple intra-articular distal tibial fractures are successfully treated with IMN and MIPO. Prevalence of valgus malunion was higher in the IMN group and recurvatum was more prevalent in the MIPO group. MIPO is the first preference according to the literature; however, successful results have been obtained with IMN in this fracture pattern. Level III, Therapeutic Study. Copyright © 2016 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.

  15. Nail dyschromias

    Directory of Open Access Journals (Sweden)

    Vibhu Mendiratta

    2011-01-01

    Full Text Available Nail dyschromias have a wide variety of presentation. There are numerous causes of discoloration of the nail affecting the nail plate, nail attachments, or the substance of the nail. The chromonychia may also be caused due to the exogenous deposition of pigments over the nail plate. Careful examination of the nail and few bed side tests may help in identifying the root cause of the nail dyschromia and many a times unravels some underlying systemic disorder too.

  16. Dispositivo de tração do membro superior para osteossínteses intramedulares bloqueadas anterógradas de fraturas diafisárias de úmero Upper limb traction device for anterograde intramedullary locked nail of humeral shaft fractures

    Directory of Open Access Journals (Sweden)

    Mário Chaves Corrêa

    2010-06-01

    surgically, usually by means of intramedullary locked nail. Some comminuted and/or very deviated shaft fractures can represent a real technical challenge. The fracture table, which allows for the vertical, horizontal and rotational instrumental stabilization of the limb, greatly facilitates reduction and implant placement maneuvers and are widely used by orthopedic surgeons. Humeral shaft fractures are mostly treated nonsurgically. However, some whose indications are well defined in literature require surgical treatment. They can be fixed by plates, or by anterograde or retrograde intramedullary nail. In the humerus, limb fracture reduction and stabilization maneuvers for implantation of intramedullary nails are done manually, usually by 2 assistants. Because they are subject to muscle fatigue, this option may be less efficient. The aim of this paper is to present an external traction device for use in anterograde intramedullary fixation of humerus shaft fractures that allows vertical, horizontal and rotational stabilization of the upper limb similarly to that used in the lower limbs. The device is portable, of simple construction, and can be installed on any operating table equipped with side rails. It was used in the surgical treatment of 29 humeral shaft fractures with anterograde locked intramedullary nail. Our experience was extremely positive. We had no complications related to its use and we believe it to have facilitated the surgical procedures in a remarkable way.

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

    Directory of Open Access Journals (Sweden)

    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.

  18. exchange femoral nailings at kenyatta national hospital abstract ...

    African Journals Online (AJOL)

    Shroeder, J. E. Mosheiff,R. And Khoury, A. The outcome of closed, intramedullary exchange nailing with reamed insertion in the treatment of femoral shaft nonunions. J.Orthopaedic Trauma. 2009: 9;653-657. 6. Yu,C.W.,Wu,C.C. and Chen,W .J. Aseptic nonunion of a femoral shaft treated using exchange nailing. Chang.

  19. 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.

  20. Nail cosmetics

    Directory of Open Access Journals (Sweden)

    Nina A Madnani

    2012-01-01

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

  1. Comprehensive global evolution of intramedullary nailing of ...

    African Journals Online (AJOL)

    Splint used in the first world war (2). Advances in asepsis in 1856 by Pasteur, and introduction of X-rays in 1895 further improved management of these fractures. The first allowed clean surgery while the latter allowed closed reduction of fractures. The discovery of Penicillin by Alexander. Fleming in 1928 further contributed ...

  2. Complications of Secondary Intramedullary Nailing Following ...

    African Journals Online (AJOL)

    Background: Polytrauma patients with multiple long bone fractures risk haemorrhagic shock and fat embolism syndrome / acute respiratory distress syndrome. Damage control orthopaedics (DCO) addresses these risks in femoral fractures and is well established for patients with physiological compromise in trauma. Sparse ...

  3. Controlled Compression Nailing for At Risk Humeral Shaft Fractures

    OpenAIRE

    Watson, J. Tracy; Sanders, Roy W.

    2017-01-01

    Summary: Compression techniques seem to be the primary factor in determining the success of both plating and nailing techniques for the management of acute fractures and for delayed and nonunion management of these fractures. An intramedullary nail that can provide continual compression (like a plate) and mechanical manipulation of the callous throughout the course of treatment is an ideal device that provides all the advantages of plating and nailing and avoids the noted limitations of both....

  4. Fixation of the midclavicular fractures with the titanium elastic nails in adults – preliminary results

    Directory of Open Access Journals (Sweden)

    Matej Drobnič

    2005-06-01

    Full Text Available Background: Elastic intramedullary fixation is an established operative treatment for fractures in childhood, which is only exceptionally used in adults. A modified intramedullary fixation of midclavicular fractures in adults with titanium elastic nails is presented.Methods: The group was comprised of five adult patients with shortened midclavicular fractures. The prior conservative treatment had been ineffective in three cases, whereas poor functional outcome was expected in the other two, as a result of fracture shortening or instability. According to the new technique titanium elastic nails were first placed into the intramedullar channel of the distal fragment through the fracture, using a mini-open exposure. The nails were advanced retrogradely into the proximal fragment to achieve a stable fixation. The initial post-operative rehabilitation included pendulary exercises in a sling. Active exercises in the range of pain allowance were introduced after the operative wounds had been healed.Results: All fractures were consolidated in the physiological position. The patients were capable of painless movements with the shoulder on the operated side in the full range of motion after six weeks. One transitory complication in the form of skin and subcutaneous decubitus over the protruded nail tip was noted without an influence on the end result.Conclusions: The preliminary results in a limited number of patients showed efficient consolidation of the midclavicular fractures in adults treated with intramedullar titanium elastic nails. The functional results and low invasivity of the procedure support its further use in treatment of midclavicular fractures, which fail to heal conservatively, or which are expected to result in poor functional or cosmetic outcome.

  5. Estudo prospectivo e randomizado de pacientes com fraturas expostas da diáfise do fêmur submetidos a osteossíntese com placa e haste intramedular bloqueada a foco aberto Prospective and randomized study of patients with open fractures of the femoral shaft, treated with plate or open intramedullary locked nail

    Directory of Open Access Journals (Sweden)

    Antonio Marcos Ferracini

    2008-01-01

    Full Text Available Trata-se de um estudo prospectivo e randomizado de duas técnicas de osteossíntese no tratamento das fraturas expostas diafisárias do fêmur, realizado entre janeiro de 2002 a abril de 2004. Haste intramedular bloqueada fresada realizada a foco aberto e placa e parafusos foram empregadas no tratamento de 20 pacientes em cada grupo. De acordo com a classificação de Gustilo, 26 (65% foram tipo I, 10 (25% tipo II e 4 (10% tipo IIIA. Quanto ao mecanismo das fraturas, 21 por trauma contuso e 19 por ferimentos de arma de fogo.Três pacientes foram excluídos nas avaliação final. Houve complicação em 12 (32,4%,sendo 4 no grupo de placas e 8 no grupo das hastes. O grupo de haste bloqueada apresentou 2 (10% infecções profundas, 2 infecções superficiais (10%, 1 falha de consolidação (5%.O grupo de placa e parafusos resultou em 1 infecção profunda associada à falha de consolidação (5,8%, 1 infecção superficial (5,8%. Pela classificação de resultados de Thorensen obteve-se bons e excelentes resultados em 28 (75,7% fraturas, 3 (7.5% casos regulares e 6 (15% casos ruins. A estabilização com placas e parafusos, trouxe menores taxas de complicações, quando comparadas com o uso de hastes fresadas a foco aberto,embora sem significado estatístico.We assessed the complications and treatment outcomes in a prospective and randomized study of two osteosynthesis techniques in open femoral shaft fractures. Between January 2002 and April 2004, 40 patients with open fractures of the femoral shaft were assessed, with 20 being treated with open reamed intramedullary locked nail and 20 with plate. Twenty-six (65% fractures were classified as Gustilo type -I open fractures; ten (25% as type II and four (10%, as type IIIA. There were 21 blunt injuries and 19 gunshot injuries. Three patients were excluded from the final assessment. Complications were observed in 12 (32.4% patients, 4 in the plate group and 8 in the nail group. Reamed intramedullary

  6. OUTCOMES IN CLOSED REAMED INTERLOCKING NAIL IN FRACTURES OF SHAFT OF FEMUR

    National Research Council Canada - National Science Library

    Mohammad, Taj; Khan, Alamzeb; Sawati, Alamzeb; Ahmed, Ashfaq; Awan, Abdus Saboor; Saboor, Abdus; Siddique

    2015-01-01

    .... 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...

  7. Intramedullary capillary haemangioma.

    LENUS (Irish Health Repository)

    Kelleher, T

    2012-02-03

    Intramedullary capillary haemangioma is extremely rare and only four cases have been previously reported. We describe a further case, outlining the clinical, radiological, surgical and pathological features.

  8. Outcome of SIGN Nail Initiative in Treatment of Long Bone Fractures ...

    African Journals Online (AJOL)

    Background: Currently the standard of treatment for femoral shaft fracture and unstable tibia fracture are closed locking intramedullary nail which require fluoroscopy and fracture table. The objective of this review was to evaluate the outcome of Surgical Implant Generation Network (SIGN ) initiative, locking intramedullary ...

  9. 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

  10. Use of Huckstep nail in the periimplant femoral shaft fracture

    Directory of Open Access Journals (Sweden)

    Hong Kyun Kim

    2012-01-01

    Full Text Available 87-year-old female underwent open reduction of distal femoral fracture and internal fixation with locking compression plate and bone graft. She was operated for ipsilateral proximal femoral fractures and stabilized by intramedullary interlocked nail 5 years ago. She developed stress fracture proximal to locked plate. We inserted Huckstep nail after removal of the previous operated proximal femoral nail without removing the remaining plate and screws. At 15 month followup the fractures have united. The Huckstep nail has multiple holes available for screw fixation at any level in such difficult situations.

  11. Nail Fungus

    Science.gov (United States)

    ... cause is a type of fungus called dermatophyte. Yeast and molds also can cause nail infections. Fungal ... more years of exposure to fungi and slower growing nails Sweating heavily Having a history of athlete's ...

  12. Nail anatomy.

    Science.gov (United States)

    de Berker, David

    2013-01-01

    The nail unit comprises the nail plate, the surrounding soft tissues, and their vasculature and innervation based upon the distal phalanx. The nail plate is a laminated keratinized structure lying on the nail matrix (15-25%), the nail bed with its distal onychodermal band (75-85%), and the hyponychium at its free edge. The distal part of the matrix, the lunula characterized by its half-moon shape, can be observed in some digits. The nail plate is embedded by the proximal and lateral folds. From the proximal nail fold, the cuticle (also known as the eponychium), adheres to the superficial surface of the proximal nail plate. The nail unit possesses a complex and abundant vascular network to ensure adequate blood supply. Finally, both the periungual soft tissues and the nail folds are innervated. The shapes, structure, and inter-relationships of these tissues are factors in the way nails present with disease and how we understand and manage those diseases. In particular, an understanding of the surgical anatomy is important for those undertaking diagnostic or curative operations on the nail. With this knowledge, the most appropriate surgery can be planned and the patient can be provided with accurate and clear guidance to enable informed consent. © 2013.

  13. Biomechanical investigation of a novel ratcheting arthrodesis nail.

    Science.gov (United States)

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

    2010-10-14

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

  14. Biomechanical investigation of a novel ratcheting arthrodesis nail

    Directory of Open Access Journals (Sweden)

    Billiar Kristen L

    2010-10-01

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

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

    Science.gov (United States)

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

    2017-03-01

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

  16. Exchange femoral nailings at Kenyatta National Hospital | Ong'ang'o ...

    African Journals Online (AJOL)

    Background: Intramedullary nailing is the method of choice in the treatment of acute femoral shaft fractures in adults. It is associated with a high fracture union rate and a low complication rate. Nonunion as well as its other rare complications are treated by exchange femoral nailing. Objective: To look at the use of the ...

  17. Outcome of SIGN Nail Initiative in Treatment of Long Bone Fractures ...

    African Journals Online (AJOL)

    DELL

    Methods: This is prospective descriptive study of 180 fractures of femur and/or tibia, which were openly reduced and fixed using SIGN intramedullary nail and screw. All were followed at least for one year, either until complete rehabilitatio followed at least for one year, either until complete rehabilitation or nail removal.

  18. Dynamic compression nail: A preliminary report

    Directory of Open Access Journals (Sweden)

    Gupta Ajay

    2001-10-01

    Full Text Available Abstract Background Interlocking nailing, which has become the method of choice for treating fractures of the femoral and tibial shafts, still lacks ability to provide the important contact-compression at the fracture. An intramedullary compression nail is described, which provides axial compression at the fracture site with tightening of the specially designed distal interlocking screw. This uses the same principle as dynamic compression plating. Methods The study included 11 femoral and tibial nailings performed for various clinical applications such as acute fractures, non-unions and malunions. Results All the fractures attained radiological union, with good skeletal continuity across the fracture, within an average time of 13 weeks in fresh fractures and 18 weeks in non-unions. Conclusions Active compression through intramedullary compression nailing has great utility for treating non-unions where it provides greater degree of impaction of its irregular ends. This may prove greatly advantageous to the fracture union through increased stability and the osteogenic potential, particularly when utilized in combination with the small diameter unreamed nails.

  19. Nail infections.

    Science.gov (United States)

    Jules, K T; Bonar, P L

    1989-04-01

    Nail infections are and will continue to be a diagnostic and therapeutic challenge to all foot physicians. Attention to basic concepts of accurate detailed history and physical examination will aid in the determination of the etiology of these infections. Following basic guidelines of incision and drainage, gram stain, soaks, and antibiotics will be the cornerstone of initial treatment of pyogenic infections. Upon resolution of the acute infection a permanent treatment plan can be constituted based on the etiology. Nail infections of mycotic nature require an understanding by both patient and doctor as to the difficulty and resistance to treatment of this problem. It is the authors' opinion that aggressive persistent treatment will provide the best long-term result when dealing with mycotic infections. This may require nail removal, local and systemic treatment as well as change in shoe environment. As we have seen and is stated throughout this text, the nail and its pathologic processes can be a mirror of systemic disease. Many times a dystrophic infected nail may be the initial clinical presentation of a much more involved disease process. It is the responsibility and duty of all foot physicians to have a total understanding of knowledge of normal and pathologic process that affect the nail plates, nail bed, and surrounding nail proper. I hope this article will stimulate the foot physician to approach the disease of the nail with a high index of suspicion and respect.

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

    African Journals Online (AJOL)

    Background: Closed interlocked intra-medullary nailing (IM), the standard method of treating of long bone shaft fracture, has been a dream to most resource poor hospitals like Kenyan regional hospitals. Surgical implant generation network (SIGN) initiative employs use of external jigs and slot finders instead of expensive ...

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

    African Journals Online (AJOL)

    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), the standard method of treating of long bone shaft fracture, has been a dream to most resource poor ...

  2. Forearm diaphyseal fractures in children: intramedullary Kirschner's wire fixation treatment.

    Science.gov (United States)

    Mahecha-Toro, M; Vergara-Amador, E; González Ramírez, M

    Diaphyseal fractures of the forearm comprise 6%-10% of all fractures in children. The treatment depends on the age and type of displacement, and conservative and surgical management with fixation of intramedullary nails, among other techniques, is valid. The aim is to show the radiological and functional outcomes, and complications of intramedullary fixation with Kirschner nails in children. A retrospective descriptive case series of patients treated with intramedullary fixation of forearm fractures. The radiological and functional results, and complications are correlated. Of the 117 patients operated, 59 met the inclusion criteria. The average age was 10 years. Eighty-four point seven percent were males and the left side was the most affected (62.7%). In 88.1% both bones were fractured and 11 cases had open fractures. An open reduction was performed in 72.8% of the cases, the main indications for this being instability, failed reduction and refracture. There were 52 excellent outcomes, 2 good, and 4 regular and 1 bad. There were 13.5% minor complications. This study shows that intramedullary fixation with Kirschner nails in radius and ulna diaphysis fractures in children is a safe, low-cost procedure and offers adequate short and medium term functional outcomes, with a low prevalence of serious complications with only 6 cases of non-consolidation and refracture. Larger preoperative angulations in the anteroposterior and lateral planes, and lateral postoperative angulations, could be considered predictors of less satisfactory functional results. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  3. Telescoping intramedullary stabilization of the lower extremities for severe osteogenesis imperfecta.

    Science.gov (United States)

    Nicholas, R W; James, P

    1990-01-01

    Intramedullary extendable Bailey-Dubow nails were used for treatment of lower extremity deformities resulting from osteogenesis imperfecta. Sixteen patients had 56 nails placed in 48 long bones, including 18 revisions. All patients were braced postoperatively. The average duration of follow-up was 4.8 years. Nine patients who were nonambulatory preoperatively walked in braces postoperatively. Despite a high rate of complication, extendable nails provide correction of the angular deformities of osteogenesis imperfecta, decrease fracturing, and allow most previously nonambulatory children to walk.

  4. The femoral supracondylar nail: preliminary experience.

    Science.gov (United States)

    Scheerlinck, T; Krallis, P; Descamps, P Y; Hardy, D; Delincé, P

    1998-12-01

    The treatment of supracondylar fractures of the femur with an intramedullary nail presents some theoretical advantages. Compared to plate osteosynthesis, intramedullary fixation requires less extensive dissection and is biomechanically more favorable. In the elderly patient, these characteristics seem important since bone quality, extensive procedures and bone grafting remain problematic. Since August 1994 we have treated 16 consecutive closed fractures of the distal femur (A.O. type: 7 A.1, 2 A.3, 4 C.1, and 3 C.2) with the Green-Seligson-Henry intramedullary retrograde supracondylar nail. Twelve elderly and osteoporotic patients had suffered low-energy trauma, three young patients had been involved in a traffic accident and one other young patient had attempted suicide. The operative technique, complications and results are described. All fractures healed within a few months (2 to 7) without bone grafting. No failure of the fixation material and no deep infection were encountered. With most elderly patients the functional result was judged satisfactory, considering the population studied. Intraoperative determination of alignment and avoiding shortening were the major difficulties, especially with long oblique or comminuted fractures. Two major complications were encountered in the young population. In one instance nail protrusion in the intercondylar notch caused a deep patellar cartilage erosion and sympathetic distrophy leading to a 15 degrees flexion deformity. Another young patient needed a quadriceps release at the fracture site and subsequently a femoral valgus osteotomy in order to achieve an acceptable final result. In elderly osteoporotic patients presenting an isolated supracondylar fracture, antegrade nailing remains the "safest" technique by avoiding an unnecessary arthrotomy. When previous hip or knee surgery precludes the use of antegrade nailing techniques or when the fracture extends into the intercondylar region, retrograde supracondylar nailing

  5. Nail Hygiene

    Science.gov (United States)

    ... Search The CDC Cancel Submit Search The CDC Water, Sanitation & Environmentally-related Hygiene Note: Javascript is disabled or is not supported ... message, please visit this page: About CDC.gov . Water, Sanitation, & Environmentally-related Hygiene Handwashing & Nail Hygiene Keeping Hands Clean Nail Hygiene ...

  6. Nail histopathology.

    Science.gov (United States)

    Martin, B

    2013-09-01

    The structure of the nail unit is complex and many dermatologists and dermatopathologists have an incomplete understanding of it. Familiarity with the anatomy and histology of this unit, however, is a key factor in improving the diagnostic yield of nail biopsy. Inflammatory or infectious conditions that affect the nail can have a marked impact on a patient's quality of life. A wide-ranging variety of tumors can also develop in this region and they may be life-threatening or require surgery that will result in functional defects. The author reviews the anatomy and histology of the nail unit as well as the basic histopathologic findings in the most common conditions affecting the nails. Copyright © 2011 Elsevier España, S.L. and AEDV. All rights reserved.

  7. The role of stable isotopes in human identification: a longitudinal study into the variability of isotopic signals in human hair and nails.

    Science.gov (United States)

    Fraser, I; Meier-Augenstein, W; Kalin, R M

    2006-01-01

    Recent natural catastrophes with large-scale loss of life have demonstrated the need for a new technique to provide information for disaster victim identification when DNA methods fail to yield the identification of an individual, or in other situations where authorities need to determine the recent geographical life history of people. The latter may be in relation to the identification of individuals detained on suspicion of terrorism or in relation to people-trafficking or smuggling. One proposed solution is the use of stable isotope profiling (SIP) using isotope ratio mass spectrometry (IRMS). Exploiting the link between the isotopic signal of dietary components and the isotopic composition of body tissue, the aim of this study was to refine a non-invasive method of analysing human material such as scalp hair and fingernails using SIP and to assess the degree of natural variability in these profiles. Scalp hair and fingernail samples were collected from British and non-British volunteers at Queen's University Belfast every 2 weeks for a minimum of 8 months. Samples were analysed using IRMS to determine their isotopic composition for 13C, 15N, 2H and 18O. The results of this longitudinal study yielded information on the natural variability of the isotopic composition of these tissues. The data demonstrate the relatively low degree of natural variation in the 13C/15N isotopic abundance of scalp hair and fingernails whilst greater variations were recorded in the hydrogen and oxygen values of the same samples. The 15N and 18O values of nail are noticeably more variable than that of scalp hair from the same subject. A hypothesis explaining this trend is put forward based on the faster rate of formation of hair than of nails. This means that there is less time for the compounds forming hair to be affected by biochemical processes that could alter their isotopic signature. Copyright 2006 John Wiley & Sons, Ltd.

  8. Comparing two intramedullary devices for treating trochanteric fractures: A prospective study

    Directory of Open Access Journals (Sweden)

    Kontogeorgakos Vasileios

    2010-02-01

    Full Text Available Abstract Background Intertrochanteric fractures are surgically treated by using different methods and implants. The optional type of surgical stabilization is still under debate. However, between devices with the same philosophy, different design characteristics may substantially influence fracture healing. This is a prospective study comparing the complication and final functional outcome of two intramedullary devices, the intramedullary hip screw (IMHS and the ENDOVIS nail. Materials and methods Two hundred fifteen patients were randomized on admission in two treatment groups. Epidemiology features and functional status was similar between two treatment groups. Fracture stability was assessed according to the Evan's classification. One hundred ten patients were treated with IMHS and 105 with ENDOVIS nail. Results There were no significant statistical differences between the two groups regarding blood loss, transfusion requirements and mortality rate. In contrast, the number of total complications was significantly higher in the ENDOVIS nail group. Moreover, the overall functional and walking competence was superior in the patients treated with the IMHS nail. Conclusions These results indicate that the choice of the proper implant plays probably an important role in the final outcome of surgical treatment of intertrochanteric fractures. IMHS nail allows for accurate surgical technique, for both static and dynamic compression and high rotational stability. IMHS nail proved more reliable in our study regarding nail insertion and overall uncomplicated outcome.

  9. Reamed nailing of Gustilo grade-IIIB tibial fractures.

    Science.gov (United States)

    Keating, J F; Blachut, P A; O'Brien, P J; Court-Brown, C M

    2000-11-01

    Reamed intramedullary nailing was carried out on R57 Gustilo grade-IIIB tibial fractures in 55 patients. After debridement, there was substantial bone loss in 28 fractures (49%). The mean time to union was 43 weeks (14 to 94). When there was no bone loss, the mean time to union was 32 weeks; it was 45 weeks if there was bone loss. Fractures complicated by infection took a mean of 53 weeks to heal. Revision nailing was necessary in 13 fractures (23%) and bone grafting in 15 (26%). In ten fractures (17.5%) infection developed, in four within six weeks of injury and in six more than four months later. Of these, nine were treated successfully, but one patient required an amputation because of osteomyelitis. Our results indicate that reamed intramedullary nailing is a satisfactory treatment for Gustilo grade-III tibial fractures.

  10. Osteossíntese das fraturas diafisárias da criança com hastes intramedulares flexíveis Osteosynthesis of children shaft fractures with flexible intramedullary nails

    Directory of Open Access Journals (Sweden)

    José Batista Volpon

    2008-07-01

    Full Text Available O tratamento de algumas das fraturas da criança tem sofrido modificações nos últimos anos, com o objetivo de obtenção de resultados mais satisfatórios, restrição do tempo de incapacidade e para melhor corresponder às expectativas da família. Isso é especialmente válido para as fraturas diafisárias de alguns ossos longos com o tratamento feito por hastes intramedulares elásticas. Esse tratamento é de baixa morbidade, respeita a biologia e a biomecânica da fratura e permite consolidação óssea por mecanismo secundário, com a formação de calo ósseo. Entretanto, requer implantes, instrumental e conhecimento técnico do cirurgião, pois os maus resultados relacionam-se diretamente com falhas técnicas. Atualmente, os ossos que mais se prestam para esse tipo de fixação, em relação à prioridade, são: fêmur, rádio, ulna, tíbia e úmero. O objetivo deste texto de atualização foi analisar a literatura e fornecer informações fundamentais para o conhecimento do método.The treatment of some fractures in children has changed over the last years aiming at improving results, shortening the time of physical limitation, and meeting family expectations. This is particularly true when long bone shaft fractures are involved and when treatment is carried out with elastic nails. This technique carries low morbidity, respects the biology and the biomechanics of the reparative process and allows secondary healing with osseous callus formation. Nevertheless, the technique requires adequate surgical implants, proper instruments and trained surgeons, since complications are related mainly to technical pitfalls. The technique has been used for the following bones: femur, radius and ulna, tibia and humerus. The objective of the present update was to review and to analyze the literature so as to present basic information about the treatment of diaphyseal fractures of some long bones of children with flexible nails.

  11. Alkaptonuria and intramedullary calcification.

    Science.gov (United States)

    Raina, S; Mahesh, D M; Kaushal, S S; Gupta, D; Dhiman, D S; Negi, A; Sharma, S

    2008-07-01

    Alkaptonuria is a rare disorder of metabolism caused by deficiency of homogentisic acid oxidase enzyme and characterized by triad of homogentisic aciduria (dark urine), relentlessly progressive arthritis and ochronosis. We have documented a case with typical features of alkaptonuria along with intramedullary calcification which has not been reported in the literature before.

  12. Mini-invasive nail versus DHS to fix pertrochanteric fractures: a case-control study.

    Science.gov (United States)

    Foulongne, E; Gilleron, M; Roussignol, X; Lenoble, E; Dujardin, F

    2009-12-01

    Fixation devices to treat trochanteric fractures belong to two general categories: dynamic hip screw (DHS) type and intramedullary type implants. In spite of possible pitfalls, both are considered valid options. Comparing a sliding screw-plate system (DHS) along a mini-invasive nailing device (BCM nail) with primary insertion of the cephalic screw, sheds light on the debated management of trochanteric fractures. Due to its design, the BCM nailing system allows a stable internal fixation and promotes enhanced postoperative functional recovery. To test this hypothesis in a comparative prospective case-control study using the DHS screw-plate as a reference. Two groups of 30 patients, older than 60 years old, with trochanteric fractures were included in this study. The screw-plates were placed according to the standard method. Regarding the nailing system, the cephalic screw was positioned first, then the nail was inserted through the screw via a mini-invasive approach and locked distally using a bicortical screw. Comparison between the two groups was based on (1) operative data: operating time, intra- and postoperative blood loss; (2) immediate postoperative course: complications, length of hospital stay, delay to sitting in a wheelchair; (3) the postdischarge evolution: weightbearing, readmission to hospital; (4) functional outcomes: recovery and mobility; (5) anatomical outcomes: restitution and bone healing. The operating time (54+/-8.8 min vs 59+/-13.8 min) and intraoperative (1.37+/-0.98 vs 1.90+/-1.43) and at Day 3 (1.25+/-1.05 vs 1.82+/-1.5) blood loss (haemoglobin loss), were favourable to the screw-plate subgroup (p<0.05). The delay to sitting in a wheelchair (4.76+/-1.53 d vs 4+/-1.44 d) was favourable to the nail subgroup (p<0.05). There was a higher incidence of secondary displacements in the screw-plate subgroup (3/26 [11.5%] vs 0/25 [0%]) (p<0.05). The screw-plate subgroup demonstrated a poorer healing rate at 3 months (88% vs 100%) (p<0.05). Regarding

  13. Use of Titanium Elastic Nails in the Adult Diaphyseal Humerus Fractures.

    Science.gov (United States)

    Upadhyay, A S; Lil, N A

    2017-07-01

    Introduction: Humerus shaft fractures in adults can be managed conservatively with functional braces or operatively with plate osteosynthesis or with intramedullary nailing. Conventionally humerus intramedullary nailing is done either using humerus interlocking nails or Enders nails. In this study we analyse the outcome of humerus shaft fractures (upper and middle third) managed with closed ante-grade intramedullary titanium elastic nailing in terms of union rates, union time, functional results and complications. Materials and Methods: A retrospective analysis of 25 patients treated with ante-grade intramedullary titanium elastic nailing was done during the period of August 2014 to June 2016 at our tertiary care centre. Skeletally mature patients with closed and acute fractures of the upper and middle shaft humerus of both sexes were included in the study. Results: Twenty-five (100%) fractures united with an average consolidation time of 14.98 weeks (10-32 weeks), and no fractures ended in non-union. Nail impingement was seen in two (8%), shoulder stiffness in one (4%). Functional results were excellent in 22 (88%), moderate in two (8%) and poor in one (4%). There were 17 males and eight females with an average age of 39.08 years (range: 18-65 years). The average duration of hospital stay was 3.84±2.30 days. Conclusion: Closed ante-grade intramedullary titanium elastic nailing offers a safe and reliable method of fixing fractures of upper humeral shaft in adults. This method provides early fracture union, high union rates and less complications, in addition to early rehabilitation and reduces the hospital stay.

  14. Use of Titanium Elastic Nails in the Adult Diaphyseal Humerus Fractures

    Directory of Open Access Journals (Sweden)

    Upadhyay AS

    2017-07-01

    Full Text Available INTRODUCTION: Humerus shaft fractures in adults can be managed conservatively with functional braces or operatively with plate osteosynthesis or with intramedullary nailing. Conventionally humerus intramedullary nailing is done either using humerus interlocking nails or Enders nails. In this study we analyse the outcome of humerus shaft fractures (upper and middle third managed with closed ante- grade intramedullary titanium elastic nailing in terms of union rates, union time, functional results and complications. MATERIALS AND METHODS: A retrospective analysis of 25 patients treated with ante-grade intramedullary titanium elastic nailing was done during the period of August 2014 to June 2016 at our tertiary care centre. Skeletally mature patients with closed and acute fractures of the upper and middle shaft humerus of both sexes were included in the study. RESULTS: Twenty-five (100% fractures united with an average consolidation time of 14.98 weeks (10-32 weeks, and no fractures ended in non-union. Nail impingement was seen in two (8%, shoulder stiffness in one (4%. Functional results were excellent in 22 (88%, moderate in two (8% and poor in one (4%. There were 17 males and eight females with an average age of 39.08 years (range: 18-65 years. The average duration of hospital stay was 3.84±2.30 days. CONCLUSION: Closed ante-grade intramedullary titanium elastic nailing offers a safe and reliable method of fixing fractures of upper humeral shaft in adults. This method provides early fracture union, high union rates and less complications, in addition to early rehabilitation and reduces the hospital stay.

  15. Your Nails

    Science.gov (United States)

    ... easier to scratch an itch or remove a dog hair from your sweater. Nails themselves are made ... and pedicures (done on feet and toenails) are popular services for girls and women (and even some ...

  16. Antegrade interlocking nailing of humeral shaft fractures.

    Science.gov (United States)

    Petsatodes, George; Karataglis, Dimitrios; Papadopoulos, Pericles; Christoforides, John; Gigis, John; Pournaras, John

    2004-01-01

    The results of 39 humeral shaft fractures (37 patients) treated with antegrade locked nailing using a Russell-Taylor nail were reviewed. There were 30 acute fractures, 6 fractures malaligned in a hanging cast or brace, and 3 pathological fractures. Patient age ranged from 26 to 80 years (average, 59.7 years) and average follow-up was 25.7 months (range, 6-48 months). Fracture union was achieved in 92.3% of our cases, while shoulder function was excellent or good in 87.2% of cases. Antegrade locked nailing offers a dependable solution for the treatment of humeral shaft fractures, especially in polytrauma patients and cases of segmental or pathological fractures. Far less satisfactory results were obtained in comminuted fractures of the proximal third in the humerus, especially in osteoporotic patients, and we therefore advocate caution with the use of intramedullary nailing in this type of fracture. Certain technical aspects such as avoiding nailing the fracture in distraction, properly countersinking the tip of the nail, and achieving adequate fixation stability have been found to be of paramount importance to reduce the incidence of delayed union/non-union rate and to obtain better functional results from the shoulder joint. The Japanese Orthopaedic Association

  17. Nail Surgery for Beginners

    OpenAIRE

    Güneş Gür

    2010-01-01

    Nail diseases have a negative impact on quality of life both by causing esthetic concerns and functional disturbances. Many disorders of the nail require nail surgery for diagnosis and treatment. Dermatologists, however, often refrain from surgical interventions of the nail due to prejudices that they are delicate and hard to perform. Appreciation of nail anatomy will render nail surgical interventions fast and easy with favorable results. Here, nail anatomy and basic nail surgical interventi...

  18. Controlled Compression Nailing for At Risk Humeral Shaft Fractures

    Science.gov (United States)

    Sanders, Roy W.

    2017-01-01

    Summary: Compression techniques seem to be the primary factor in determining the success of both plating and nailing techniques for the management of acute fractures and for delayed and nonunion management of these fractures. An intramedullary nail that can provide continual compression (like a plate) and mechanical manipulation of the callous throughout the course of treatment is an ideal device that provides all the advantages of plating and nailing and avoids the noted limitations of both. The UNYTE compression humeral nail is based on the PRECICE intramedullary limb lengthening system. This nail provides the ability to intraoperatively compress a humeral fracture immediately and continue compression in the outpatient setting with the external remote controller. This compression nail allows the surgeon to continually modulate stability through controlled compression and the ability to relengthen if necessary. The capacity to achieve constant compression at the fracture site has demonstrated rapid healing of the “at risk” humerus fracture in this series. We review the current indications for use of this device after its early introduction. In most cases, this was the failure of conservative brace management that presented with a progressive distraction gap and minimal callous formation or those fractures that could not be adequately controlled in the brace with malalignment greater than 20 degrees. The protocol for intraoperative compression using the external remote controller is detailed, as is the outpatient protocol for follow-up. The compression algorithm for progression to full fracture healing is also reviewed. PMID:28486287

  19. Controlled Compression Nailing for At Risk Humeral Shaft Fractures.

    Science.gov (United States)

    Watson, J Tracy; Sanders, Roy W

    2017-06-01

    Compression techniques seem to be the primary factor in determining the success of both plating and nailing techniques for the management of acute fractures and for delayed and nonunion management of these fractures. An intramedullary nail that can provide continual compression (like a plate) and mechanical manipulation of the callous throughout the course of treatment is an ideal device that provides all the advantages of plating and nailing and avoids the noted limitations of both. The UNYTE compression humeral nail is based on the PRECICE intramedullary limb lengthening system. This nail provides the ability to intraoperatively compress a humeral fracture immediately and continue compression in the outpatient setting with the external remote controller. This compression nail allows the surgeon to continually modulate stability through controlled compression and the ability to relengthen if necessary. The capacity to achieve constant compression at the fracture site has demonstrated rapid healing of the "at risk" humerus fracture in this series. We review the current indications for use of this device after its early introduction. In most cases, this was the failure of conservative brace management that presented with a progressive distraction gap and minimal callous formation or those fractures that could not be adequately controlled in the brace with malalignment greater than 20 degrees. The protocol for intraoperative compression using the external remote controller is detailed, as is the outpatient protocol for follow-up. The compression algorithm for progression to full fracture healing is also reviewed.

  20. Study to prospectively evaluate reamed intramedually nails in patients with tibial fractures (S.P.R.I.N.T.: Study rationale and design

    Directory of Open Access Journals (Sweden)

    2008-06-01

    Full Text Available Abstract Background Surgeons agree on the benefits of operative treatment of tibial fractures – the most common of long bone fractures – with an intramedullary rod or nail. Rates of re-operation remain high – between 23% and 60% in prior trials – and the two alternative nailing approaches, reamed or non-reamed, each have a compelling biological rationale and strong proponents, resulting in ongoing controversy regarding which is better. Methods/Design The objective of this trial was to assess the impact of reamed versus non-reamed intramedullary nailing on rates of re-operation in patients with open and closed fractures of the tibial shaft. The study to prospectively evaluate reamed intramedullary nails in tibial fractures (S.P.R.I.N.T was a multi-center, randomized trial including 29 clinical sites in Canada, the United States and the Netherlands which enrolled 1200 skeletally mature patients with open (Gustilo Types I-IIIB or closed (Tscherne Types 0–3 fractures of the tibial shaft amenable to surgical treatment with an intramedullary nail. Patients received a statically locked intramedullary nail with either reamed or non-reamed insertion. The first strategy involved fixation of the fracture with an intramedullary nail following reaming to enlarge the intramedullary canal (Reamed Group. The second treatment strategy involved fixation of the fracture with an intramedullary nail without prior reaming of the intramedullary canal (Non-Reamed Group. Patients, outcome assessors, and data analysts were blinded to treatment allocation. Peri-operative care was standardized, and re-operations before 6 months were proscribed. Patients were followed at discharge, 2 weeks post-discharge, and at 6 weeks, 3, 6, 9, and 12 months post surgery. A committee, blinded to allocation, adjudicated all outcomes. Discussion The primary outcome was re-operation to promote healing, treat infection, or preserve the limb (fasciotomy for compartment syndrome after

  1. Artificial Nails Require Care to Keep Nails Healthy

    Science.gov (United States)

    ... public", "mcat1=de12", ]; for (var c = 0; c Artificial nails: Dermatologists’ tips for reducing nail damage Nail technician applying an artificial nail: Covering up brittle, soft, or damaged nails ...

  2. Staged Custom, Intramedullary Antibiotic Spacers for Severe Segmental Bone Loss in Infected Total Hip Arthroplasty

    Directory of Open Access Journals (Sweden)

    Atul F. Kamath

    2011-01-01

    Full Text Available Introduction. Total hip arthroplasty (THA infections with severe bone loss pose significant reconstructive challenges. We present our experience with two-stage hip reimplantation using an intramedullary, antibiotic-impregnated nail. Methods. Three patients with infected THA with severe proximal femoral bone loss (Mallory type IIIB or greater were treated using a custom antibiotic spacer. Clinical outcomes and any complications were recorded. Average followup was 49 months from final reimplantation. Results. Mean age at spacer placement (stage 1 was 53 years. The mean Harris Hip Score at final followup was 80. Two patients had asymptomatic heterotopic ossification, and one patient had a 2 cm leg-length discrepancy. Conclusions. A custom intramedullary nail antibiotic spacer is a reliable option in the staged management of the infected THA with severe proximal femoral bone loss. Benefits of this technique include limb salvage with maintenance of leg length, soft tissue tension, and functional status.

  3. The Lottes nail in the closed treatment of tibia fractures.

    Science.gov (United States)

    Sedlin, E D; Zitner, D T

    1985-01-01

    The effectiveness of the Lottes nail was evaluated in 63 consecutive cases of tibia fractures treated by closed intramedullary fixation with image intensification. The procedure was offered to all adults except those with Gustillo and Anderson Type III open wounds and with fractures less than 10 cm from the knee or 5 cm from the ankle. The operations were generally performed within a few days in closed fractures and somewhat later in open fractures. Patellar-tendon-bearing casts were applied five to ten days after operation, and weight-bearing to tolerance was emphasized. All fractures united. Bridging callus was generally seen by seven or eight weeks. Complications not necessarily peculiar to the procedure included one each of delayed wound infection, peroneal neurapraxia, compartment syndrome, heel decubitus, and shortening of more than 2 cm. Technical failures included malunion of fracture, loss of fixation by the nail, backing out of the nail, and penetration into the ankle joint. Most of the complications and technical failures could be remedied and did not influence the ultimate result. The authors recommended the Lottes nail and closed intramedullary nail fixation as the preferred method of treatment of diaphyseal fractures of the tibia in adults.

  4. 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.

  5. Nail Surgery for Beginners

    Directory of Open Access Journals (Sweden)

    Güneş Gür

    2010-10-01

    Full Text Available Nail diseases have a negative impact on quality of life both by causing esthetic concerns and functional disturbances. Many disorders of the nail require nail surgery for diagnosis and treatment. Dermatologists, however, often refrain from surgical interventions of the nail due to prejudices that they are delicate and hard to perform. Appreciation of nail anatomy will render nail surgical interventions fast and easy with favorable results. Here, nail anatomy and basic nail surgical interventions that we often need to use in everyday practice are discussed.

  6. Intramedullary Cervical Spinal Cord Abscess.

    Science.gov (United States)

    Bakhsheshian, Joshua; Kim, Paul E; Attenello, Frank J

    2017-10-01

    Intramedullary spinal cord abscesses are rarely encountered in modern neurosurgical practice. Select patients are at high risk for developing an intramedullary spinal cord abscess, which can result in acute neurologic deficits. Patients with failed conservative management may benefit from early surgical intervention; however, the evidence is limited by level 3 studies. In this case presentation, the patient failed conservative management for a cervical intramedullary spinal cord abscess and developed acute neurologic deficits. The decision was made to perform an urgent cervical laminectomy and drainage to avoid any further decline that may have occurred with continued conservative management. Increased awareness of intramedullary spinal cord abscess is warranted for its clinical suspicion and emergent treatment in select circumstances. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. A STUDY OF THE MANAGEMENT OF OPEN FRACTURES OF TIBIA BY UNREAMED INTERLOCKING NAIL

    OpenAIRE

    Harsha Kumar

    2015-01-01

    AIMS AND OBJECTIVES : 1. To evaluate the results of closed interlocking intramedullary nailing without reaming in the treatment of open fractures of the tibial shaft. (Gustillo type 1, type 2, type 3a, type 3b) . 2. To study the difficulties ( C omplications) encountered during the operative study. 3. To mobilize the patient early. ...

  8. Primary fixation and delayed nailing of long bone fractures in severe trauma

    DEFF Research Database (Denmark)

    Friedl, H.P.; Stoker, R.; Czermak, B.

    1996-01-01

    . The fracture per se and the manipulation of fragments may cause additional release of mediators and pulmonary embolism of microaggregates. Related to this, there is striking clinical and experimental evidence that reaming of the intramedullary cavity and inserting a nail generates extremely high temperatures...

  9. Intertrochanteric Fracture After Hip Resurfacing Arthroplasty Managed with a Reconstruction Nail

    Directory of Open Access Journals (Sweden)

    Jason Chow

    2013-12-01

    Full Text Available Periprosthetic fractures after hip resurfacings are rare occurrences that can pose a challenge to orthopaedic surgeons. With hip resurfacings becoming more common, the prevalence of these fractures is likely to increase because these patients are usually younger and more active. We report a case of traumatic periprosthetic proximal femur fracture treated with a reconstruction intramedullary nail technique.

  10. A cadaveric biomechanical study comparing the ease of femoral nail insertion: 1.0- vs 1.5-m bow designs.

    Science.gov (United States)

    Yuan, Huan; Acklin, Yves; Varga, Peter; Gueorguiev, Boyko; Windolf, Markus; Epari, Devakar; Schuetz, Michael; Schmutz, Beat

    2017-05-01

    Anatomic fit of intramedullary nails was suggested by previous studies to improve significantly when the nail radius of curvature (ROC) is closer to the average femoral anatomy. However, no attempt has been made to investigate the impact of different ROC designs on the nail insertion process. Therefore, this biomechanical study quantitatively compared the ease of insertion between femoral intramedullary nails with a 1.0-m and a 1.5-m bow radius. Long TFN-ADVANCED™ (TFNA, 1.0 m ROC) and Proximal Femoral Nail Antirotation nails (PFNA, 1.5 m ROC) were implanted pairwise into seven paired cadaver femora. All bones were reamed 1.5 mm larger than the nail diameter. Using a material testing machine, intramedullary nailing was then performed stepwise with 20-mm steps and a 10-mm/s insertion rate, and force was measured. The nail deformation caused by the insertion was assessed through 3D computer models built from pre- and post-nailing CT scans. The ease of insertion between TFNA and PFNA nails was quantified in terms of insertion force, insertion energy and nail deformation. There was no significant difference in the peak force generated during nailing between TFNA and PFNA nails (P = 0.731). However, the force measured at the end of insertion (P = 0.002) was significantly smaller in TFNA nails compared to PFNA nails. After implantation, TFNA nails showed significantly smaller deformation when compared to PFNA nails (P = 0.005, both ends aligned). Furthermore, less energy was required to insert TFNA nails; however, the difference was not significant (P = 0.25). Compared to PFNA nails, a significant decrease in insertion force and nail deformation was found at the end of insertion for TFNA nails. Results suggest that TFNA having a 1.0-m ROC is easier to insert for the set of femora used in this study compared to PFNA with a 1.5-m ROC.

  11. skeletal traction and intramedullary nailing cost-effectiveness

    African Journals Online (AJOL)

    form of tables, and figures. Results: Males were more affected than females, with a mean age of 31.5 years. The mean length of hospital stay was 11.48 days for the operative group and 66.7 days for the skeletal traction group. The average total hospital cost for the operative group was Kshs 54, 380.44 (US$640) compared ...

  12. Open Intramedullary Nailing for Segmental Long Bone Fractures: An ...

    African Journals Online (AJOL)

    commenced on the range of motion exercises by the 1st postoperative day and nonweight‑bearing ambulation by the 3rd postoperative day under the supervision of physiotherapists. Nonweight‑bearing or toe‑touch ambulation was maintained for the first 6 weeks because of the unstable nature of segmental fractures.

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

    African Journals Online (AJOL)

    2017-12-05

    Dec 5, 2017 ... significant evolution over the past century. Before the 20th century, the definitive treatment method was traction or splinting. These methods were .... need to be adequately managed using sound orthopedic principles. The goal of treatment of these fractures is to achieve union in acceptable alignment while ...

  14. 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.

  15. 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

  16. [Nail diseases in cosmetology].

    Science.gov (United States)

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

    2010-01-01

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

  17. The SIGN Nail: Factors in a Successful Device for Low-Resource Settings.

    Science.gov (United States)

    Haonga, Billy Thomson; Zirkle, Lewis G

    2015-10-01

    Surgeons in low-resource settings manage an increasing number of patients presenting with high-energy fractures. The number of surgeons and the operating time available are frequently not adequate to treat these fractures in a timely manner. A common cause of delay in treating fractures is waiting for the patient to accumulate sufficient funding to pay for the surgery, including the surgical implant. The donation of the SIGN intramedullary nail interlocking screw system obviates a major delay in timing of surgery. The SIGN intramedullary nail has been designed to be used in low-resource settings as it can be placed without fluoroscopy or electricity. The SIGN-trained surgeons are very skillful in hand reaming the canal, placing the nail, and interlocking screws without fluoroscopy. As more is learned about fracture healing, the SIGN system continues to evolve. The SIGN system is expanding to include deformity correction and soft tissue coverage.

  18. Intramedullary schwannoma of conus medullaris with syringomyelia

    Directory of Open Access Journals (Sweden)

    Mete Karatay

    2017-05-01

    Full Text Available Intramedullary schwannomas of the spinal cord are rare tumors. They are most commonly observed in the cervical region; however, few have been described in the conus medullaris. The association of intramedullary schwannomas with syringomyelia is also rare. In this report, we present a case of intramedullary schwannoma of the conus medullaris with syringomyelia, which was treated surgically.

  19. Intramedullary schwannoma of conus medullaris with syringomyelia.

    Science.gov (United States)

    Karatay, Mete; Koktekir, Ender; Erdem, Yavuz; Celik, Haydar; Sertbas, Idris; Bayar, Mehmet Akif

    2017-05-01

    Intramedullary schwannomas of the spinal cord are rare tumors. They are most commonly observed in the cervical region; however, few have been described in the conus medullaris. The association of intramedullary schwannomas with syringomyelia is also rare. In this report, we present a case of intramedullary schwannoma of the conus medullaris with syringomyelia, which was treated surgically. Copyright © 2017. Published by Elsevier Taiwan.

  20. Nutrition and nail disease.

    Science.gov (United States)

    Cashman, Michael W; Sloan, Steven Brett

    2010-01-01

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

  1. Treatment of long bone osteomyelitis with a mechanically stable intramedullar antibiotic dispenser: nineteen consecutive cases with a minimum of 12 months follow-up.

    Science.gov (United States)

    Sancineto, Carlos Federico; Barla, Jorge Daniel

    2008-12-01

    Antibiotic cement beads are the most common system of local antibiotic delivery. Unfortunately, bead strings do not give mechanical support to the fracture site, stability being fundamental in osteomyelitis treatment. Local treatment associated with bone stability should improve the results in posttraumatic osteomyelitis. The objective of this article is to present our experience in the treatment of long bone osteomyelitis using an intramedullary, mechanically stable antibiotic dispenser. We present a retrospective review of a consecutive series of patients with a long bone osteomyelitis treated using an intramedullary, mechanically stable antibiotic dispenser. The dispenser used with a T-95 chest tube filled with poly(methyl methacrylate) + antibiotic (vancomycin, gentamycin, or both, tobramycin or imipenem; depending on culture results) and with a metal center (Ender nail). Fifteen patients were men and three were women, with an average age of 37 years (range, 18-52 years). In four cases, treatment involved the femur and in 15 the tibia. Positive cultures were obtained from each patient. Methicillin-resistant Staphylococcus aureus was isolated in 17 cases. The intramedullary dispenser was removed between 6 and 76 weeks after surgery. Success was defined as negative cultures after dispenser removal. Follow-up period was between 10 and 54 months. Negative cultures were obtained from intramedullary reaming after dispenser removal in all but one patient who could not finish treatment because of local intolerance to antibiotic treatment. None of the 17 patients presented an infection recurrence. The combination of local antibiotic treatment with bone segment stability showed acceptable results in our short series of patients. Further investigation on locked intramedullary antibiotic dispensers providing improved stability will help us learn about this difficult clinical scenario.

  2. Nailing Pompeii

    Science.gov (United States)

    Showstack, Randy

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

  3. Intramedullary ependymoma: Microsurgical resection technique.

    Science.gov (United States)

    Giammattei, L; Penet, N; Parker, F; Messerer, M

    2016-04-27

    Spinal ependymomas are predominantly slow-growing lesions constituting approximately 30-88% of primary spinal intramedullary tumors. They usually present as circumscribed lesions, with regular margins and a clear surgical plane. Gross-total resection is often feasible and potentially curative but neurosurgeons should keep in mind that the ultimate goal of surgery is the preservation of spinal cord function. We present the surgical technique to safely resect an intramedullary ependymoma using a posterior median sulcus approach. A brief description of current management of this pathology is also presented. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  4. Idiopathic 20-nail dystrophy

    DEFF Research Database (Denmark)

    Larsen, Camilla; Bygum, Anette

    2016-01-01

    Twenty-nail dystrophy is a rare disease, typically with all 20 nails affected, which normally occurs as an idiopathic condition in childhood but can be linked to other diseases. We report a case of a 7-year-old girl with a 3-year history of 20-nail dystrophy and no associated diseases or family...... history of skin or nail diseases. She was followed and treated conservatively and, after 6 years of follow-up, we found a marked improvement and almost full resolution of her nail dystrophy. The aim of this report is to show that idiopathic 20-nail dystrophy in children is a self-limiting condition...

  5. Diagnosis using nail matrix.

    Science.gov (United States)

    Richert, Bertrand; Caucanas, Marie; André, Josette

    2015-04-01

    Diagnosing nail matrix diseases requires knowledge of the nail matrix function and anatomy. This allows recognition of the clinical manifestations and assessment of potential surgical risk. Nail signs depend on the location within the matrix (proximal or distal) and the intensity, duration, and extent of the insult. Proximal matrix involvement includes nail surface irregularities (longitudinal lines, transverse lines, roughness of the nail surface, pitting, and superficial brittleness), whereas distal matrix insult induces longitudinal or transverse chromonychia. Clinical signs are described and their main causes are listed to enable readers to diagnose matrix disease from the nail's clinical features. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. How to Stop Biting Your Nails

    Medline Plus

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

  7. 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 ...

  8. OUTCOMES IN CLOSED REAMED INTERLOCKING NAIL IN FRACTURES OF SHAFT OF FEMUR.

    Science.gov (United States)

    Mohammad, Taj; Khan, Alamzeb; Sawati, Alamzeb; Ahmed, Ashfaq; Awan, Abdus Saboor; Saboor, Abdus; Siddique

    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. 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. 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. 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.

  9. Quantitative fit assessment of tibial nail designs using 3D computer modelling.

    Science.gov (United States)

    Schmutz, B; Rathnayaka, K; Wullschleger, M E; Meek, J; Schuetz, M A

    2010-02-01

    Intramedullary nailing is the standard fixation method for displaced diaphyseal fractures of the tibia in adults. The bends in modern tibial nails allow for an easier insertion, enhance the 'bone-nail construct' stability, and reduce axial malalignments of the main fragments. Anecdotal clinical evidence indicates that current nail designs do not fit optimally for patients of Asian origin. The aim of this study was to develop a method to quantitatively assess the anatomical fitting of two different nail designs for Asian tibiae by utilising 3D computer modelling. We used 3D models of two different tibial nail designs (ETN (Expert Tibia Nail) and ETN-Proximal-Bend, Synthes), and 20 CT-based 3D cortex models of Japanese cadaver tibiae. With the aid of computer graphical methods, the 3D nail models were positioned inside the medullary cavity of the intact 3D tibia models. The anatomical fitting between nail and bone was assessed by the extent of the nail protrusion from the medullary cavity into the cortical bone, in a real bone this might lead to axial malalignments of the main fragments. The fitting was quantified in terms of the total surface area, and the maximum distance by which the nail was protruding into the cortex of the virtual bone model. In all 20 bone models, the total area of the nail protruding from the medullary cavity was smaller for the ETN-Proximal-Bend (average 540 mm(2)) compared to the ETN (average 1044 mm(2)). Also, the maximum distance of the nail protruding from the medullary cavity was smaller for the ETN-Proximal-Bend (average 1.2mm) compared to the ETN (average 2.7 mm). The differences were statistically significant (p<0.05) for both the total surface area and the maximum distance measurements. By utilising computer graphical methods it was possible to conduct a quantitative fit assessment of different nail designs. The ETN-Proximal-Bend shows a statistical significantly better intramedullary fit with less cortical protrusion than the

  10. Subtrochanteric hip fractures treated with cerclage cables and long cephalomedullary nails: a review of 17 consecutive cases over 2 years.

    LENUS (Irish Health Repository)

    Kennedy, Muiris T

    2011-11-01

    The conflict between the anatomist and biologist surgeons is exemplified by the debate about subtrochanteric hip fractures. Closed intramedullary nailing is biologically friendly but may result in prolonged procedures and malunion. By contrast, accurate anatomical open reduction may disturb the biological composition of the fracture environment.

  11. Treatment of distal tibial fractures: plate versus nail: a retrospective outcome analysis of matched pairs of patients.

    NARCIS (Netherlands)

    Janssen, K.W.; Biert, J.; Kampen, A. van

    2007-01-01

    A study of 24 patients who sustained an extra-articular fracture of the distal third of the tibial shaft was performed to determine the effect of the type of treatment, open reduction and internal fixation (ORIF) or closed reduction and intramedullary (IM) nailing, on the occurrence of malalignment.

  12. Single stage management of Gustilo type III A/B tibia fractures: Fixed with nail & covered with fasciocutaneous flap

    Directory of Open Access Journals (Sweden)

    G.I. Nambi

    2017-04-01

    Conclusion: Multidisciplinary management of severe lower limb trauma is important and provides good outcomes. Intramedullary nailing and immediate flap fixation can achieve early bone union and good soft tissue coverage, leading to good outcomes in patient with Grade III A & B tibia fractures.

  13. Green Nail Syndrome

    Science.gov (United States)

    ... Derm App Skin Facts Aging and Sun Damage Beauty Myths Preventing Sun Damage Skin Cancer Detection Skin ... doubt, a nail sample can be taken for culture. Green nail syndrome responds well to treatment. Therapy ...

  14. Nail polish poisoning

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/article/002722.htm Nail polish poisoning To use the sharing features on this ... is from swallowing or breathing in (inhaling) nail polish. This article is for information only. DO NOT ...

  15. Nail care for newborns

    Science.gov (United States)

    ... Supplements Videos & Tools Español You Are Here: Home → Medical Encyclopedia → Nail care for newborns URL of this page: //medlineplus.gov/ency/article/001914.htm Nail care for newborns To use ...

  16. The Results of the Treatment of Osteogenesis Imperfecta with Corkscrew Tipped Telescopic Nail

    Directory of Open Access Journals (Sweden)

    Hüseyin Günay

    2017-03-01

    Full Text Available Aim: We aimed to evaluate the clinical and radiological results of an intramedullary fixation system used in surgeries for fractures and deformities of osteogenesis imperfecta where we applied a new design corkscrew tipped intramedullary nailing. Materials and Methods: Twenty extremities of 14 osteogenesis cases, who underwent surgery and to whom corkscrew tipped intramedullary treatment was applied, were retrospectively scanned. Ambulation, discrepancies in the lenght of extremities, deformities and joint mobility range were all noted before the operation. Postoperative union rates, complications and our experience regarding the nail were also evaluated. Results: Six tibia and 14 femurs were operated using corkscrew tipped telescopic nails. Two bones were operated due to non-union, while seven bones underwent surgery due to acute fractures and 11 bones due to deformities. All the bones were seen to have achieved the aimed union. No major complications were observed. Infection was present in two cases. Conclusion: Corkscrew tipped telescopic nail is a safe and effective method of fixation in patients with osteogenesis imperfecta.

  17. Nail bed injuries and deformities of nail

    Directory of Open Access Journals (Sweden)

    R Ravindra Bharathi

    2011-01-01

    Full Text Available Nail bed injuries are common and management of these requires good knowledge of the nail bed anatomy. Proper management of these injuries will ensure good healing and prevent late deformities. When loss occurs it is challenging to reconstruct which can be done by grafts or microsurgical reconstruction to restore aesthetic appearance of fingers.

  18. Nail bed injuries and deformities of nail

    OpenAIRE

    R Ravindra Bharathi; Babu Bajantri

    2011-01-01

    Nail bed injuries are common and management of these requires good knowledge of the nail bed anatomy. Proper management of these injuries will ensure good healing and prevent late deformities. When loss occurs it is challenging to reconstruct which can be done by grafts or microsurgical reconstruction to restore aesthetic appearance of fingers.

  19. Nail bed injuries and deformities of nail

    Science.gov (United States)

    Bharathi, R. Ravindra; Bajantri, Babu

    2011-01-01

    Nail bed injuries are common and management of these requires good knowledge of the nail bed anatomy. Proper management of these injuries will ensure good healing and prevent late deformities. When loss occurs it is challenging to reconstruct which can be done by grafts or microsurgical reconstruction to restore aesthetic appearance of fingers. PMID:22022029

  20. Intramedullary pressure of the patella in Chondromalacia.

    Science.gov (United States)

    Björkström, S; Goldie, I F; Wetterqvist, H

    1980-01-01

    Degenerative changes in load-bearing joints are often combined with altered intramedullary circulation. This may cause an alteration in intramedullary pressures. It has been said that articular symptoms are connected with a change in intramedullary pressures being high they are suspected to cause pain. In this investigation the intramedullary pressure has been evaluated in chondromalacia and osteoarthrosis of the patella. A comparison has been made with normal patellae. A biopsy needle was drilled into the intramedullary bone of the patella and connected with a registering unit. In a control group an average value of 19 mm Hg was registered. In the condromalacia group the mean intramedullary pressure was 44 mm Hg and in osteoarthrosis 37 mm Hg.

  1. A prospective study of biological fixation with either plate or interlocking nail on the mean duration of union in diaphyseal fractures of tibia

    Directory of Open Access Journals (Sweden)

    Rajendra B Uppin

    2013-01-01

    Full Text Available Objective: To study the results of Biological plating or Interlocking nail for the closed diaphyseal fracture of the tibia in Department of Orthopedics, KLE University′s, Dr. Prabhakar Kore Hospital and Medical Research Center, Belgaum. The aim of this study was the evaluation of the results of biological plating or interlocking nail for closed diaphyseal fractures of the tibia. Materials and Methods: The study included 30 patients. All the patients underwent a comprehensive orthopedic examination and work-up was done to diagnose and classify tibial fractures. The treatment modalities were suggested accordingly. Results: Intramedullary nailing should be the method of choice for treating the closed type of tibial shaft fractures. Biological plating should be considered as an alternative in intramedullary interlocking nail in specific indications. Conclusion: Comprehensive orthopedic examination with detailed study of fracture pattern and type of fracture help to evaluate the different modalities of treatment.

  2. Evaluation of nail abnormalities.

    Science.gov (United States)

    Tully, Amber S; Trayes, Kathryn P; Studdiford, James S

    2012-04-15

    Knowledge of the anatomy and function of the nail apparatus is essential when performing the physical examination. Inspection may reveal localized nail abnormalities that should be treated, or may provide clues to an underlying systemic disease that requires further workup. Excessive keratinaceous material under the nail bed in a distal and lateral distribution should prompt an evaluation for onychomycosis. Onychomycosis may be diagnosed through potassium hydroxide examination of scrapings. If potassium hydroxide testing is negative for the condition, a nail culture or nail plate biopsy should be performed. A proliferating, erythematous, disruptive mass in the nail bed should be carefully evaluated for underlying squamous cell carcinoma. Longitudinal melanonychia (vertical nail bands) must be differentiated from subungual melanomas, which account for 50 percent of melanomas in persons with dark skin. Dystrophic longitudinal ridges and subungual hematomas are local conditions caused by trauma. Edema and erythema of the proximal and lateral nail folds are hallmark features of acute and chronic paronychia. Clubbing may suggest an underlying disease such as cirrhosis, chronic obstructive pulmonary disease, or celiac sprue. Koilonychia (spoon nail) is commonly associated with iron deficiency anemia. Splinter hemorrhages may herald endocarditis, although other causes should be considered. Beau lines can mark the onset of a severe underlying illness, whereas Muehrcke lines are associated with hypoalbuminemia. A pincer nail deformity is inherited or acquired and can be associated with beta-blocker use, psoriasis, onychomycosis, tumors of the nail apparatus, systemic lupus erythematosus, Kawasaki disease, and malignancy.

  3. Intramedullary hemangioblastoma: Microsurgical resection technique.

    Science.gov (United States)

    Messerer, M; Cossu, G; Pralong, E; Daniel, R T

    2017-11-01

    Spinal hemangioblastomas are benign and highly vascular tumors accounting for 1-5% of intramedullary spinal tumors in surgical series. Surgery is curative in sporadic cases. We present the description of a surgical technique to safely resect an intramedullary hemangioblastoma. A dorsal midline myelotomy provides an excellent exposure of the tumor and identification of the feeding arteries. Interruption of these arteries and precise dissection of the tumor from the cord tissue followed by division of the venous drainage allow the in toto excision of the tumor. Closure of the dorsal myelotomy may be achieved with sequential fusion of the pial and arachnoid edges using a "welding" technique. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  4. Prediction of a nail polish colour applied on a nail.

    Science.gov (United States)

    Monpeurt, C; Cinotti, E; Razafindrakoto, J; Rubegni, P; Fimiani, M; Perrot, J L; Hebert, M

    2018-02-01

    The colour of a nail polish varies according to the nail on which it is applied. The objective of this study was to predict the colour of the nail polish on a given nail and to study how the colour varies depending on the nail polish thickness. Six nail polishes were applied in one, two and three layers on the nails of one subject, thus forming eighteen samples. The spectral reflectances of the eighteen nail polishes applied on the nails with different thicknesses were obtained by spectrophotometry. The spectral reflectances of the nails without polish were also measured using the same technique. The thicknesses of nail polishes were measured by high-definition optical coherence tomography (HD-OCT). Then, to determine the physical parameters of the nail polish itself, we applied the six nail polishes on an opacity drawdown chart and we measured the spectral reflectance and the thickness of each patch using spectrophotometry and HD-OCT, respectively. The Kubelka-Munk theory was used to get the predicted spectral reflectance of the nail polish applied on the nail according to the polish thickness by knowing the parameter of the polish itself and the spectral reflectance of the nail. The predicted spectral reflectances were finally compared with those measured directly on the nails. The predicted spectral reflectances were rather close to measured ones. Consequently, knowing the colour of the nail without polish and the optical parameters of the nail polish itself, we can estimate the colour of the nail polish applied on the nail depending on its thickness. Our study showed that the Kubelka-Munk theory can be used to predict the nail polish colour. The ability to predict the real colour of a nail polish applied on a nail could help a nail polish manufacturer to improve his polish formulae in order to obtain a precise colour. © 2017 Society of Cosmetic Scientists and the Société Française de Cosmétologie.

  5. How to Stop Biting Your Nails

    Medline Plus

    Full Text Available ... district office Invite elected officials to your practice Life After Residency Webinars Event calendar Previous meetings archive ... Injured skin Nail care Artificial nails Healthy nails Child nail care Manicure safety Nail biting Anti-aging ...

  6. Aspecific inflammatory lesion (histiocytosis?) simulating intramedullary astrocytoma. Case report.

    Science.gov (United States)

    Palma, L; Rizzo, G; Lio, R; Mariottini, A; Mazzocchio, R

    1999-03-01

    We report an exceptional case of aspecific inflammatory lesion of the thoracic spinal cord simulating an intramedullary glial tumor. Patient history was characterized by progressive spastic paraparesis with urinary incontinence; MR imaging (T4-T5) showed an enhancing intrinsic mass lesion. Myelotomy enabled partial resection of grayish astrocytoma-like tissue. Only light microscope examination was possible and disclosed aspecific inflammatory tissue composed of eosinophils, lymphocytes and histiocytes. After the operation, the patient improved promptly and no further therapy was administered. Control MRI after four months, one year and two years showed complete disappearance of the intramedullary mass lesion and the patient remained clinically stable with no other signs of disease. Since electron microscopic as well as immunohistochemical studies were not available, a definitive histological diagnosis was not possible. However on the basis of some clinical similarities with cases of isolated histiocytosis X of the CNS reported in the literature, we suggest that a diagnosis of isolated intramedullary eosinophilic granuloma could be reasonable.

  7. Nail Deformities and Injuries.

    Science.gov (United States)

    Tucker, James Rory J

    2015-12-01

    A variety of nail deformities commonly presents in the primary care office. An understanding of nail anatomy coupled with inspection of the nails at routine office visits can reveal undetected disorders. Some problems are benign, and treatment should be attempted by the primary care provider, such as onychomycosis, paronychia, or ingrown toenails. For conditions such as benign melanonychia, longitudinal ridges, isolated Beau lines, and onycholysis, clinicians may offer reassurance to patients who are concerned about the change in their nails. For deformities such as early pterygium or clubbing, a thorough evaluation and referral to an appropriate specialist may be warranted. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. A STUDY OF THE MANAGEMENT OF OPEN FRACTURES OF TIBIA BY UNREAMED INTERLOCKING NAIL

    Directory of Open Access Journals (Sweden)

    Kuppa Srinivas

    2015-01-01

    Full Text Available AIMS AND OBJECTIVES: To evaluate the results of closed interlocking intramedullary nailing without reaming in the treatment of open fractures of t he tibial shaft and study the difficulties (complications encountered during the operative study. To compare the efficacy of interlocking intramedullary nailing without reaming in treating open fractures of tibia, Time required for the union of fracture, Range of motion of ankle and knee joint, Rate of malunion and mal rotation and Pain at the knee joint. RESULTS: The average age of patient is 32 years,83.33% are males, road traffic accidents account for majority(79.16%,right side involved in 58.33%,gustillo type II and type I compound fractures are common, full range of movements is seen in 66.67% by 12 weeks and union occurred in 95.83% by 9 months. Thirteen (54.17% patients had excellent results, six (25% patients had good results, four (1 6.67% patients had fair results and one (4.16 patient had poor result. CONCLUSION: Unreamed interlocking intramedullary nailing with the help of image intensifier seems feasible in open diaphyseal fractures of tibia with the advantages of minimal blood l oss, low risk of infection, early mobilisation , earlier soft tissue coverage , Promotes early union , minimal hospital stay and early returns to activities

  9. Rush nail and management of fracture both bone forearm

    Directory of Open Access Journals (Sweden)

    Soumya Ghosh

    2014-01-01

    -operatively and no refracture has been reported until date (after 4 months. Conclusion: Use of rush nail continues to have predictable and good results. Complication rates are lower when compared to plate osteosynthesis and even in locked intramedullary nails although application of above elbow cast after nailing is a downside of this procedure. The rush nail has still a future in repair of forearm fractures considering its low complications rates, cost and acceptable results in a developing country where financial matters are to be considered.

  10. Drug-induced nail disorders.

    Science.gov (United States)

    2014-07-01

    Nail disorders are defined according to their appearance and the part of the nail affected: the nail plate, the tissues that support or hold the nail plate in place, or the lunula. The consequences of most nail disorders are purely cosmetic. Other disorders, such as ingrown nails, inflammation, erythema, abscesses or tumours, cause functional impairment or pain. The appearance of the lesions is rarely indicative of their cause. Possible causes include physiological changes, local disorders or trauma, systemic conditions, toxic substances and drugs. Most drug-induced nail disorders resolve after discontinuation of the drug, although complete resolution sometimes takes several years. Drugs appear to induce nail disorders through a variety of mechanisms. Some drugs affect the nail matrix epithelium, the nail bed or the nail folds. Some alter nail colour. Other drugs induce photosensitivity. Yet others affect the blood supply to the nail unit. Nail abnormalities are common during treatment with certain cytotoxic drugs: taxanes, anthracyclines, fluorouracil, EGFR, tyrosine kinase inhibitors, etc. Some drugs are associated with a risk of serious and painful lesions, such as abscesses. When these disorders affect quality of life, the benefits of withdrawing the drug must be weighed against the severity of the condition being treated and the drug's efficacy, taking into account the harm-benefit balance of other options. Various anti-infective drugs, including tetracyclines, quinolones, clofazimine and zidovudine, cause the nail plate to detach from the nail bed after exposure to light, or cause nail discoloration. Psoralens and retinoids can also have the same effects.

  11. SURGICAL OUTCOME OF DIAPHYSEAL FRACTURES OF HUMERUS BY ANTEGRADE INTERLOCKING NAILING IN CLOSED REDUCTION

    Directory of Open Access Journals (Sweden)

    Koramutla Harsha

    2015-03-01

    Full Text Available BACKGROUND: Fractures involving the shaft of humerus are commonly encountered by orthopedic surgeons in day to day practice. Humeral shaft fracture can be treated using intramedullary fixation technique. Flexibl e intramedullary nails like Rush nail, Enders nail have been used utilizing ante grade and retrograde methods. This technique has largely replaced plating method very often. But, retrograde nailing can be regarded as a minimally invasive procedure and just ifiable to use for fixation of isolated humeral shaft fractures in certain situation. In this study we have evaluated the effectiveness of surgical and functional outcomes of closed ante grade interlocking nailing in the management of diaphyseal fractures of humerus. METHODS: A series of 30 patients with diaphyseal fractures of humerus were treated with ante grade interlocking nailing during October 2008 to October 2010. All the patients were followed up 6 weeks, 12 weeks and 24 weeks and results were analy sed. X rays were taken to assess radiological union of fracture during the follow up. Assessment of fracture union and shoulder and elbow movement was recorded. Final evaluation was done at the end of 6 months. Data was presented as mean ± SD, actual numbe rs and percentages. Wilcoxo n test and chi - square test were used appropriately. RESULTS: All 30 patients in our study were followed up for a minimum period of 6 months. 56.7%cases were male patients 43.3% were female patients. More than 50 % of cases in the series were between the ages of 18 - 35 years. 60% fractures were comminuted 6.6% were of oblique type, 33.3% were of transverse type. The average time interval from the time of admission to the time of surgery was 3 days. The most common mode of injury was road traffic accident. Commented fractures are predominant in our study. Clinical outcome was 60% of cases had excellent results and 30 % had moderate result. 3 patients (10% had poor result, due to limitation of shoulder

  12. Outcome of Both Bone Forearm Fracture Fixation in Children by Rush Nails

    Directory of Open Access Journals (Sweden)

    Rajeev Dwivedi

    2016-10-01

    Full Text Available Introduction: Forearm fractures are common upper limb injuries among children and usually treated non-operatively. Failure of non-operative treatment, open injuries and multiple fractures are the indications for surgery in paediatric both bone forearm fractures. Intramedullary nailing is considered as minimally invasive procedure with excellent to fair outcomes but it is not free of complications. We reviewed the results and evaluated the outcomes of IM xation of forearm fractures in children by Rush nails to understand the risks and complications associated with these procedures.  Methods: A retrospective crossectional study of all paediatric patients treated for diaphyseal forearm fractures for period of ve years in a tertiary care setup. Complications were classi ed according to modied Clavien-Dindo complication classication system. Outcomes were graded depending upon complication grade along with range of motion of forearm. Results: A total of 25 patients were included in the study. Mean time for fracture union was 10.56 weeks. Outcomes were excellent in 16 (64%, good in 7 (28%, fair in 2 (8% patients and no poor outcome was noted. Ten minor complications were seen.  Conclusion: Fixation of paediatric forearm fractures by intramedullary Rush nail is minimally invasive procedure and outcomes are excellent to fair with acceptable complication rates. Keywords: complication; forearm fractures; intramedullary nailing; outcome; paediatrics; Rush nail.

  13. [Cosmetology and brittle nails].

    Science.gov (United States)

    Abimelec, P

    2000-12-15

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

  14. 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.

  15. Hair and nail relationship.

    NARCIS (Netherlands)

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

    2005-01-01

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

  16. Nail Patella Syndrome

    Directory of Open Access Journals (Sweden)

    V K Jain

    1987-01-01

    Full Text Available A 14-year-old male having nail-patella syndrome, manifested as deficient nails on the ubw aspect of thumbs, V-shaped half- moons, rudimentry patella on right side and absence on left side. X-ray of pelvis showed iliac horns.. Family history was suggestive of autosomal dominant of inheritance

  17. 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.

  18. 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

  19. MRI of intramedullary cavernous haemangiomas

    Energy Technology Data Exchange (ETDEWEB)

    Turjman, F. [Service de Radiologie, Hopital Neurologique, 69 Lyon (France); Joly, D. [Service de Neuroradiologie, Centre Hospitalier Universitaire Bicetre, 94 Le Kremlin Bicetre (France); Monnet, O. [Service de Neuroradiologie, Centre Hospitalier Universitaire Bicetre, 94 Le Kremlin Bicetre (France); Faure, C. [Service de Radiologie, Hopital Neurologique, 69 Lyon (France); Doyon, D. [Service de Neuroradiologie, Centre Hospitalier Universitaire Bicetre, 94 Le Kremlin Bicetre (France); Froment, J.C. [Service de Radiologie, Hopital Neurologique, 69 Lyon (France)

    1995-05-01

    We reviewed 11 cases of intramedullary cavernous haemangiomas (IMCH) studied by MRI, to assess its diagnostic value in these lesions. Follow-up MRI was obtained in five patients 7 days-2 years following the initial study. In one case a postoperative examination was obtained. The diagnosis was pathologically proven in ten cases, and supported in the last by a family and personal history of cavernous haemangiomas. A reticulate appearance with areas of mixed signal intensity in both T1- and T2-weighted images was the most common finding. Homogeneous high, low or intermediate signal intensity was each found in one case. Two small lesions gave low signal. A rim of low signal was less common than in cerebral cavernous haemangiomas. In one case, the brain showed more than 20 lesions with the MRI appearances of cavernous haemangiomas. In two of five patients, serial preoperative MRI showed progressive disappearance of high-signal areas on both T1- and T2-weighted images. To find a haemorrhagic intramedullary lesion on MRI is not rare. Although the appearances are not pathognomonic, an IMCH can be suggested. We suggest that the following characteristics may help: (1) a personal and/or family history of cavernous haemangiomas; (2) typical MRI appearances of mixed acute, subacute and chronic haemorrhage; (3) a tendency for signal intensity to decrease on follow-up; (4) normal spinal angiography; and (5) associated brain lesions. (orig.)

  20. Single-bone intramedullary fixation of unstable both-bone diaphyseal forearm fractures in children leads to increased re-displacement: a multicentre randomised controlled trial.

    Science.gov (United States)

    Colaris, Joost; Reijman, Max; Allema, Jan Hein; Kraan, Gerald; van Winterswijk, Peter; de Vries, Mark; van de Ven, Cees; Verhaar, Jan

    2013-08-01

    Both-bone diaphyseal forearm fractures in children can be stabilised without cast by a flexible intramedullary nail in both the radius and the ulna. Adequate results with single-bone fixation combined with a complementary cast are also reported. However, because those results are based on a selection of children, this trial investigates whether single-bone intramedullary fixation, compared with both-bone intramedullary fixation, results in similar pronation and supination in children with an unstable diaphyseal both-bone forearm fracture. In four Dutch hospitals, 24 consecutive children aged fracture were randomly allocated to single-bone or both-bone intramedullary fixation. Primary outcome was limitation of pronation and supination 9 months after initial trauma. Secondary outcomes were limitation of flexion/extension of wrist/elbow, complication rate, operation time, cosmetics of the fractured arm, complaints in daily life, and assessment of radiographs. Between January 2006 and August 2010, 11 children were randomised to single-bone fixation and 13 to both-bone fixation. In the both-bone fixation group, two fractures were stabilized by only one nail. In both groups, median limitation of pronation/supination at 9-month follow-up was 5°-10°. In both groups operation time was similar but in the single-bone fixation group cast immobilisation was longer (median of 37 vs. 28 days). In four children, re-displacement of the fracture occurred in those fractures without an intramedullary nail. These results caution against the use of single-bone fixation in all both-bone forearm fractures. This method may lead to increased re-displacement and reduced clinical results.

  1. An Achilles tendinosis masking an intramedullary astrocytoma.

    Science.gov (United States)

    Stappers, Jeroen; Herregods, Piet; Chappel, Rudi; Surgeloose, Didier De; Stassijns, Gaëtane

    2015-01-01

    We report the case of a 53-year-old male with a right Achilles tendinosis, who complains about a mild gait disorder starting after walking several kilometers. In the following months he develops neurological symptoms. MRI lumbar spine shows an intramedullary tumor at level Th12. A biopsy confirms the diagnosis of an intramedullary astrocytoma. Primary intramedullary tumors are relatively rare. Clinical presentation is often insidious. The authors want to make a point to reconsider a diagnosis in case it does not explain completely the anamnestic or clinical findings. According to the literature there is no optimal approach to the management of these tumors.

  2. Treatment of inflammatory nail disorders.

    Science.gov (United States)

    Dehesa, Luis; Tosti, Antonella

    2012-01-01

    This article provides an updated review on diagnosis and treatment of inflammatory nail disorders including psoriasis, lichen planus, trachyonychia, and autoimmune bullous disorders. Despite the significant negative repercussion of the nail psoriasis in the quality of life of patients, treatment is often not sufficiently effective. The efficacy of topical therapies is limited to nail bed psoriasis. Intralesional corticosteroid injections are extensively utilized in nail matrix psoriasis. Systemic immunosuppressant drugs such as methotrexate and cyclosporine have shown efficacy. Biologics, particularly infliximab and etanercept, have also demonstrated high efficacy in the treatment of severe nail disease. Nail matrix lichen planus can cause nail atrophy and irreversible nail scarring and requires prompt treatment with systemic steroids. There is not gold standard therapy for trachyonychia, but in most cases the nail signs improve spontaneously and treatment is not necessary. Nail changes in pemphigus and other autoimmune disorders respond promptly to systemic therapy with steroids and immunosuppressants. © 2012 Wiley Periodicals, Inc.

  3. Nail Photography: Tips and Tricks

    OpenAIRE

    Feroze Kaliyadan; K T Ashique

    2016-01-01

    Photographic documentation of the nails is important in the objective evaluation of response to treatment and in disseminating scientific information related to nail diseases. The key to a good image of the nail is proper framing and achieving a sharp focused image with good contrast with the background, at the same time avoiding strong reflections from the nail surface. While the general principles of clinical photography apply to nail imaging also, this article attempts to highlight some ti...

  4. Nail cosmetics: allergies and irritations.

    Science.gov (United States)

    Baran, Robert

    2002-01-01

    Recent precise figures are not available for the number of adverse reactions related to the use of nail care products. Reactions to nail cosmetic procedures may be divided into reactions at the site of application to the nail itself and ectopic reactions, when the hand transfers a small amount of nail cosmetic to other areas of the skin. Fingernail coatings encompass two types: coatings that harden upon evaporation (nail enamel, base coat, top coat); and coatings that polymerize (sculptured nails, light-curing gels, preformed artificial nails, nail mending and nail wrapping). The test battery enables us to distinguish allergic reactions from irritant reactions. Interestingly, some reactions, such as distant allergic contact dermatitis, are more frequent with nail enamel than with coatings that polymerize. On the other hand, the latter are greater offenders in the nail area. Nail hardeners may just be modified nail enamels containing nylon fibers, acrylate resin and hydrolyzed proteins. Others may contain up to 5% formaldehyde tissue fixative (which can have adverse effects on the nail), but are designed in the US to be applied only to the free edge of the nail while the skin is shielded. Caution is necessary in interpreting formaldehyde patch testing reactions.

  5. Intramedullary Dermoid Cyst- A Rare Case Report

    Directory of Open Access Journals (Sweden)

    Aditi Gujarathi

    2014-07-01

    Full Text Available A 35 years old male came with complaints of low back ache radiating to right lower limb and is associated with tingling numbness and thin stream of urine since 1 year. Radiograph lumbo-scaral spine came out to be normal and thus MRI lumbo-sacral spine was done which revealed an intramedullary spinal tumour. Subsequent CT scan was done for the patient. Considering the tumour characteristics, diagnosis of intramedullary dermoid was made.

  6. Intra-abdominal migration of a lag screw in gamma nailing: report of a case.

    Science.gov (United States)

    Heineman, David J; van Buijtenen, Jesse M; Heuff, Gijsbert; Derksen, Eric J; Pöll, Ruud G

    2010-12-01

    An 83-year-old female patient was referred to the emergency room with progressive pain on mobilization. Three weeks before presentation, she had been treated with a gamma nail for an unstable right intertrochanteric fracture. Pelvic x-ray showed an intra-abdominally migrated lag screw. No evidence of intra-abdominal lesions was visible on computed tomographic scan. The lag screw as well as the intramedullary nail was extracted and in a second operation, a total hip arthroplasty was implanted. Unfortunately, the total hip implant dislocated and needed reduction. The three consecutive operations seriously weakened the soft tissue envelope. A plaster cast and brace, immobilizing the right hip and pelvis, were provided to prevent recurrences of dislocation. After 6 weeks of immobilization, the patient did well. No late complication occurred. A review of the literature with an emphasis on pathophysiology of intra-abdominal or retroperitoneal migration of lag screws in gamma nailing is presented.

  7. Biomechanical comparison of semi-rigid pediatric locking nail versus titanium elastic nails in a femur fracture model.

    Science.gov (United States)

    Flinck, Marianne; von Heideken, Johan; Janarv, Per-Mats; Wåtz, Veronica; Riad, Jacques

    2015-02-01

    The treatment for length-unstable diaphyseal femur fractures among school-age children is commonly intramedullary elastic nails, with or without end caps. Another possible treatment is the semi-rigid pediatric locking nail (PLN). The purpose of this biomechanical study was to assess the stability of a length-unstable oblique midshaft fracture in a synthetic femur model stabilized with different combinations of intramedullary elastic nails and with a PLN. Twenty-four femur models with an intramedullary canal diameter of 10.0 mm were used. Three groups with various combinations of titanium elastic nails (TEN) with end caps and one group with a PLN were tested. An oblique midshaft fracture was created, and the models underwent compression, rotation, flexion/extension, and a varus/valgus test, with 50 and 100 % of the forces generated during walking in corresponding planes. We present the results [median (range)] from 100 % loading during walking. In axial compression, the PLN was less shortened than the combination with two 4.0-mm TEN [by 4.4 (3.4-5.4) mm vs. 5.2 (4.8-6.6) mm, respectively; p = 0.030]. No difference was found in shortening between the PLN and the four 3.0-mm TEN [by 7.0 (3.3-8.4) mm; p = 0.065]. The two 3.0-mm TEN did not withstand the maximum shortening of 10.0 mm. In external rotation, the PLN rotated 12.0° (7.0-16.4°) while the TEN models displaced more than the maximum of 20.0°. No model withstood a maximal rotation of 20.0° internal rotation. In the four-point bending test, in the coronal and the sagittal plane, all combinations except the two 3.0-mm TEN in extension withstood the maximum angulation of 20.0°. PLN provides the greatest stability in all planes compared to TEN models with end caps, even though the difference from the two 4.0-mm or four 3.0-mm TEN models was small.

  8. How to Stop Biting Your Nails

    Medline Plus

    Full Text Available ... tissue that makes nails grow, resulting in abnormal-looking nails. Chronic nail biting can also leave you ... regular manicures: Spending money to keep your nails looking attractive may make you less likely to bite ...

  9. Genetics Home Reference: nail-patella syndrome

    Science.gov (United States)

    ... Twitter Home Health Conditions Nail-patella syndrome Nail-patella syndrome Printable PDF Open All Close All Enable ... to view the expand/collapse boxes. Description Nail-patella syndrome is characterized by abnormalities of the nails, ...

  10. Microscopy of Common Nail Cosmetics.

    Science.gov (United States)

    Zimmer, Katelyn A; Clay, Tiffany; Vidal, Claudia I; Chaudhry, Sofia; Hurley, Maria Y

    2017-11-01

    Nail clipping specimens are commonly submitted for the microscopic evaluation of nail disease; however, there may be missing clinical history regarding nail polish or other adornments present on the nail at the time of specimen retrieval. For this study, 6 types of nail cosmetics were chosen and applied to the nail plate of a volunteer. After a period of at least 24 hours, the nail plates with adornments and a control nail plate were clipped and placed in formalin. Specimens were processed using a standard nail protocol. All of the specimens, except the sticker appliqué, survived the fixation process. The glitter nail polish was the only specimen found to be polarizable. None of the specimens that survived fixation were found to be PAS-positive. Cosmetic nail enhancements are easily differentiated from the nail plate microscopically; nail cosmetics appear as a distinct layer of inorganic material lying atop the nail plate. There were 2 main microscopic patterns noted on the specimens: those with 2 layers and those with 3 layers.

  11. [Cosmetic nail products].

    Science.gov (United States)

    Baran, R; Goettmann, S; André, J

    2016-05-01

    Cosmetic embellishment of fingernails involves the use of substance that harden either after the evaporation of solvents (varnishes) or after polymerisation (artificial acrylic nails, gel tips, glue-on artificial nails). Pathological reactions to cosmetics usually occur at a remote site for varnishes, and, most commonly, in situ with polymerising substances. Unvarnished artificial nails do not affect pulse oximetry readings, and in theory, patients are not required to remove them. However, a real problem of contamination via artificial nails exists. Increased carriage of pathological Gram-negative organisms and of Staphylococcus aureus and yeasts has been noted among nursing staff wearing artificial nails, both before and after fingernail cleaning. Fingernail fragility manifests itself through a number of different physical signs such as soft, breaking nails, with longitudinal or transverse fissures, showing distal doubling or friability. In some subjects, excessive manicuring with metal instruments or manicure sticks results in rolled onycholysis, of evocative appearance, or transverse onycholysis. Copyright © 2016. Published by Elsevier Masson SAS.

  12. Intramedullary Fixation of Clavicle Fractures: Anatomy, Indications, Advantages, and Disadvantages.

    Science.gov (United States)

    Eichinger, Josef K; Balog, Todd P; Grassbaugh, Jason A

    2016-07-01

    Historically, management of displaced midshaft clavicle fractures has consisted of nonsurgical treatment. However, recent literature has supported surgical repair of displaced and shortened clavicle fractures. Several options exist for surgical fixation, including plate and intramedullary (IM) fixation. IM fixation has the potential advantages of a smaller incision and decreased dissection and soft-tissue exposure. For the last two decades, the use of Rockwood and Hagie pins represented the most popular form of IM fixation, but concerns exist regarding stability and complications. The use of alternative IM implants, such as Kirschner wires, titanium elastic nails, and cannulated screws, also has been described in limited case series. However, concerns persist regarding the complications associated with the use of these implants, including implant failure, migration, skin complications, and construct stability. Second-generation IM implants have been developed to reduce the limitations of earlier IM devices. Although anatomic and clinical studies have supported IM fixation of midshaft clavicle fractures, further research is necessary to determine the optimal fixation method.

  13. Nail photography: Tips and tricks

    Directory of Open Access Journals (Sweden)

    Feroze Kaliyadan

    2016-01-01

    Full Text Available Photographic documentation of the nails is important in the objective evaluation of response to treatment and in disseminating scientific information related to nail diseases. The key to a good image of the nail is proper framing and achieving a sharp focused image with good contrast with the background, at the same time avoiding strong reflections from the nail surface. While the general principles of clinical photography apply to nail imaging also, this article attempts to highlight some tips which can be specifically used to improve the quality of nail images.

  14. Nail Photography: Tips and Tricks.

    Science.gov (United States)

    Kaliyadan, Feroze; Ashique, K T

    2016-01-01

    Photographic documentation of the nails is important in the objective evaluation of response to treatment and in disseminating scientific information related to nail diseases. The key to a good image of the nail is proper framing and achieving a sharp focused image with good contrast with the background, at the same time avoiding strong reflections from the nail surface. While the general principles of clinical photography apply to nail imaging also, this article attempts to highlight some tips which can be specifically used to improve the quality of nail images.

  15. How to Stop Biting Your Nails

    Medline Plus

    Full Text Available ... var c = 0; c public SPOT Skin Cancer™ Diseases and treatments Skin, hair, and nail care Skin care Hair care / hair loss Injured skin Nail care Artificial nails Healthy nails Child nail care Manicure safety Nail biting Anti-aging ...

  16. [A young man with discoloured nails

    NARCIS (Netherlands)

    Schers, H.J.; Kleinpenning, M.M.

    2016-01-01

    A 23-year-old man consulted his general practitioner with discoloured nails. The nails showed the typical pattern of half and half nails or Lindsay's nails. This condition sometimes accompanies renal failure or thyroid disease and must be differentiated from Terry's nails, psoriatic nails and

  17. How to Stop Biting Your Nails

    Medline Plus

    Full Text Available ... for (var c = 0; c public SPOT Skin Cancer™ Diseases and treatments Skin, hair, and nail care Skin care Hair care / hair loss Injured skin Nail care Artificial nails Healthy nails Child nail care Manicure safety Nail biting Anti-aging ...

  18. How to Stop Biting Your Nails

    Medline Plus

    Full Text Available ... for (var c = 0; c public SPOT Skin Cancer™ Diseases and treatments Skin, hair, and nail care Skin care Hair care / hair loss Injured skin Nail care Artificial nails Healthy nails Child nail care Manicure safety Nail biting Younger skin ...

  19. Nail involvement in psoriatic arthritis.

    Science.gov (United States)

    Sobolewski, Piotr; Walecka, Irena; Dopytalska, Klaudia

    2017-01-01

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

  20. Single stage management of Gustilo type III A/B tibia fractures: Fixed with nail & covered with fasciocutaneous flap.

    Science.gov (United States)

    Nambi, G I; Salunke, Abhijeet Ashok; Thirumalaisamy, S G; Babu, V Lenin; Baskaran, K; Janarthanan, T; Boopathi, K; Chen, Yong Sheng

    2017-04-01

    To evaluate the role of immediate and definitive management of Gustilo type III A/B tibia fractures with intramedullary nailing and fasciocutaneous flap. From August 2010 to July 2012, 22 patients with Gustilo Grade III A/B tibia fractures were managed with a single stage treatment of ipsilateral fasciocutaneous flap & reamed intramedullary nailing and were included in the study. The severity of the injury was calculated with Ganga Hospital injury severity score. The mean age of patients was 41 years and the follow-up time ranged from six months to one year. Among the 22 patients, 73% were type III B fractures with upper leg involved in 55% of them. The time interval from injury to completion of surgery was 8-14 h. The incidence of bone infection requiring secondary procedure was 9%; the major and minor soft tissue complication rate was 9% and 14% respectively. The limb salvage rate was 100%. Multidisciplinary management of severe lower limb trauma is important and provides good outcomes. Intramedullary nailing and immediate flap fixation can achieve early bone union and good soft tissue coverage, leading to good outcomes in patient with Grade III A & B tibia fractures. Copyright © 2017 Daping Hospital and the Research Institute of Surgery of the Third Military Medical University. Production and hosting by Elsevier B.V. All rights reserved.

  1. Fracture union in closed interlocking nail in humeral shaft fractures.

    Science.gov (United States)

    Sahu, Ramji Lal; Ranjan, Rajni; Lal, Ajay

    2015-06-05

    Fracture shaft humerus is a major cause of morbidity in patients with upper extremity injuries. The aim of this study was to evaluate the outcome of interlocking nail in humeral shaft fractures. This study was conducted in the Department of Orthopedic Surgery in SMS and R Sharda University from January 2010 to November 2013. Seventy-eight patients were recruited from emergency and out-patient department having a close fracture of humerus shaft. All patients were operated under general anesthesia and closed reamed interlocking nailing was done. All patients were followed for 9 months. Out of 78 patients, 69 patients underwent union in 90-150 days with a mean of 110.68 days. Complications found in four patients who had nonunion, and five patients had delayed union, which was treated with bone grafting. All the patients were assessed clinically and radiologically for fracture healing, joint movements and implant failure. The results were excellent in 88.46% and good in 6.41% patients. Complete subjective, functional, and clinical recovery had occurred in almost 100% of the patients. 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.

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

    African Journals Online (AJOL)

    2017-09-14

    Sep 14, 2017 ... fracture patterns as informed in a biomechanical study. Maher et al.[36] compared the expandable nail with a standard locked nail in fracture model, finding that spiral fracture patterns, rather than transverse fractures, were more suitable for expandable nail fixation.. However, in this study bending and ...

  3. A COMPAR A TIVE STUDY OF FIXATION OF DISTAL END FRACTURES OF FEMUR BY SUPRACONDYLAR NAIL AND DYNAMIC CONDYLAR SCREW

    Directory of Open Access Journals (Sweden)

    Penugonda Ravi Shankar

    2015-01-01

    Full Text Available AIMS AND OBJECTIVES : To study the functional outcome of fractures of distal end of femur in adults surgically treated with supracondyl ar nail and Dynamic condylar screw. To study the complications of Dynamic Condylar screw and supracondylar nail in fractures of distal end of femur in Adults . RESULTS : In this study 20 cases of distal femoral fractures were treated with DCS and Supracondyl ar Nail. Our aim was to treat these fractures by rigid internal fixation, early mobilization and to know the outcome of DCS and SC Nail in these fractures.The mean age group of patients was 41.8 years in DCS and 38.4 in Nail group. Males were predominating in our study. Radiological union was seen at an average of 14.6 weeks in DCS and 13 weeks in supracondylar Nail. Average Range of Knee motion was 97 0 in DCS and 101 0 in Nail. Overall results were excellent in 10 cases (4 in DCS, 6 in Nail Good in 4 cases (2 in DCS, 2 in Nail Poor in 6 cases (4 in DCS 2 in Nail. CONCLUSION : From the study, We concluded DCS and Supracondylar Nail can be used for treating fractures of distal femur and supracondylar Nail is a better implant than DCS as it provides stable fr acture fixation with minimal disruption of soft tissues allowing early joint mobilization. The simplicity of the procedure (SC Nail also facilitates fracture fixation in patients with multiple trauma, including those with multiple fractures

  4. Nail manifestations in pemphigus vulgaris

    OpenAIRE

    Cahali Juliana Burihan; Kakuda Everton Yuji Soyama; Santi Cláudia Giuli; Maruta Celina Wakisaka

    2002-01-01

    Nail involvement in pemphigus vulgaris is rare. We describe 5 patients with pemphigus vulgaris presenting nail involvement. In this disease, nail manifestations present, by order of frequency, as chronic paronychia, onychomadesis, onycholysis, Beau's lines and trachyonychia. All our 5 cases presented with paronychia, and 1 of them also had Beau's lines. Treatment with prednisone and/or cyclophosphamide controlled mucocutaneous and nail manifestations in all cases. O acometimento ungueal no...

  5. Yellow nail syndrome and bronchiectasis

    African Journals Online (AJOL)

    ABSTRACT. 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;.

  6. Intramedullary tumours in patients with neurofibromatosis type 2: MRI features associated with a favourable prognosis

    Energy Technology Data Exchange (ETDEWEB)

    Rennie, A.T.M. [Department of Neuroradiology, West Wing, John Radcliffe Hospital, Headington, Oxford (United Kingdom)], E-mail: atmrennie@hotmail.com; Side, L. [Department of Clinical Genetics, Churchill Hospital, Headington, Oxford (United Kingdom); Kerr, R.S.C. [Department of Neurosurgery, West Wing, John Radcliffe Hospital, Headington, Oxford (United Kingdom); Anslow, P.; Pretorius, P. [Department of Neuroradiology, West Wing, John Radcliffe Hospital, Headington, Oxford (United Kingdom)

    2008-02-15

    Aim: To assess the magnetic resonance imaging (MRI) features and natural history of intramedullary tumours in patients with neurofibromatosis type 2 (NF2). Materials and methods: Eleven NF2 patients with intramedullary spinal cord tumours were identified from the database of the multidisciplinary NF2 clinic. All the imaging studies of these patients were individually reviewed by two neuroradiologists to evaluate the size, number, location, imaging characteristics, and interval growth of the intramedullary tumours. Results: Two of the 11 patients had lesions that required surgery. Both these lesions were in the cervical region, and extended over three and five segments respectively. Nine patients with a mean imaging follow-up period of 77 months had lesions that remained stable, apart from the development of small peritumoral cysts in three. The lesions were well circumscribed, often multiple, usually less than 1 cm in diameter, and were most frequently found in the cervical cord. Conclusion: The majority of intramedullary tumours in NF2 patients are very slow growing and share certain MRI features that differ from those of progressive or symptomatic lesions.

  7. OUTCOME OF INTERTROCHANTERIC FRACTURES TREATED WITH SHORT FEMORAL NAIL

    Directory of Open Access Journals (Sweden)

    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.

  8. Outcome of Both Bone Forearm Fracture Fixation in Children by Rush Nails.

    Science.gov (United States)

    Dwivedi, R; Joshi, R; Panthi, S; Byanjankar, S; Shrestha, R

    2015-01-01

    Forearm fractures are common upper limb injuries among children and usually treated non-operatively. Failure of non-operative treatment, open injuries and multiple fractures are the indications for surgery in paediatric both bone forearm fractures. Intramedullary nailing is considered as minimally invasive procedure with excellent to fair outcomes but it is not free of complications. We reviewed the results and evaluated the outcomes of IM fixation of forearm fractures in children by Rush nails to understand the risks and complications associated with these procedures. A retrospective crossectional study of all paediatric patients treated for diaphyseal forearm fractures for period of five years in a tertiary care setup. Complications were classified according to modified Clavien-Dindo complication classification system. Outcomes were graded depending upon complication grade along with range of motion of forearm. A total of 25 patients were included in the study. Mean time for fracture union was 10.56 weeks. Outcomes were excellent in 16 (64%), good in 7 (28%), fair in 2 (8%) patients and no poor outcome was noted. Ten minor complications were seen. Fixation of paediatric forearm fractures by intramedullary Rush nail is minimally invasive procedure and outcomes are excellent to fair with acceptable complication rates.

  9. Humeral nailing revisited.

    Science.gov (United States)

    Rommens, P M; Kuechle, R; Bord, Th; Lewens, T; Engelmann, R; Blum, J

    2008-12-01

    Unreamed interlocked humeral nailing for stabilisation of acute humeral fractures was introduced a decade ago. Antegrade and retrograde nail insertion are equally popular. The role of nailing as opposed to plating of humeral fractures is the subject of continuous debate. Between 1997 and 2005, 99 acute fractures of the humeral shaft were treated operatively with the unreamed humeral nail (UHN, Synthes) in our Level I Trauma Centre. The mean age of the patients was 63 years. Only eight patients (8.1%) were polytraumatised, nine patients had an open fracture (9.1%), five had a primary radial nerve palsy (5.1%). There were 54 antegrade and 45 retrograde nailings. The procedures were performed by 19 different surgeons, who carefully followed a detailed operation protocol. There were 6 adverse events: 3 secondary radial nerve palsies (3%), 2 fissures at the insertion point (2%) and one false placement of a locking screw (1%). Three patients developed pseudarthrosis (3%). Eight further operation were necessary (8.1%): 3 exploration of the radial nerve, 3 for treatment of pseudarthrosis, one replacement of a locking screw and one wound revision for superficial wound infection. Ninety patients (92 fractures) were evaluated after bone healing. Shoulder function was assessed using the Constant Score, elbow function with the Mayo Elbow Score. 91.3% and 5.4% of patients had an excellent or good shoulder function, 81.5% and 14.1% had an excellent or good elbow function. All patients with a functional deficit of the shoulder joint had antegrade, all patients with a deficit at the elbow joint retrograde nailing. Motor function recovered in all radial nerve palsies. 93.5% of patients had an excellent or good functional end result. Unreamed humeral nailing is a valid therapeutic option for stabilisation of acute humeral shaft fractures. Antegrade and retrograde nailing are associated with specific but different complications. By strictly adhering to the operation technique, the

  10. Limb lengthening with fully implantable magnetically actuated mechanical nails (PHENIX(®))-preliminary results.

    Science.gov (United States)

    Thaller, Peter Helmut; Fürmetz, Julian; Wolf, Florian; Eilers, Thorsten; Mutschler, Wolf

    2014-01-01

    Limb lengthening and deformity correction with fully implantable systems is becoming more and more widespread. Different actuation techniques are known and every system has its specific limitations in distraction control and/or stability. A new system with magnetic actuation offers outstanding options. The mechanism of the Phenix M2(®) bone lengthening nail (Phenix Medical, France) is driven by a strong external magnet. The device can provide lengthening, shortening and bone transport. Between December 2011 and November 2012 we applied the nail in 10 patients with an average age of 25 years (range 15-40 years). There were 6 femoral and 4 tibial procedures. The intended distraction goal was achieved in 8 of 10 patients. In three cases we simultaneously corrected malalignment. Average lengthening was 4.6 cm (range 1.3-7.6 cm). Average distraction index was 0.85 mm/day (range 0.6-1.3mm/day). Average weight bearing index was 27 days/cm (range 16-37 days/cm). Three patients had revisions due to early distraction arrest. The early results are comparable to those of other intramedullary systems in the literature like the ISKD(®), the Albizzia(®) or the Fitbone(®) system. All intramedullary procedures require accurate analysis and planning, advanced operative technique and close follow-up. The custom made design of the Phenix nail with unique options for size, stroke and locking provides new options for small bones and improved stability. The shortening option may be helpful for soft tissue problems, joint subluxation and additional stimulation of bone formation. Magnetic forces have to be considered and too much soft tissue around the nail might be a limiting factor. The magnetically actuated Phenix nail offers new therapeutic options in limb lengthening. Copyright © 2013 Elsevier Ltd. All rights reserved.

  11. 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...... of nail row, edge distance, fixed nail-plate, bending direction, unloading, and grain direction, plate and load direction on the load-displacement curves are analysed. Mean load-displacement curves from all the tests are given....

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

    Science.gov (United States)

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

    2012-09-01

    Proximal femoral nail antirotation (PFNA) device is an intramedullary nail system designing for the treatment of trochanteric fractures. It is composed of a helical neck blade, a nail and a distal locking bolt. There were some reports of femoral shaft fractures even after the fractures were healed. The stress shielding effects of the PFNA device made of stiff titanium alloy on the bone-remodeling behavior of the host femur and the uneven distribution of interface shear stress may contribute to this complication. Recently, a new class of composite called functionally graded material (FGM) was developed, that consisted a gradual pattern of material composition and/or microstructures, and was introduced in dental implant and cementless hip stem. Accordingly, in this paper, we hypothesized that FGM might be used as the material of the nail in PFNA device with the material composition of the nail gradually shifting from more stiff at the proximal side of the femur to more flexible 'iso-elastic' towards the distal side. This hypothesis can be evaluated from the long-term remodeling behavior of host femur and the stress distributions in the PFNA device and bone. Copyright © 2012 Elsevier Ltd. All rights reserved.

  13. Lead and zinc concentrations in hair and nail of some Kano ...

    African Journals Online (AJOL)

    The advantages of hair and nail tissues analysis over other biological samples are that trace metal concentrations in them are not subjected to rapid fluctuation due to diet, air and water hence a long term stable nutritional status. Lead and zinc concentrations in hair and nail samples were determined by flame atomic ...

  14. Rupture of the extensor pollicis longus tendon following dorsal entry flexible nailing of radial shaft fractures in children.

    Science.gov (United States)

    Brooker, Ben; Harris, P Christian; Donnan, Leo T; Graham, H Kerr

    2014-08-01

    Diaphyseal forearm fractures are common in children and adolescents. Intramedullary fixation with flexible nails has a high success rate. Complications related to the insertion of the radial nail include injury to the superficial branch of the radial nerve and rupture of the extensor pollicis longus (EPL) tendon. We report a series of nine patients who sustained an EPL injury related to the insertion of an elastic intramedullary nail into the radius. All nine patients underwent operative management, consisting of either EPL release, EPL direct repair, or tendon transfer (using extensor indicis proprius). In all cases, the nail entry site was directly related to the location of EPL. In many of the cases the EPL dysfunction occurred early on but it's recognition was often delayed. Based on our findings, we recommend the use of a radial entry point. For surgeons who prefer the dorsal entry point, we recommend that they use an incision which allows visualisation of the extensor tendons and that any post-operative EPL dysfunction is addressed promptly.

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

    Science.gov (United States)

    Haneke, Eckart

    2015-06-01

    The nail unit is the largest and a rather complex skin appendage. It is located on the dorsal aspect of the tips of fingers and toes and has important protective and sensory functions. Development begins in utero between weeks 7 and 8 and is fully formed at birth. For its correct development, a great number of signals are necessary. Anatomically, it consists of 4 epithelial components: the matrix that forms the nail plate; the nail bed that firmly attaches the plate to the distal phalanx; the hyponychium that forms a natural barrier at the physiological point of separation of the nail from the bed; and the eponychium that represents the undersurface of the proximal nail fold which is responsible for the formation of the cuticle. The connective tissue components of the matrix and nail bed dermis are located between the corresponding epithelia and the bone of the distal phalanx. Characteristics of the connective tissue include: a morphogenetic potency for the regeneration of their epithelia; the lateral and proximal nail folds form a distally open frame for the growing nail; and the tip of the digit has rich sensible and sensory innervation. The blood supply is provided by the paired volar and dorsal digital arteries. Veins and lymphatic vessels are less well defined. The microscopic anatomy varies from nail subregion to subregion. Several different biopsy techniques are available for the histopathological evaluation of nail alterations. ©2015 Frontline Medical Communications.

  16. 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.

  17. Scoring nail psoriasis

    NARCIS (Netherlands)

    Klaassen, K.M.G.; Kerkhof, P.C.M. van de; Bastiaens, M.T.; Plusje, L.G.; Baran, R.L.; Pasch, M.C.

    2014-01-01

    BACKGROUND: Scoring systems are indispensable in evaluating the severity of disease and monitoring treatment response. OBJECTIVE: We sought to evaluate the competence of various nail psoriasis severity scoring systems and to develop a new scoring system. METHODS: The authors conducted a prospective,

  18. Evaluation of methods and timing in nail dynamisation for treating delayed healing femoral shaft fractures.

    Science.gov (United States)

    Huang, Kui-Chou; Tong, Kwok-Man; Lin, Yu-Min; Loh, El-Wui; Hsu, Cheng-En

    2012-10-01

    Dynamisation is a simple method for treating femoral shaft fractures (FSFs) in patients with delayed healing after intramedullary nailing. However, only around half of patients with a slow-healing FSF have been successfully treated with this strategy. Although it is thought that dynamisation with a screw preserved in the dynamic locking hole improves treatment outcome in these patients, to date, no studies have demonstrated empirical evidence supporting this technique. In this study, we investigated the effects of dynamisation with and without rotation and length control as well as timing of dynamisation on treatment outcomes in FSF patients with delayed healing. Thirty-nine consecutive acute FSF patients with static locking intramedullary nails who subsequently underwent dynamisation were recruited between January 2000 and June 2011. The indication for dynamisation was the presence of gap caused by bone absorption or over-traction at the fracture site when the locking screws were placed. Age, gender, dynamisation method, fracture classification, duration from nail insertion to dynamisation (i.e., timing of dynamisation) and dynamisation outcome were included in the statistical analysis. Patients whose nail was dynamised with a screw preserved in the dynamic locking hole had a significantly higher successful bone union rate (14/15 vs. 14/24, p=0.028) compared with those with all screws removed from one end of the nail. The patients treated in 10-24 weeks had a significantly increased chance of bone union than those treated after 24 weeks (p=0.027). A significantly higher bone union rate (p=0.036) was observed in 10-24 weeks (83.3%) than after 24 weeks (33.3%) in the group of dynamisation with all screws removed from one end of the nail. No statistical difference in bone union success rate was found between patients at 10-24 weeks and after 24 weeks in the group of dynamisation with a screw preserved in the dynamic locking hole. There were no significant differences

  19. Glycolic Acid peels for nail rejuvenation.

    Science.gov (United States)

    Banga, Gurvinder; Patel, Kalpana

    2014-01-01

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

  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. Surgical anatomy of the nail apparatus.

    Science.gov (United States)

    Haneke, Eckart

    2006-07-01

    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 correctly.

  2. The use of gentamicin-coated nails in complex open tibia fracture and revision cases: A retrospective analysis of a single centre case series and review of the literature.

    Science.gov (United States)

    Metsemakers, W J; Reul, M; Nijs, S

    2015-12-01

    Despite modern advances in fracture care, deep (implant-related) infection remains a problem in the treatment of tibia fractures. There is some evidence that antibiotic-coated implants are beneficial in the prevention of this sometimes devastating complication. In the following study we describe our results using a gentamicin-coated intramedullary tibia nail (Expert Tibia Nail (ETN) PROtect™) for the surgical treatment of complex open tibia fracture and revision cases. We describe the outcome of patients treated between January 2012 and September 2013, using a gentamicin-coated intramedullary tibia nail. Treatment indications included acute, Gustilo grade II-III, open tibia fractures or closed tibia fractures with long-term external fixation prior to intramedullary nailing and complex tibia fracture revision cases with a mean of three prior surgical interventions. Outcome parameters in this study were deep infection and nonunion. In total, 16 consecutive patients with 16 tibia fractures were treated with a gentamicin-coated intramedullary nail. The overall patient population was subdivided into two groups. The first group consisted of 11 patients (68.8%) with acute fractures who were treated with a gentamicin-coated intramedullary nail. The second group consisted of 5 complex revision cases (31.2%). In our patient population no deep infections could be noted after the treatment with a gentamicin-coated tibia nail. Nonunion was diagnosed in 4 patients (25.0%), 1 of these was a revision case. Musculoskeletal complications place a cost burden on total healthcare expenditure. Better understanding of the epidemiology and pathogenesis is essential because this can lead to prevention rather than treatment strategies. The purpose of the study was to evaluate a gentamicin-coated tibia nail in the prevention of deep (implant-related) infection. In our patient population no deep infections occurred after placement of the gentamicin-coated nail. Following this study and

  3. Diagnostic use of intramedullary reaming biopsy in metastatic long bone disease.

    Science.gov (United States)

    Afinowi, R A; Chaturvedi, A; Cattermole, H R

    2017-07-01

    INTRODUCTION Bone is the third most common site of metastasis. A histological diagnosis is important in guiding therapy and prognosis. In up to 15% of cases of metastatic disease, the primary tumour remains unknown. This emphasises the importance of adequate, reliable and accurate sampling when performing any type of biopsy. Reaming biopsy is commonly performed during intramedullary nailing of metastatic long-bone disease but there is little published evidence on the diagnostic use and reliability of this technique. AIMS AND METHODS We reviewed 49 cases of confirmed metastatic bone disease to determine adequacy for analysis, diagnostic accuracy and factors affecting reliability. RESULTS Adequate tissue for histopathological analysis was obtained in 96% of cases but metastasis was confirmed in only 51% of cases. The presence of a pathological fracture had no effect on accuracy of the results but metastasis was more likely to be missed in the presence of tissue crushing and or necrosis (P = 0.015). DISCUSSION This study determines the use and accuracy of bone reaming biopsy in metastatic disease and, to the best of our knowledge, is the only study determining the effect of additional factors such as the presence of a pathological fracture and tissue necrosis or crushing on the diagnostic accuracy of this technique. CONCLUSIONS In spite of adequate tissue sampling, the diagnostic accuracy and, hence, reliability of intramedullary reaming biopsy in metastatic bone disease is less than optimal. A reaming histopathology report suggesting no evident metastasis should always be taken in clinical context.

  4. Results of the proximal femoral nail anti-rotation (PFNA) in elderly Chinese patients

    OpenAIRE

    Pu, Jin-Song; Liu, Lei; Wang, Guang-lin; Fang, Yue; Yang, Tian-Fu

    2009-01-01

    A prospective study is presented of 87 unstable intertrochanteric fractures treated with the proximal femoral nail anti-rotation (PFNA) with a follow-up of one year. Of the patients 76% were female. The average age was 75.3 years. The fracture was treated by closed reduction and intramedullary fixation. Pre-injury activity level was recovered in 77% of the patients. Fractures united in all patients. Mechanical failure and cut-out were not observed. A technical problem related to the mismatch ...

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

    Directory of Open Access Journals (Sweden)

    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.

  6. 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 ... Child nail care Manicure safety Nail biting Anti-aging skin care Kids’ zone Video library Find a ...

  7. How to Stop Biting Your Nails

    Medline Plus

    Full Text Available ... over-the-counter, this safe, but awful-tasting formula discourages many people from biting their nails. Get ... to break the habit. Try to stop biting one set of nails, such as your thumb nails, ...

  8. How to Stop Biting Your Nails

    Medline Plus

    Full Text Available ... such as your thumb nails, first. When that’s successful, eliminate your pinky nails, pointer nails, or even ... dermatologist . Explore AAD Member resources Practice Tools Education Meetings & events Advocacy Public & patients AAD Resources For: Dermatologists ...

  9. 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 Teledermatology Compliance HIT ... Child nail care Manicure safety Nail biting Nail changes a dermatologist should examine Anti-aging skin care ...

  10. How to Stop Biting Your Nails

    Medline Plus

    Full Text Available ... public", "mcat1=de12", ]; for (var c = 0; c How to stop biting your nails Nail biting typically ... to bite your nails, you can figure out how to avoid these situations and develop a plan ...

  11. How to Stop Biting Your Nails

    Medline Plus

    Full Text Available ... nail biting can also leave you vulnerable to infection as you pass harmful bacteria and viruses from ... your nails and develop a skin or nail infection, consult a board-certified dermatologist . Explore AAD Member ...

  12. 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= ...

  13. How to Stop Biting Your Nails

    Medline Plus

    Full Text Available ... de12", ]; for (var c = 0; c How to stop biting your nails Nail biting typically begins in ... to your face and mouth. To help you stop biting your nails, dermatologists recommend the following tips: ...

  14. How to Stop Biting Your Nails

    Medline Plus

    Full Text Available ... set of nails, such as your thumb nails, first. When that’s successful, eliminate your pinky nails, pointer ... c = 0; c Explore AAD Member resources Practice Tools Education Meetings & events Advocacy Public & patients AAD Resources ...

  15. How to Stop Biting Your Nails

    Medline Plus

    Full Text Available ... mcat1=de12", ]; for (var c = 0; c How to stop biting your nails Nail biting typically begins ... Chronic nail biting can also leave you vulnerable to infection as you pass harmful bacteria and viruses ...

  16. 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, ...

  17. The nail in the elderly.

    Science.gov (United States)

    Baran, Robert

    2011-01-01

    Treating elderly patients has become common in daily clinical practice. Consequently, it is important to focus our interest on a neglected region: the nail area. Anatomy and physiology are indispensable for a good comprehension of some phenomenons. Histopathology of senile changes may explain some pathologic situations and is indispensable for diagnosing uncommon tumors. Chemical composition shows that a normal nail contains 18% water. The rate of linear nail decreases as age advances. Ridging is a normal finding on fingernails, with color varying from shades of yellow to grey. The most common disorders, however, are linked to repeated trauma, with sometimes ingrowing toenails with different appearances. Tumors in the nail area are relatively frequent. Nail fungal infection may be isolated or associated with conditions such as psoriasis and diabetes. The management of the main nail disorders observed in the elderly are presented. Copyright © 2011 Elsevier Inc. All rights reserved.

  18. Cephalomedullary nails: factors associated with impingement of the anterior cortex of the femur in a Hispanic population.

    Science.gov (United States)

    Peña, Omar R; Gómez Gélvez, Amparo; Espinosa, Kristian A; Cardona, José R

    2015-11-01

    Impingement and penetration of the anterior cortex of the femur have been reported as complications after cephalomedullary nailing. The purpose of this study was to determine factors related to nail impingement in our population of Hispanic patients. A non-matched case-control study was carried out and 156 patients who underwent cephalomedullary nailing from 2010 and 2013 were included; 78 cases with anterior cortical impingement and 78 control cases without impingement were documented. Demographic variables and specifications of the nails such as manufacture and radius of curvature were recorded. The presence of impingement, angle of incidence on radiographs--indirect measurement of the femoral bow on the sagittal plane--and nail entry site were determined. Bivariate and multivariate logistic regression analyses were performed to identify the factors associated with cortical impingement. The distribution by sex corresponded to 87 females (56%) and 69 males (44%) with a mean age of 75 years [SD 18.2]. Cortical impingement was presented in 78 cases (50%) and 6 (3.8%) patients evidenced penetration of the anterior cortex of the femur. On the bivariate analysis the posterior nail start site is highlighted, which showed a positive association with impingement (OR 4.3; 95% CI 1.1-36 and p = 0.04). After the multivariate analysis, the factors associated with anterior cortical impingement included female gender (OR 2.2; 95 % CI 1.1-4.6 and p ≤ 0.038), straight nails-short nails-(OR 4.9; 95% CI 2.2-10 and p ≤ 0.001) and angle of incidence ≥7° (OR 4.9; 95% CI 2.2-10 and p ≤ 0.001), the latter showing a likelihood of 57 % for impingement, increasing to 90% with an angle of incidence of 11°. Posterior entry site should be avoided and an anterior site should be used. Female gender, straight nails and greater angle of incidence of the femur were associated with cortical impingement. A specific intramedullary nail design is needed for the Hispanic population due to

  19. Intramedullary compression device for proximal ulna fracture.

    Science.gov (United States)

    Hong, Choon Chiet; Han, Fucai; Decruz, Joshua; Pannirselvam, Vinodhkumar; Murphy, Diarmuid

    2015-02-01

    Proximal ulna fractures account for 20% of all proximal forearm fractures. Many treatment options are available for such fractures, such as cast immobilisation, plate and screw fixation, tension band wiring and intramedullary screw fixation, depending on the fracture pattern. Due to the subcutaneous nature of the proximal forearm, it is vulnerable to open injuries over the dorsal aspect of the proximal ulna. This may in turn prove challenging, as it is critical to obtain adequate soft tissue coverage to reduce the risk of implant exposure and bony infections. We herein describe a patient with a Gustillo III-B open fracture of the proximal ulna, treated with minimally invasive intramedullary screw fixation using a 6.0-mm cannulated headless titanium compression screw (FusiFIX, Péronnas, France).

  20. Spinal Intramedullary Metastasis of Breast Cancer

    Directory of Open Access Journals (Sweden)

    Recep Basaran

    2014-01-01

    Full Text Available Objective. Breast cancer accounts for approximately one-third of all cancers in females. Approximately 8.5 % of all central nervous system metastases are located in the spinal cord. These patients have rapidly progressing neurological deficits and require immediate examination. The aim of surgery is decompression of neural tissue and histological evaluation of the tumor. In this paper, we present a case of breast cancer metastasis in thoracic spinal intramedullary area which had been partially excised and then given adjuvant radiotherapy. Case. A 43-year-old female patient with breast cancer for 8 years was admitted to our hospital with complaints of weakness in both legs. Eight years ago, she received chemotherapy and radiotherapy. On her neurological examination, she had paraparesis (left lower extremity: 2/5, right lower extremity: 3/5 and urinary incontinence. Spinal MRI revealed a gadolinium enhancing intramedullary lesion. Pathologic examination of the lesion was consistent with breast carcinoma metastasis. The patient has been taken into radiotherapy. Conclusion. Spinal intramedullary metastasis of breast cancer is an extremely rare situation, but it has a high morbidity and mortality rate. Microsurgical resection is necessary for preservation or amelioration of neurological state and also for increased life expectancy and quality.

  1. Treatments of intramedullary spinal cord tumors

    Energy Technology Data Exchange (ETDEWEB)

    Ueyama, Kazumasa; Okada, Akihiro; Echigoya, Naoki; Yokoyama, Toru; Harata, Seiko [Hirosaki Univ., Aomori (Japan). School of Medicine

    2001-04-01

    In order to establish a treatment for intramedullary spinal cord tumors, histology, symptoms (preoperative, upon discharge from the hospital, and at the final follow-up examination), postoperative combination therapy, postoperative complications, and recurrence were assessed in patients with intramedullary spinal cord tumors treated in the author's hospital during the past 19 years. There were 26 subjects (astrocytoma in 8, ependymoma in 6, intramedullary neurinoma in 3, lipoma in 3, hemangioblastoma in 3, cavernous angioma in 1, capillary hemangioma in 1, and enterogenous cyst in 1). Surgery had been performed in 24 of them, and 7 of the tumors were completely resected, 6 were incompletely resected, and 3 were partially resected. Radiotherapy had been performed to treat 7 astrocytomas and 2 ependymomas. Kyphosis was noted as a postoperative complication in 1 patient with an astrocytoma who had received postoperative radiotherapy. Postoperative improvement was better in the patients who had the ependymomas, lipoma, and angioma, and in 1 patient with an astrocytoma. The astrocytomas were very difficult to completely remove surgically, and postoperative radiotherapy was thought to be indispensable. The ependymomas, hemangioblastomas, and angiomas could be surgically resected, but the surgeon must has to exercise sufficient care during the operation. The lipomas were also difficult to resect surgically and intratumoral decompression or decompression should be performed. For adolescents spinal deformity should be considered as one of the postoperative complications. (K.H.)

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

    Directory of Open Access Journals (Sweden)

    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

  3. Operative treatment of 2-part surgical neck fractures of the proximal humerus (AO 11-A3) in the elderly: Cement augmented locking plate Philos™ vs. proximal humerus nail MultiLoc®.

    Science.gov (United States)

    Helfen, Tobias; Siebenbürger, Georg; Mayer, Marcel; Böcker, Wolfgang; Ockert, Ben; Haasters, Florian

    2016-10-28

    Proximal humeral fractures are with an incidence of 4-5 % the third most common fractures in the elderly. In 20 % of humeral fractures there is an indication for surgical treatment according to the modified Neer-Criteria. A secondary varus dislocation of the head fragment and cutting-out are the most common complications of angle stable locking plates in AO11-A3 fractures of the elderly. One possibility to increase the stability of the screw-bone-interface is the cement augmentation of the screw tips. A second is the use of a multiplanar angle stablentramedullary nail that might provide better biomechanical properties after fixation of 2-part-fractures. A comparison of these two treatment options augmented locking plate versus multiplanar angle stable locking nail in 2-part surgical neck fractures of the proximal humerus has not been carried out up to now. Forty patients (female/male, ≥60 years or female postmenopausal) with a 2-part-fracture of the proximal humerus (AO type 11-A3) will be randomized to either to augmented plate fixation group (PhilosAugment) or to multiplanar intramedullary nail group (MultiLoc). Outcome parameters are Disabilities of the Shoulder, Arm and Hand-Score (DASH) Constant Score (CS), American Shoulder and Elbow Score (ASES), Oxford Shoulder Score (OSS), Range of motion (ROM) and Short Form 36 (SF-36) after 3 weeks, 6 weeks, 3 months, 6 months, 12 and 24 months. Because of the lack of clinical studies that compare cement augmented locking plates with multiplanar humeral nail systems after 2-part surgical neck fractures of the proximal humerus, the decision of surgical method currently depends only on surgeons preference. Because only a randomized clinical trial (RCT) can sufficiently answer the question if one treatment option provides advantages compared to the other method we are planning to perform a RCT. Clinical Trial ( NCT02609906 ), November 18, 2015, registered retrospectively.

  4. Nail unit ultrasound: a complete guide of the nail diseases.

    Science.gov (United States)

    Aluja Jaramillo, Felipe; Quiasúa Mejía, Diana Carolina; Martínez Ordúz, Hector Mauricio; González Ardila, Cesar

    2017-09-01

    The nails have a functional and esthetic importance for patients. Almost always, the nail disorders are diagnosed on the basis of clinical findings, but imaging methods may be required for a better assessment. These imaging methods, such as ultrasound and magnetic resonance, may help to establish an accurate diagnosis. Magnetic resonance imaging is not widely available and sometimes may be very expensive; that is why, ultrasound is an excellent imaging modality. Our objective is to expose the nail unit anatomy, the nail unit anatomy in ultrasound, and some of the frequent pathologies found in our daily practice. A review of the literature was done to review the anatomy, technical aspects, and different findings in normal and abnormal nail unit ultrasound. Ultrasound offers an appropriate alternative for the evaluation of the nail unit, allows a real-time evaluation of each one of the components of the nail unit with an optimal visualization of these structures, and allows the evaluation of the thickness of the components, the vascularity, and blood flow by Doppler application. In addition, the nail unit disorder, such as infectious diseases, inflammatory and rheumatologic conditions, nail tumors, among others, may be assessed, not only in the diagnosis but also in the follow-up. Pre-surgical evaluation, surgical follow-up, and some procedures, such as biopsies, may be done by this technique. Ultrasound is an excellent technique for evaluation of normal anatomy, diagnosis, and follow-up of patients with nail unit diseases. This is an alternative for other imaging methods and may be used for an accurate diagnosis approach.

  5. [Suprapatellar approach to tibial medullary nailing with electromagnetic field-guided distal locking].

    Science.gov (United States)

    Rueger, J M; Rücker, A H; Hoffmann, M

    2015-04-01

    Closed tibial shaft fractures are the domain of intramedullary nailing. With the introduction of new nail designs and technologies, even small, dislocated distal fragments can be anatomically aligned and safely fixed. Unsolved or to a lesser degree controlled are the problems of distal locking in the freehand technique, which can still be difficult and can lead to a significant radiation exposure, and how to control very short proximal tibial fragments in metaphyseal tibial fractures or tibial segmental fractures, where the proximal fracture line also runs through the metaphysis.By using a suprapatellar approach, i.e. a skin incision proximal to the patella with an entry point into the tibial bone from within the knee at the same site as for a standard infrapatellar approach, and then nailing the tibia in a semi-extended position, i.e. the knee is only flexed 10-20°, the intraoperative dislocation of a short proximal fragment can be avoided. The main indications for semi-extended tibial nailing are a short diaphyseal fragment in an isolated tibial shaft fracture, a segmental fracture where the proximal fracture line is metaphyseal and in patients where infrapatellar soft tissues are compromised.The use of the electromagnetic guidance system SureShot® generates reliable and reproducible results, reduces the operating time and is independent from radiation for distal locking.

  6. Assessment of the Treatment Outcome of Closed Extra-Articular Distal Tibia Fracture: IM Nailing vs Plating

    Directory of Open Access Journals (Sweden)

    Seyed Abas Behgoo

    2009-11-01

    Full Text Available Background:The tibial diaphyseal fractures are the most common type of long bone fractures encountered by most orthopedic surgeons.In accordance with descriptive indices of tibia fractures on the basis of their location in the bone,distal tibia fractures have the second incidence of all tibia fractures after the middle tibia fractures.The purpose of the study was to assess the complications and treatment outcome of closed extra-articular distal tibia fracture. Methods:The results of the management for 76 patients with closed extra-articular distal tibia fracture by intramedullary nailing and plating were reviewed retrospectively.The variables included AO (Arbeitsgemeinschaft fur Osteosynthesefragenclassification of tibia fracture, the mean duration of union, malunion,and nonunion.   Results: Twenty seven and forty nine patients were treated by intramedullary(IM nailing and plating respectively.The most common type of fractures was A1 which was observed in twenty five patients. Initial union and nonunion occurred in   sixty three and thirteen patients respectively. Eight patients had nonunion in plating   group and five of twenty seven patients in IM nailing group. Eleven of twenty seven patients in IM nailing group suffered from malunion while only four patients in the other group had this complication.   Conclusion: The plating Technique in comparison with IM nailing has a satisfactory functional outcome.The technique has a lower incidence of malunion and nonunion, and it should be recommended as a good treatment option for the management of extra-articular closed fracture of distal tibia.  

  7. Anatomy of the Greater Trochanteric ‘Bald Spot’: A Potential Portal for Abductor Sparing Femoral Nailing?

    Science.gov (United States)

    Robertson, William J.; Boraiah, Sreevathsa; Barker, Joseph U.; Lorich, Dean G.

    2008-01-01

    Soft tissue injury occurs when using a piriformis portal for femoral nailing. Standard trochanteric portals also can injure the gluteus medius and external rotator tendons, which may be a source of hip pain after nailing. On the lateral facet of the greater trochanter, a “bald spot” may exist that is devoid of tendon insertion. This may be a potential portal for intramedullary nail insertion. We defined the dimensions and location of this region. Cadaveric specimens were dissected to expose the tendon insertions on the greater trochanter. A computer navigation system was used with a stylus and bone morphing to determine the tendon insertions and bald spot anatomy. The greater trochanteric bald spot is covered by the subgluteus medius bursa and has no tendon insertions. Its center lies 11 mm distal to the tip of the greater trochanter and 5 mm anterior to the midline. The shape is ellipsoid with a diameter of 21 mm. This region is large enough to accommodate the size of most nailing system reamers without tendon footprint infringement. Use of this modified entry site may reduce soft tissue injury with nailing procedures and minimize subsequent hip pain. PMID:18347886

  8. [Randomized prospective study on the influence distal block and Gamma 3 nail on the treatment of intertrochanteric fractures of femur].

    Science.gov (United States)

    López-Vega, M; Gil-Monzó, E R; Rodrigo-Pérez, J L; López-Valenciano, J; Salanova-Paris, R H; Peralta-Nieto, J; Morales-Suárez, M M

    2015-01-01

    The purpose of this study is to assess the need to lock the Gamma 3 nail (Stryker, Mahwah New Jersey USA) distally for intertrochanteric fractures of femur 31-A1 and 31-A2 of the AO. Details were recorded on a sample of 177 patients with intertrochanteric femoral fractures treated in our hospital by a standard Gamma nail between June 2011 and January 2013. A prospective study was conducted by randomizing patients by year of birth, even numbers with, or odd number without, distal locking, forming two groups of 90 and 87 fractures, respectively. The patients treated with a distal locking nail had an increased incidence of medical complications, a lower incidence of biomechanical complications, and an increase in the fracture collapse compared with the control group, with statistical significance (p < 0.05). It is also observed in the group with distal locking increased transfusion requirement and a higher death rate, with statistically significant differences (p < 0.05), but this significance disappears when adjusting for other patient-related characteristics. Based on the results found in this work, the use of distal locking screw in the Gamma 3 nails should be restricted to unstable trochanteric fractures after reduction where additional stability to the intramedullary nail is required, and may decrease the risk of complications from use. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

  9. The effect of nail polish on pulse oximetry readings.

    Science.gov (United States)

    Hakverdioğlu Yönt, Gülendam; Akin Korhan, Esra; Dizer, Berna

    2014-04-01

    Pulse oximeters utilise the pulsatile nature of arterial blood flow to distinguish it from venous flow and estimate oxygen saturation in arterial blood. Pulse oximetry is primarily used in hospital wards, emergency rooms, intensive care units, operating rooms and home care. The objective of this study is to determine whether the use of nail polish of various colours have an effect on oximeter readings of oxygen saturation value. The sample group of this study is comprised of 40 healthy women. In the first phase of the study, readings were taken on left and right hand fingers, with no nail polish, to determine any differences in oxygen saturation value. In the second phase of the study, 10 different colours of nail polish, namely dark red, yellow, dark blue, green, purple, brown, white, metallic, black and pink, of the same brand were applied. Readings were recorded once oxygen saturation values on the screen became stable. Number and percentage distributions along with Wilcoxon signed ranks and Friedman test were used in the analysis of data. Only red nail polish did not yield statistically significant reading results. We conclude that different nail polish colours cause a clinically significant change in pulse oximeter readings in healthy volunteers. Copyright © 2013 Elsevier Ltd. All rights reserved.

  10. 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.

  11. Percutaneous elastic intramedullary nailing of metacarpal fractures: surgical technique and clinical results study.

    Science.gov (United States)

    Mohammed, Riazuddin; Farook, Mohamed Z; Newman, Kevin

    2011-07-19

    We reviewed our results and complications of using a pre-bent 1.6 mm Kirschner wire (K-wire) for extra-articular metacarpal fractures. The surgical procedure was indicated for angulation at the fracture site in a true lateral radiograph of at least 30 degrees and/or in the presence of a rotatory deformity. A single K-wire is pre-bent in a lazy-S fashion with a sharp bend at approximately 5 millimeters and a longer smooth curve bent in the opposite direction. An initial entry point is made at the base of the metacarpal using a 2.5 mm drill by hand. The K-wire is inserted blunt end first in an antegrade manner and the fracture reduced as the wire is passed across the fracture site. With the wire acting as three-point fixation, early mobilisation is commenced at the metacarpo-phalangeal joint in a Futuro hand splint. The wire is usually removed with pliers post-operatively at four weeks in the fracture clinic. We studied internal fixation of 18 little finger and 2 ring finger metacarpal fractures from November 2007 to August 2009. The average age of the cohort was 25 years with 3 women and 17 men. The predominant mechanism was a punch injury with 5 diaphyseal and 15 metacarpal neck fractures. The time to surgical intervention was a mean 13 days (range 4 to 28 days). All fractures proceeded to bony union. The wire was extracted at an average of 4.4 weeks (range three to six weeks). At an average follow up of 8 weeks, one fracture had to be revised for failed fixation and three superficial wound infections needed antibiotic treatment. With this simple and minimally invasive technique performed as day-case surgery, all patients were able to start mobilisation immediately. The general outcome was good hand function with few complications.

  12. Is intramedullary nailing superior to plating in patients with extraarticular fracture of the distal tibia?

    Directory of Open Access Journals (Sweden)

    Jorge Cabrolier

    2015-12-01

    Full Text Available Las fracturas metafisarias de tibia distal se producen generalmente por traumatismos de alta energía, como accidentes automovilísticos, y pueden causar discapacidad severa por dolor y deformidad. En el manejo de estas fracturas existen múltiples alternativas quirúrgicas, sin embargo es incierto cuál es la mejor opción. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 30 bases de datos, identificamos seis revisiones sistemáticas que en conjunto incluyen tres estudios aleatorizados. Realizamos un metanálisis y tablas de resumen de los resultados utilizando el método GRADE. Concluimos que no está claro si existe superioridad de una intervención quirúrgica sobre la otra porque la certeza de la evidencia disponible es muy baja. Existen dos estudios clínicos aleatorizados en curso que podrían resolver esta interrogante.

  13. Percutaneous elastic intramedullary nailing of metacarpal fractures: Surgical technique and clinical results study

    Directory of Open Access Journals (Sweden)

    Farook Mohamed Z

    2011-07-01

    Full Text Available Abstract Background We reviewed our results and complications of using a pre-bent 1.6 mm Kirschner wire (K-wire for extra-articular metacarpal fractures. The surgical procedure was indicated for angulation at the fracture site in a true lateral radiograph of at least 30 degrees and/or in the presence of a rotatory deformity. Methods A single K-wire is pre-bent in a lazy-S fashion with a sharp bend at approximately 5 millimeters and a longer smooth curve bent in the opposite direction. An initial entry point is made at the base of the metacarpal using a 2.5 mm drill by hand. The K-wire is inserted blunt end first in an antegrade manner and the fracture reduced as the wire is passed across the fracture site. With the wire acting as three-point fixation, early mobilisation is commenced at the metacarpo-phalangeal joint in a Futuro hand splint. The wire is usually removed with pliers post-operatively at four weeks in the fracture clinic. Results We studied internal fixation of 18 little finger and 2 ring finger metacarpal fractures from November 2007 to August 2009. The average age of the cohort was 25 years with 3 women and 17 men. The predominant mechanism was a punch injury with 5 diaphyseal and 15 metacarpal neck fractures. The time to surgical intervention was a mean 13 days (range 4 to 28 days. All fractures proceeded to bony union. The wire was extracted at an average of 4.4 weeks (range three to six weeks. At an average follow up of 8 weeks, one fracture had to be revised for failed fixation and three superficial wound infections needed antibiotic treatment. Conclusions With this simple and minimally invasive technique performed as day-case surgery, all patients were able to start mobilisation immediately. The general outcome was good hand function with few complications.

  14. Closed and open grade I and II tibial shaft fractures treated by reamed intramedullary nailing

    OpenAIRE

    Djahangiri, A.

    2006-01-01

    RESUME Objectif : Le but de cette étude est d'évaluer les résultats du traitement par enclouage centre-médullaire alésé des fractures diaphysaires du tibia aussi bien fermées que pour les fractures ouvertes de stade I et II selon Gustillo. Méthodes: Entre 1997 et 2000, 119 patients présentant une fracture diaphysaire du tibia ont été traités dans notre service par un enclouage centre-médullaire alésé. En postopératoire, 96 patients, soit 70 fractures fermées et 26 fractures ouvert...

  15. Circumferential wires as a supplement to intramedullary nailing in unstable trochanteric hip fractures

    DEFF Research Database (Denmark)

    Ban, Ilija; Birkelund, Lasse; Palm, Henrik

    2012-01-01

    Fixation of unstable trochanteric fractures is challenging. Application of a circumferential wire may facilitate bone contact and avoid postoperative fracture displacement. However, the use of circumferential wires remains controversial due to possible disturbance of the blood supply to the under...

  16. Damage control and intramedullary nailing for long bone fractures in polytrauma patients.

    Science.gov (United States)

    Patka, Peter

    2017-06-01

    The early fracture treatment in patients with multiple injuries should be focused on damage control. The fracture type and its location, local soft tissue condition as well as the patient's physiological condition shall determine the time and type of fracture treatment. Prevention of local and systemic complications must be immediately considered and included in the treatment planning. The use of external fixator (ExFix), which will be replaced by IM-implants in most cases at a later stage, provides adequate temporary fracture stabilization with less collateral damage. Good clinical results can be expected in patients with long bone fractures if the principles of damage control surgery are applied and local complications are prevented through proper reduction, firm fixation, early soft tissue reconstruction, and early rehabilitation. Copyright © 2017 Elsevier Ltd. All rights reserved.

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

    Science.gov (United States)

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

    2009-01-01

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

  18. Primary Intradural Hemangiopericytoma With Intramedullary Invasion

    Directory of Open Access Journals (Sweden)

    Chiang-Wei Chou

    2009-10-01

    Full Text Available Hemangiopericytoma (HPC is a rare tumor of the central nervous system and is usually found intracranially. Intraspinal HPCs are very rare and mostly involve the extradural bony structures. Primary intradural HPC has only been reported in 10 cases, all of which occurred in the extramedullary region. Intramedullary invasion has never been reported. Here, we describe a case of primary intradural HPC of the thoracic spine that presented initially with paresthesia and paraplegia of both legs. Magnetic resonance imaging of the thoracic spine showed an intradural dumbbell-shaped tumor at the T10 level. The initial impression was neurogenic tumor, meningioma, or metastasis. During operation, the tumor was found to have obvious intramedullary invasion. Gross-total removal was done, and the patient's neurological function improved; there was no recurrence at the 3-year follow-up. There is no consensus as to what constitutes the optimal treatment of HPC, but most neurosurgeons will advocate gross-total resection. A comparative analysis between intradural and extradural HPCs showed a higher chance of gross-total resection for intradural HPCs, while the recurrence rates showed no difference. The role of adjuvant radiotherapy remains uncertain. Due to the high risk of recurrence and metastasis of HPCs, close follow-up for a long period is mandatory. [J Chin Med Assoc 2009;72(10:536–541

  19. Les complications de l'ECMES dans le traitement des fractures des ...

    African Journals Online (AJOL)

    This study aims to describe the complications of elastic stable intramedullary nailing (ESIN) in the treatment of both-bone forearm diaphyseal fractures in the child. Between January 2009 and December 2013, 87 children with both-bone forearm diaphyseal fractures were treated by elastic stable intramedullary nailing with ...

  20. Allergenic ingredients in nail polishes.

    Science.gov (United States)

    Sainio, E L; Engström, K; Henriks-Eckerman, M L; Kanerva, L

    1997-10-01

    It has been known since the 1940s that nail polishes contain allergenic ingredients. The aim of this study was to clarify whether the nail polishes on the market today contain significant amounts of allergens, and what the solvents are. The following ingredients were determined: toluene, toluene sulfonamide formaldehyde resins, free formaldehyde, acrylates, methacrylates and certain organic solvents. The study comprised 20 brands and 42 samples. All the nail polishes analysed contained allergenic toluene sulfonamide formaldehyde resins (TSFR), in concentrations from 0.08 to 11.0%. The concentration of total formaldehyde varied from 0.02% to 0.5%. The more TSFR a nail polish contained, the higher was its formaldehyde content. Probably not only TSFR-allergic but also formaldehyde-allergic persons may get dermatitis from many of the nail polishes studied. The concentrations of acrylates and methacrylates were so small that they are of practical significance only to those previously sensitized to acrylates. Of the organic solvents, toluene was still widely used, whereas xylene was found in only 1 product. The nail polishes on the market today are not safe for all consumers. However, according to the regulations of the European Union, the packaging labeling of all cosmetic products must be supplied with a list of ingredients from the beginning of 1998. This will help the consumer to avoid allergenic products. A better alternative could, however, be to substitute the most allergenic ingredients with substances possessing minor allergy potency.

  1. Revisiting Pneumatic Nail Gun Trigger Recommendations.

    Science.gov (United States)

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

    2015-03-01

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

  2. An arachnoid cyst presenting as an intramedullary tumour

    NARCIS (Netherlands)

    Willems, P. W.; van den Bergh, W. M.; Vandertop, W. P.

    2000-01-01

    A case of thoracic intradural extramedullary arachnoid cyst is presented in which an intramedullary low grade glioma was suspected preoperatively. The cyst was widely fenestrated and postoperatively, the patient experienced considerable improvement in her symptoms. As postoperative MRI studies also

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

    Science.gov (United States)

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

    2017-05-01

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

  4. 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 ...

  5. How to Stop Biting Your Nails

    Medline Plus

    Full Text Available ... silly putty instead. This will help keep your hands busy and away from your mouth. Identify your ... pinky nails, pointer nails, or even an entire hand. The goal is to get to the point ...

  6. Teaching Your Child Healthy Nail Care

    Science.gov (United States)

    ... public", "mcat1=de12", ]; for (var c = 0; c Teaching your child healthy nail care Nails take a ... teach your child how to care for them. Teaching your child the following tips from dermatologists can ...

  7. How to Safely Use Nail Care Products

    Science.gov (United States)

    ... Products For Consumers Home For Consumers Consumer Updates How to Safely Use Nail Care Products Share Tweet Linkedin ... more than 10 minutes per hand, per session. How to Report Problems with Nail Care Products If you ...

  8. How to Stop Biting Your Nails

    Medline Plus

    Full Text Available ... mcat1=de12", ]; for (var c = 0; c How to stop biting your nails Nail biting typically begins ... Education Meetings & events Advocacy Public & patients AAD Resources For: Dermatologists in the US and Canada Dermatologists outside ...

  9. 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 Video ... you stop biting your nails, dermatologists recommend the following tips: Keep your nails trimmed short: Having less ...

  10. Nail disorder among patients on maintenance hemodialysis

    Directory of Open Access Journals (Sweden)

    Malihe Charkhchian

    2013-03-01

    Conclusion: The prevalence of nail disorder in this study was correlated with age, DM, and gender. To decrease the prevalence of nail disorder, attention to duration of HD, age, male sex, and DM is very important.

  11. 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. ...

  12. Recurrent intramedullary epidermoid cyst of conus medullaris.

    LENUS (Irish Health Repository)

    Fleming, Christina

    2011-01-01

    Spinal intramedullary epidermoid cyst is a rare condition. Recurrent epidermoid cyst in the spine cord is known to occur. The authors describe a case of recurrent conus medullaris epidermoid cyst in a 24-year-old female. She initially presented at 7 years of age with bladder disturbance in the form of diurnal enuresis and recurrent urinary tract infection. MRI lumbar spine revealed a 4 cm conus medullaris epidermoid cyst. Since the initial presentation, the cyst had recurred seven times in the same location and she underwent surgical intervention in the form of exploration and debulking. This benign condition, owing to its anatomical location, has posed a surgical and overall management challenge. This occurrence is better managed in a tertiary-care centre requiring multi-disciplinary treatment approach.

  13. Combined spinal intramedullary arteriovenous malformation and lipomyelomeningocele

    Energy Technology Data Exchange (ETDEWEB)

    Weon, Y.C.; Roh, H.G.; Byun, H.S. [Samsung Medical Center, Sungkyunkwan University School of Medicine, Department of Radiology, Seoul (Korea); Chung, J.I. [Medimoa Hospital, Department of Radiology, Seoul (Korea); Eoh, W. [Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea)

    2005-10-01

    Combined spinal arteriovenous malformation and lipomyelomeningocele are extremely rare. We present a rare combined case of a lipomyelomeningocele with an intramedullary arteriovenous malformation (AVM) occurred at the L3-L4 level in a 30-year-old man who suffered from low back pain radiating to the lower extremities, dysuria, and frequency for 5 years. The MR studies showed an intradural mass with high-signal intensity on both T1-weighted and T2-weighted images, intermingled with multiple signal-void structures. The mass extended extradurally toward a subcutaneously forming fatty mass on the patient's back. Spinal angiography showed an AVM supplied by the radiculopial branches of the lumbar arteries and drained by tortuous, dilated, perimedullary veins. Endovascular embolization and surgical resection were performed. (orig.)

  14. Nail changes and disorders among the elderly

    National Research Council Canada - National Science Library

    Singh Gurcharan, Haneef NayeemSadath, A Uday

    2005-01-01

    .... Age associated disorders include brittle nails, trachyonychia, onychauxis, pachyonychia, onychogryphosis, onychophosis, onychoclavus, onychocryptosis, onycholysis, infections, infestations, splinter...

  15. Dramatic Response of Nail Psoriasis to Infliximab

    Directory of Open Access Journals (Sweden)

    Gilles Safa

    2011-01-01

    Full Text Available Nail psoriasis, affecting up to 50% of psoriatic patients, is an important cause of serious psychological and physical distress. Traditional treatments for nail psoriasis, which include topical or intralesional corticosteroids, topical vitamin D analogues, photochemotherapy, oral retinoids, methotrexate, and cyclosporin, can be time-consuming, painful, or limited by significant toxicities. Biological agents may have the potential to revolutionize the management of patients with disabling nail psoriasis. We present another case of disabling nail psoriasis that responded dramatically to infliximab.

  16. A comparative prospective study of dynamic variable angle hip screw and Gamma nail in intertrochanteric hip fractures.

    Science.gov (United States)

    Tarantino, Umberto; Oliva, Francesco; Impagliazzo, Angelo; Mattei, Antonio; Cannata, Giuseppe; Pompili, Gian Francesco Spurio; Maffulli, Nicola

    To compare the results between a variable angle dynamic screw-plate(DMS) and the Gamma nail in the treatment of intertrochanteric hip fractures. A comparative prospective study of 142 patients (AO/OTA Type 31-A1; A2; A3 and B2) treated by variable angle dynamic screw-plate (DMS Group = 71) or by intramedullary nailing (Gamma Nail Group = 71). At the 12-month follow-up, we did not find any statistically significant difference, intraoperatively, radiographically, or clinically, between the two groups of patients, except for shortening. In 12 patients in the DMS group (17%) and in one patient in the Gamma nail group, there was shortening of the operated leg between 1 cm and 3 cm (p = 0.02). In all instances, shortening occurred in patients who sustained A.O. type fractures 31A2. 2 and 3 (19 patients), which are unstable and comminuted. The DMS allows effective management of intertrochanteric fractures of the femur. Surgeons should consider choosing surgical treatment according to the type of intertrochanteric fracture. In less comminuted fractures, a compression hip screw may be a faster and safer surgical solution. In comminuted fractures, surgical difficulties may increase in parallel to fracture complexity.

  17. 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 ...

  18. How to Stop Biting Your Nails

    Medline Plus

    Full Text Available ... public", "mcat1=de12", ]; for (var c = 0; c How to stop biting your nails Nail biting typically begins ... to bite your nails, you can figure out how to avoid these situations and develop a plan to ...

  19. 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, ...

  20. Diagnosis of nail psoriasis: evaluation of nail-derived microRNAs as potential novel biomarkers.

    Science.gov (United States)

    Wang, Zhongzhi; Jinnin, Masatoshi; Harada, Miho; Kudo, Hideo; Inoue, Kuniko; Nakayama, Wakana; Honda, Noritoshi; Makino, Katsunari; Kajihara, Ikko; Fukushima, Satoshi; Ihn, Hironobu

    2017-02-01

    MicroRNA levels in sera or hair may potentially be useful biomarkers for various diseases. The diagnosis of nail diseases is sometimes difficult, and nail psoriasis without skin lesions is indistinguishable from nail changes caused by other diseases. We evaluated nail microRNA levels as biomarkers for the diagnosis of psoriasis patients. MicroRNA levels were examined in psoriasis patients with (11 patients) and without (six patients) nail changes. Normal control nails were collected from 17 healthy subjects. Eight patients with other diseases who also had nail changes were also included as disease controls. Microarray, real-time PCR, and in situ hybridisation indicated that the expression levels of nail miR-4454 were decreased in psoriasis patients with nail changes, compared to those patients with other diseases involving nail change, or healthy subjects. The miR-4454 levels in nails showed a significant inverse correlation with the Nail Psoriasis Severity Index (NAPSI) score, suggesting that nail miR-4454 levels reflect nail condition. The levels of microRNAs in nails may be suitable biomarkers for diagnosis or evaluation of disease activity of psoriasis.

  1. Bone healing and mineralization, implant corrosion, and trace metals after nickel-titanium shape memory metal intramedullary fixation.

    Science.gov (United States)

    Ryhänen, J; Kallioinen, M; Serlo, W; Perämäki, P; Junila, J; Sandvik, P; Niemelä, E; Tuukkanen, J

    1999-12-15

    Its shape memory effect, superelasticity, and good wear and damping properties make the NiTi shape memory alloy a material with fascinating potential for orthopedic surgery. It provides a possibility for making self-locking, self-expanding, and self-compressing implants. Problems, however, may arise because of its high nickel content. The purpose of this work was to determine the corrosion of NiTi in vivo and to evaluate the possible deleterious effects of NiTi on osteotomy healing, bone mineralization, and the remodeling response. Femoral osteotomies of 40 rats were fixed with either NiTi or stainless steel (StSt) intramedullary nails. The rats were killed at 2, 4, 8, 12, 26, and 60 weeks. Bone healing was examined with radiographs, peripheral quantitative computed tomography, (pQCT) and histologically. The corrosion of the retrieved implants was analyzed by electron microscopy (FESEM). Trace metals from several organs were determined by graphite furnace atomic absorption spectrometry (GF-AAS) or by inductively coupled plasma-atomic emission spectrometry (ICP-AES). There were more healed bone unions in the NiTi than in the StSt group at early (4 and 8 weeks) time points. Callus size was equal between the groups. The total and cortical bone mineral densities did not differ between the NiTi and StSt groups. Mineral density in both groups was lower in the osteotomy area than in the other areas along the nail. Density in the nail area was lower than in the proximal part of the operated femur or the contralateral femur. Bone contact to NiTi was close. A peri-implant lamellar bone sheet formed in the metaphyseal area after 8 weeks, indicating good tissue tolerance. The FESEM assessment showed surface corrosion changes to be more evident in the StSt implants. There were no statistically significant differences in nickel concentration between the NiTi and StSt groups in any of the organs. NiTi appears to be an appropriate material for further intramedullary use because it

  2. Iontophoretic drug delivery across the nail.

    Science.gov (United States)

    Delgado-Charro, Maria Begoña

    2012-01-01

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

  3. Nail abnormalities in patients with vitiligo.

    Science.gov (United States)

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

    2016-01-01

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

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

    Science.gov (United States)

    Baran, Robert

    2014-11-01

    For those interested in nails, a fairly good knowledge of the anatomy of the nail unit is indispensable. But nothing will replace a careful, clinical examination of the nail apparatus. The shape of the nail, surface abnormalities and coloration, with or without a magnifying glass, may well provide a medical diagnosis not only in dermatology but also for medicine in general. Pits on the surface of the nail plate may be enough to diagnose psoriasis on a limited area of scalp dandruff. Even partial detachment of the nail apparatus might lead to the suspicion of psoriatic arthritis. A triangular lunula is associated with the absence of patellas. Finally, no pulmonary examination of a smoker is complete without looking for clubbing. It is high time to pay tribute to the nail. Copyright © 2014. Published by Elsevier Masson SAS.

  5. Treatment outcomes of intertrochanteric femur fractures treated with DLT™ nail

    Directory of Open Access Journals (Sweden)

    Mehmet Arıcan

    2015-12-01

    Full Text Available Objective: Intramedullary nails frequently use in proximal femur fractures. In this study, 49 patients with intertrochanteric fractures were evaluated clinical and radiological results treated with dyna locking trochanteric (DLT™ nail retrospectively. Methods: Twenty-two (44.9% patients were male and 27 (55.1% patients were female. Mean age was 74.29±1.98 (28-99 years and Followed up for a mean of 14.35±3.43 (9-24 months. Thirty-seven (75.6% of the fractures resulted from simple falls while 6 (12.2% caused from traffic accidents and 6 (12.2% fall down from height. There were 24 (49.0% left and 25 (51.0% right lower extremities fractured. According to Orthopaedic Trauma Association classification system; 21 (42.9%, 21 (42.9% and 7 (14.2% fractures were classified as 31A1, 31A2, and 31A3 respectively. One (2.0% patient had claviculae fracture, 3 (6.1% patients had radius distal fracture and 1 (2.0% patient had total knee arthroplasty. After surgery, X-ray was used for radiological results and functional outcomes were evaluated according to the Harris hip scoring system. Results: The average waiting time for the surgery was 2.02±0.18 (1-7 days and hospitalization time was 6.23±0.29 (4-15 days. Mean fracture healing time was 11.74±1.82 (8-15 weeks. Three patients had screw cut-out in the follow-up time and performed hemiarthroplasty. The average Harris hip score was 88.02±1.21 (42-97 points and included 29 (59.2% excellent cases, 17 (34.7% good and 3 (6.1% poor. Conclusion: DLT ™ nail is a safe and successful method because of low complication rates, and capability of detection.

  6. Internal fixation of proximal humerus fractures using the T2-proximal humeral nail.

    Science.gov (United States)

    Popescu, Dragos; Fernandez-Valencia, Jenaro A; Rios, Moisés; Cuñé, Jordi; Domingo, Anna; Prat, Salvi

    2009-09-01

    Surgical management of proximal humerus fractures remains controversial and there is an increasing interest in intramedullary nailing. Created to improve previous designs, the T2-proximal humeral nail (PHN) (Stryker) has been recently released, and the English literature lacks a series evaluating its results. We present a clinical prospective study evaluating this implant for proximal humeral fractures. We evaluated the functional and radiological results and possible complications. Twenty-nine patients with displaced fractures of the proximal humerus were treated with this nail. One patient was lost right after surgery and excluded from the assessment. Eighteen patients were older than 70 years. There were 21 fractures of the proximal part of the humerus and 7 fractures that also involved the shaft; 15 of the fractures were two-part fractures (surgical neck), 5 were three-part fractures, and 1 was a four-part fracture. All fractures healed in a mean period of 2.7 months. There was one delayed union that healed in 4 months. One case of avascular necrosis of the humeral head was observed (a four-part fracture), but remained asymptomatic and did not require further treatment. In one case a back-out of one proximal screw was observed. A final evaluation with a minimum 1 year follow-up was performed by an independent observer; in 18 patients, the mean Constant score was 65.7 or 76.1% with the adjustment of age and gender; in 19 patients, the mean Oxford Shoulder Score was 21.7. The results obtained with the T2-PHN nail indicate that it represents a safe and reliable method in the treatment of two- and three-part fractures of the proximal humerus. The proximal fixation mechanism diminishes the rate of back-out of the screws, a frequent complication described in the literature. Better functional results were obtained from the patients younger than 70 years, but these were not statistically significant.

  7. The retropatellar portal as an alternative site for tibial nail insertion: a cadaveric study.

    Science.gov (United States)

    Eastman, Jonathan G; Tseng, Susan S; Lee, Mark A; Yoo, Brad J

    2010-11-01

    To define spatial relationships between major intra-articular structures of the knee and the entry site of a tibial nail inserted using a retropatellar portal. Cadaveric study using 16 fresh-frozen limbs. University-affiliated cadaver and anatomy laboratory. The mean distance of the nail entry site and the medial and lateral menisci were 6.6 ± 3.2 mm and 6.4 ± 4.4 mm, respectively. The distance to the medial and lateral articular surfaces were 5.6 ± 3.6 mm and 7.4 ± 4.2 mm, respectively. The mean distance to the anterior cruciate ligament footprint was 7.5 ± 3.5 mm. The lateral meniscus was never injured during the procedure. The anterior cruciate ligament was undisturbed in all specimens. The medial meniscus was injured 1 to 2 mm in 12.5% of specimens. The intermeniscal ligament was injured 1 to 2 mm in 81.2% of the specimens. The intermeniscal ligament and medial meniscus are at the most risk during intramedullary nailing of the tibia using the retropatellar technique. This may be corrected by avoiding an excessively medial start point. Damage to the intermeniscal ligament and medial meniscus occurs more commonly with the retropatellar portal, but this damage was never more than 1 to 2 mm. This risk, however, appears similar to the pattern and incidence of injury that occurred in prior studies investigating tibial nail insertion through a standard patellar tendon approach. The retropatellar technique demands clinical investigation to further define both its safety and its use.

  8. Compression plating versus hackethal nailing in closed humeral shaft fractures failing nonoperative reduction.

    Science.gov (United States)

    Rodríguez-Merchán, E C

    1995-06-01

    Prospectively, 40 patients with an average age of 45 (20-65) with closed transverse fractures of the middle one-third of the humerus without associated radial nerve palsy were treated. All had failed nonoperative reduction and were then operated on with either compression plating or intramedullary fixation with Hackethal nails and a postoperative ready-made fracture brace. These surgeries were performed at an average of 7 days (4-10) after closed reduction. The Hackethal nailing group consisted of 20 patients (17 men, 3 women) with a mean age of 47 years (22-64); within 2 days after surgery the patients were allowed to begin active and passive range-of-motion exercises of the elbow and the shoulder with the arm protected by a ready-made fracture brace; the average follow-up period for this group was 18 months (12-50). These patients (with one exception) required a second surgical procedure with a second anesthesia to remove the symptomatic nails; moreover, they had to be protected in a brace for 6 months. The compression plate group consisted of 20 patients (14 men, 6 women) with a mean age of 45 years (20-65); within 2 days after surgery the patient was allowed to begin the same rehabilitation program; in this group no braces were used postoperatively. All fractures treated with Hackethal nailing healed except for one delayed union. Functional results in this group were 12 excellent, 4 good, 1 fair, and 3 poor. All fractures treated by compression plating healed except in one case of delayed union.(ABSTRACT TRUNCATED AT 250 WORDS)

  9. Comparative anatomy of mouse and human nail units.

    Science.gov (United States)

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

    2013-03-01

    Recent studies of mice with hair defects have resulted in major contributions to the understanding of hair disorders. To use mouse models as a tool to study nail diseases, a basic understanding of the similarities and differences between the human and mouse nail unit is required. In this study we compare the human and mouse nail unit at the macroscopic and microscopic level and use immunohistochemistry to determine the keratin expression patterns in the mouse nail unit. Both species have a proximal nail fold, cuticle, nail matrix, nail bed, nail plate, and hyponychium. Distinguishing features are the shape of the nail and the presence of an extended hyponychium in the mouse. Expression patterns of most keratins are similar. These findings indicate that the mouse nail unit shares major characteristics with the human nail unit and overall represents a very similar structure, useful for the investigation of nail diseases and nail biology. Copyright © 2013 Wiley Periodicals, Inc.

  10. Nail beauty therapy: an attractive enhancement or a potential hazard?

    Science.gov (United States)

    Baran, Robert

    2002-01-01

    Nail coatings which harden upon evaporation and coatings that polymerize may produce some reactions at the site of application to the nail itself, and distant reactions when small amounts of nail cosmetics are transferred by the hand to other areas of the skin. Nail cosmetic hazards may be occupational, or accidental, especially in children. Individuals wearing artificial nails tend to wear their nails longer, and are more careful about their nails when washing their hands. The sanitary conditions for the application of artificial nails are therefore paramount in preventing nail infections.

  11. THE AFRICAN ELEPHANTS' TOE NAILS

    African Journals Online (AJOL)

    L.A

    Loxodonta africana Blumenbach, 1797 to test the contention that the savanna elephant. L. africana has four toe nails on the front foot and three on the hind, which differentiates it from the forest elephant L. cyclotis Matschie, 1900, which has five on the front foot and four on the hind (Frade, 1931). Smithers (1983) was among ...

  12. Onycholysis induced by nail hardener.

    Science.gov (United States)

    Helsing, Per; Austad, Joar; Talberg, Hans Jørgen

    2007-10-01

    Nail hardeners appeared in the market during the 1960s. They were basically solutions of formaldehyde. The first adverse effects were published in 1966 (1). Reactions were onycholysis, chromonychia, subungual haemorrhage, and hyperkeratosis. Onycholysis may be non-inflammatory or inflammatory, and is accompanied by throbbing pain. Inflammatory reactions are followed by paronychia and occasional dermatitis on the digital pulpa.

  13. 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.

  14. Neuroglial intramedullary tumors: The collaboration between neurosurgeons and neuropathologists.

    Science.gov (United States)

    Cossu, G; Lacroix, C; Adams, C; Daniel, R T; Parker, F; Messerer, M

    2017-11-01

    Intramedullary tumors constitute approximately 5% of spinal tumors and about 80% are of neuroglial origin. We reviewed our series of adult patients with spinal neuroglial intramedullary tumors operated on between 1984 and 2011 at the neurosurgical department of Bicêtre hospital. The histopathological records for 196 patients were retrospectively analyzed. The majority of tumors were ependymomas (68%) and astrocytomas (27.5%). The importance of a proper and detailed neuropathological diagnosis is the key to define patient management. The available literature data about the genetic profiles of these rare tumors are summarized and reviewed. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  15. Pigmented lesions of the nail bed - clinical assessment and biopsy

    National Research Council Canada - National Science Library

    Rtshiladze, Michael Alexander; Stretch, Jonathan Raymond; Stewart, David Alexander; Saw, Robyn PM

    2016-01-01

    .... We describe the anatomy of the nail bed to offer a rationale for our technique of nail bed biopsy, and warn of the potential to cause permanent nail dystrophy through other approaches. Discussion...

  16. [Black nails caused by Proteus mirabilis].

    Science.gov (United States)

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

    2001-07-01

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

  17. Effectiveness of Hindfoot Arthrodesis by Stable Internal Fixation in Various Eichenholtz Stages of Neuropathic Ankle Arthropathy.

    Science.gov (United States)

    Sundararajan, Silvampatty R; Srikanth, Kanchana P; Nagaraja, Handenahally S; Rajasekaran, Shanmuganathan

    The optimal time to treat neuropathic (Charcot) arthropathy of the ankle and peritalar joint is controversial because of the various treatment options available and the variable results reported in published studies. We sought to determine the outcome of hind foot arthrodesis with stable internal fixation in patients with different Eichenholtz stages of arthropathy. We prospectively studied patients with substantial disabilities caused by neuropathic arthropathy in deformed, unstable ankle and peritalar joints, with or without ulcerations, who had undergone treatment from July 2007 to December 2012. All patients underwent ankle arthrodesis, autologous iliac crest bone grafting, and subtalar joint arthrodesis, with or without talonavicular joint arthrodesis, fixed internally with an intramedullary hindfoot nail, with or without an additional plate or cancellous screws. Of the 33 enrolled patients, 9 (27.3%) had stage I, 13 (39.4%) had stage II, and 11 (33.3%) had stage III Charcot arthropathy. The cause of arthropathy was diabetes mellitus in 25 (75.8%) patients. The duration of symptoms ranged from 1 to 120 (median 7) months. The mean follow-up period was 40 (range 12 to 76) months and did not differ markedly among the groups. The hindfoot scores, rate of salvage or amputation, or complication rates did not differ significantly across Eichenholtz stage. For the patients with stage I, II, and III, the preoperative hindfoot score was 50, 49, and 48, respectively (p = .9). The corresponding postoperative scores were 68, 68, and 70 (p = .5). We found no evidence that the effectiveness of hindfoot arthrodesis by stable fixation varied across the Eichenholtz stage of Charcot arthropathy involving ankle and peritalar joint. Furthermore, we found that stable internal fixation and bone grafting using a hindfoot nail results in an 84.84% union rate and salvages the unstable and disabled foot in 90.9% of patients with ankle and peritalar Charcot arthropathy. Copyright

  18. A Clinical Study of 35 Cases of Pincer Nails

    OpenAIRE

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

    2011-01-01

    Background Pincer nail is a nail deformity characterized by transverse overcurvature of the nail plate. Pincer nail can affect a patient's quality of life due to its chronic, recurrent course; however, there have been no clinical studies on the pincer nail condition in Korean patients. Objective The purpose of this study was to characterize the clinical findings and treatment of pincer nail. In addition, possible etiological factors were considered, and treatment efficacy was evaluated. Metho...

  19. Efficacy of Nail Brace Treatment For Ingrown Na

    OpenAIRE

    Fatma Gülru Erdoğan; Münevver Güven; Atilla Halil Elhan

    2010-01-01

    Background and Design: Ingrown nail is a common, painful health problem. Various conservative and surgical methods have been defined for treatment of ingrown nails. In this study we aimed to evaluate the efficacy of nail brace treatment which is a cheap conservative treatment, recurrence percentages after nail brace treatment and risk factors for recurrence. Material and Method: Thirty-two female and 19 male patients with the complaint of ingrown nail aged 14-73 with a total of 73 nails are i...

  20. The Photodynamic Bone Stabilization System: a minimally invasive, percutaneous intramedullary polymeric osteosynthesis for simple and complex long bone fractures

    Directory of Open Access Journals (Sweden)

    Vegt P

    2014-12-01

    Full Text Available Paul Vegt,1 Jeffrey M Muir,2 Jon E Block2 1Department of Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands; 2The Jon Block Group, San Francisco, CA, USA Abstract: The treatment of osteoporotic long bone fractures is difficult due to diminished bone density and compromised biomechanical integrity. The majority of osteoporotic long bone fractures occur in the metaphyseal region, which poses additional problems for surgical repair due to increased intramedullary volume. Treatment with internal fixation using intramedullary nails or plating is associated with poor clinical outcomes in this patient population. Subsequent fractures and complications such as screw pull-out necessitate additional interventions, prolonging recovery and increasing health care costs. The Photodynamic Bone Stabilization System (PBSS is a minimally invasive surgical technique that allows clinicians to repair bone fractures using a light-curable polymer contained within an inflatable balloon catheter, offering a new treatment option for osteoporotic long bone fractures. The unique polymer compound and catheter application provides a customizable solution for long bone fractures that produces internal stability while maintaining bone length, rotational alignment, and postsurgical mobility. The PBSS has been utilized in a case series of 41 fractures in 33 patients suffering osteoporotic long bone fractures. The initial results indicate that the use of the light-cured polymeric rod for this patient population provides excellent fixation and stability in compromised bone, with a superior complication profile. This paper describes the clinical uses, procedural details, indications for use, and the initial clinical findings of the PBSS. Keywords: osteoporosis, long bone fracture, bone density, polymeric rod, orthopaedics, surgery

  1. Primary Spinal Intramedullary Neurocysticercosis: A Report of 3 Cases.

    Science.gov (United States)

    Datta, Subramanya G S; Mehta, Ritu; Macha, Shrikant; Tripathi, Sanjog

    2017-09-01

    We describe a series of 3 cases of the rare intramedullary form of primary spinal neurocysticercosis. The cases were seen in varied age groups and showed different profiles at presentation. All the cases were thoroughly evaluated clinically and radiologically. Serologic tests were not conducted. In all cases, magnetic resonance imaging showed a large intramedullary lesion in the thoracic spinal cord consisting of a cystic lesion with a well-defined intramural nodule. One case was managed with steroids and cysticidal therapy, a second case was managed with steroids and surgery (2 emergency procedures), while the third case was managed without any medical or surgical intervention, as the patient was unwilling for either. All cases showed good neurologic recovery. In the second case where surgery was done, histologic examination of the resected specimen demonstrated the cysticercal parasite surrounded by mixed inflammatory infiltrate. As there were no intracranial lesions in all 3 cases, the final diagnosis was primary isolated intramedullary neurocysticercosis. Primary isolated intramedullary-neurocysticercosis remains a rare condition afflicting the spinal cord. It forms a small subset of cysticercal infestation of the neuraxis. Such evidence is rare, and only anecdotal reports are available. Our case series captures the wide spectrum of presentations, as well as the management options, and highlights the varied ways in which these cases were managed. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Intramedullary fixation of boxer's fractures: evaluation of functional ...

    African Journals Online (AJOL)

    Introduction: The majority of the fifth metacarpal neck fractures can be treated conservatively. Nevertheless, surgical treatment is justified in certain cases. This retrospective study was designed to evaluate the clinical results of intramedullary Kirschner-wire fixation of these fractures. Material and methods: Between May 2005 ...

  3. Intramedullary spinal epidermoid presenting after thoracic meningocele repair: case report.

    Science.gov (United States)

    Grobelny, Bartosz T; Weiner, Howard L; Harter, David H

    2015-06-01

    A 4-year-old girl with a history of thoracic meningocele repair at the age of 3 months presented with progressive myelopathy. An intramedullary thoracic epidermoid was identified on MRI. The patient underwent excision of the epidermoid and subsequently returned to neurological baseline. This case illustrates the potential for delayed development of intraspinal epidermoid after initial repair of a simple meningocele.

  4. Intramedullary cavernous haemangioma of spinal cord: A case ...

    African Journals Online (AJOL)

    Thoracic myelography done showed bilateral symmetrical funnelling of the contrast at the level of T5 with widening of the spinal cord, which are typical characteristics of an intramedullary mass of spinal cord. T2-T6 Laminectomy was done. Near total excision of a 4 by 2.5 cm intradural, intramedulary bluish black, necrotic, ...

  5. [Centro-medullary nailing in the complex fractures of the upper end of the humerus: preliminary results in 6 cases].

    Science.gov (United States)

    Jamal, Louaste; Cherrad, Taoufik; Bousbaa, Hicham; Wahidi, Mohammed; Amhajji, Larbi; Rachid, Khalid

    2016-01-01

    Antegrade intramedullary nailing has become the gold standard to treat two-, three-, and four-part cephalo-tuberosity fractures. We report a retrospective study of 6 patients who have undergone centro-medullary nailing since January 2012. Mean follow-up was 12 months; the average age was 57 years. Clinical evaluation was based on gross and weighted Constant and Murley score, based on the age and sex, compared to the "normal" body surface area. Radiological assessment allowed us to evaluate bone healing, the occurrence of osteonecrosis of femoral head or of post-traumatic arthrosis. Radiological examination focused even on the state of the tuberosities and on the existence or not of osteolysis of the greater tubercle of the humerus. It was also used to identify the criteria for good reduction, namely cephalic cap angle and diaphyseal axis (αF) in face views. All patients underwent the same surgical procedure. Constant and Murley score for all patients was 64.13 points. Weighted score based on age and sex was 73%. Joint mobility was estimated at an average of 116° for all patients in anterior elevation, 99.9° in lateral elevation, and 42° in external rotation. Average αF angle was 42°. All patients met criteria for good reduction, namely αF. Centro-medullary nailing allows simple and cost-effective bone synthesis with very promising functional results. Comminuted fractures and osteoporosis may limit these indications.

  6. Nail tic disorders: Manifestations, pathogenesis and management

    Directory of Open Access Journals (Sweden)

    Archana Singal

    2017-01-01

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

  7. Dermoscopy of non-skin cancer nail disorders.

    Science.gov (United States)

    Piraccini, Bianca Maria; Bruni, Francesca; Starace, Michela

    2012-01-01

    Nail dermoscopy is becoming more and more frequently utilized for the diagnosis of nail disorders. It can be performed with handy dermoscope or with a video dermoscope, which allows magnifications of up to 200. Nail dermoscopy requires a good knowledge of nail anatomy and physiology and the pathogenesis of nail diseases: we have to know which part of the nail we have to look at! The nail is in fact not visible as a whole at one time, but its different parts should be observed, moving the lens back and forth and transversally. All nail disorders can be observed by dermoscopy. However, except for some diseases in which the technique really adds a lot to clinical examination, in most of the cases, nail dermoscopy only permits a better visualization of symptoms already evident to the naked eye. Dermoscopic features of nail signs are always very interesting and surprising, and may help in our understanding of nails. © 2012 Wiley Periodicals, Inc.

  8. Spinal intramedullary cavernomas. Personal experience reffering to six cases

    Directory of Open Access Journals (Sweden)

    Iacob G.

    2014-12-01

    Full Text Available Despite cavernous malformations of the CNS are pathologically similar, intramedullary cavernous malformations are very rare lesions, increasingly recognized after introduction of magnetic resonance image, generating gradual neurological decline, with severe deficits or acute loss of spinal function. We report our experience on six patients with intramedullary cavernomas defining the spectrum of presenting symptoms and signs analyzing the role of surgery as a treatment for these lesions. We present our experience with 2 cervical and 4 thoracal spinal intramedullary cavernoma from 2010 to 2014 searching history, onset of clinical manifestation, neurological status, radiological findings, operation, and clinical outcome. Among 6 patients male were 2 cases; female 4 cases; mean age was 42 years (range 25-72 years; mean duration of symptoms were 1,5 years (range 5 days and 2 years with slowly progressive neurological decline. In two cases there was acute onset of neurological compromise. In all cases diagnosis was made on MRI and lesions were possible to be radically excised and gently extracted from the hemosiderin-stained bed inside of the spinal cord via a laminectomy and midline myelotomy with microsurgical techniques. The surgical outcome on a mean duration of follow up of 12 months were: for 4 cases - the patients neurological conditions remarkably improved 1 month later, for 2 cases no improvement were remarked. No recurrent hemorrhages were recorded. A follow-up MRI examination was made in all cases to confirm complete removal of the cavernous angioma. Spinal intramedullary cavernoma should be early recognized by MRI, can be positioned in a precarious position and generate significant neurologic deficits than cranial cavernomas. For symptomatic intramedullary cavernous malformations extended to the dorsal surface of the spinal cord, total resection with microsurgical techniques can offer good or excellent outcome, restoring neurological

  9. 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

  10. Nail Psoriasis, the unknown burden of disease

    NARCIS (Netherlands)

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

    2014-01-01

    BACKGROUND: Psoriasis can be found at several different localizations which may be of various impact on patients' quality of life (QoL). One of the easy visible, and difficult to conceal localizations are the nails. OBJECTIVE: To achieve more insight into the QoL of psoriatic patients with nail

  11. 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.

  12. Nail disorders in infants and children.

    Science.gov (United States)

    Piraccini, Bianca Maria; Starace, Michela

    2014-08-01

    Nail diseases in infants and children are an uncommon cause of consultation and are often difficult to diagnose and to manage. This review will cover nail diseases that are most commonly seen in clinical practice, including congenital and hereditary disorders and inflammatory, infective, and neoplastic nail diseases. The purpose of the review is to help the reader to recognize nail disorders at an early age and to manage them appropriately. Two recent large studies have reported the clinical findings of genetic disorders involving the nails, that is, pachyonychia congenita and epidermolysis bullosa. Only a few articles gave a comprehensive review of a disease, as occurred for onychomycosis, while the majority of the reports published in the recent literature involve single cases. Nail diseases in children and neonates are not easy to diagnose by nonexperts. Basic knowledge of the anatomy and biology of the nail facilitates their diagnosis as the understanding of their pathophysiology. This review gives hints at the most common nail diseases that affect infants and children.

  13. Cerebral damage caused by nail gun injury

    DEFF Research Database (Denmark)

    Andersen, Chris

    2016-01-01

    . The forensic examination showed lesions of intracranial surgery and minor bruises on the arms. No sign of defense injuries was found. There were no signs of malfunction of the nail gun-wielding robot. On the side of the machine, there were a handheld nail gun and the police investigated the case as a possible...

  14. Contact Sensitization to Allergens in Nail Cosmetics.

    Science.gov (United States)

    Chou, Margaret; Dhingra, Nikhil; Strugar, Tamara Lazic

    Ingredients found in the nail cosmetic industry, including but not limited to methacrylate and acrylate monomers, formaldehyde, and toluene sulfonamide-formaldehyde resin, can incite allergic contact dermatitis. An eczematous outbreak presents on areas surrounding the nail plate and may spread through contact transfer of the allergen, commonly to the face and neck. Even components that were originally deemed nonsensitizing, such as the ubiquitous cyanoacrylate adhesive family, have been found to be allergenic. They do not, however, cross-react with methacrylates and acrylates. Alternative options for individuals with allergic contact dermatitis reactions to these ingredients can be avoidance of these procedures or use of products that are "3, 4, 5 free" in which the common allergens dibutyl phthalate, toluene, and formaldehyde are absent. In cases where strengthening of the nail is the sole purpose, nail wraps or preformed nails can be applied for non-cyanoacrylate-sensitive individuals.

  15. 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.

  16. Penetrating cranial nail injury an unusual domestic assault: Case ...

    African Journals Online (AJOL)

    A rare case of intracranial nail injury caused by domestic violence is presented. The 35-year old female patient was found unconscious with a 12cm nail almost completely buried into her skull. Xray of the skull showed the nail in the cranial cavity. A burr hole was made and the nail removed. Immediate post-operative period ...

  17. Severe Onychodystrophy due to Allergic Contact Dermatitis from Acrylic Nails.

    Science.gov (United States)

    Mattos Simoes Mendonca, Marcela; LaSenna, Charlotte; Tosti, Antonella

    2015-09-01

    Acrylic nails, including sculptured nails and the new ultraviolet-curable gel polish lacquers, have been associated with allergic contact dermatitis (ACD). We report 2 cases of ACD to acrylic nails with severe onychodystrophy and psoriasiform changes including onycholysis and subungual hyperkeratosis. In both cases, the patients did not realize the association between the use of acrylate-based manicures and nail changes. One patient had been previously misdiagnosed and treated unsuccessfully for nail psoriasis. The informed clinician should elicit a history of acrylic manicure in patients with these nail changes, especially in cases of suspected nail psoriasis refractory to treatment. Patch testing is a useful tool in confirming diagnosis.

  18. [Influence of nail polish on pulse oximeter readings of oxygen saturation: a systematic review].

    Science.gov (United States)

    Ballesteros-Peña, Sendoa; Fernández-Aedo, Irrintzi; Picón, Artzai; Lorrio-Palomino, Sergio

    2015-10-01

    Nail polish has traditionally been assumed to absorb light emitted by pulse oximeters and to interfere with the detection and measurement of oxygenated hemoglobin. In a systematic review of the literature we aimed to assess the influence of nail polish on the measurement of oxygen saturation by pulse oximetry (SpO2). A search protocol for online databases (MEDLINE, Embase, Web of Science, Scopus, Cumulative Index to Nursing and Allied Health Literature, and IBECS [the Spanish health sciences index]) was established to find clinical trials or observational studies published between 1999 and February 2014. Twelve nonrandomized clinical trials were found. Ten were in healthy volunteers. One of the remaining 2 studies was in critical patients undergoing mechanical ventilation, and the other was in patients with stable chronic obstructive pulmonary disease. One study recreated the low oxygen level of high altitudes, while the others were done in normal atmospheric conditions. Differences between pulse oximeters and type of nail polish were found. Nail polish was associated with a statistically significant decrease in SpO2 for at least 1 color in all but 2 studies. However, the differences were within the standard error (±2.0%) of the pulse oximeters used. The authors of the studies all concluded that although nail polish might change SpO2 readings significantly, the variations are not clinically significant.

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

    OpenAIRE

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

    2013-01-01

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

  20. Ultrasound-mediated nail drug delivery system.

    Science.gov (United States)

    Abadi, Danielle; Zderic, Vesna

    2011-12-01

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

  1. [Predictive factors of spinal deformity following surgery for intramedullary tumors].

    Science.gov (United States)

    Knafo, S; Messerer, M; Court, C; Parker, F

    2017-11-01

    Spinal deformity following surgery for intramedullary tumors is a serious potential complication. The aim of the study was to identify potential predictive risk factors of spinal deformity after intramedullary tumor surgery. Retrospective study including patients harboring intramedullary tumors who underwent surgery in a single center (Hôpital Bicêtre, AP-HP, Paris) between 1985 and 2011. The main outcome was the difference at last follow-up between post- and preoperative measure of Cobb angles formed by the superior and inferior limits of the laminectomy (Δ_Cobb). Sixty-three patients included. Mean sagittal deformity was 15.9° (0°-77°) for a mean follow-up of 85 months (4-240). Univariate analysis of potential predictive factors showed an increased deformity for patients undergoing a 4-or-more levels laminectomy, (19.3° versus 12.1°; P=0.04), for patients aged less or equal to 30 years of age and when it included a junction (20.8° versus 12.4°; P=0.02). A neurological deficit, either pre- or postoperatively, was not associated with a greater deformity. Multivariate analysis showed that only age (P=0.01) and the number of spinal levels involved (P=0.014) were significant and independent predictors of postoperative deformity. This study indicates predictive factors of spinal deformity in any patient undergoing surgery for intramedullary tumors, allowing improvement in the planning of surgery and patients' follow-up. Copyright © 2016. Published by Elsevier Masson SAS.

  2. [Occupational asthma in a structure nail maker].

    Science.gov (United States)

    Hannu, Timo; Tuppurainen, Matti; Kauppi, Paula; Alanko, Kristina; Henriks-Eckerman, Maj-Len; Sauni, Riitta

    2009-01-01

    Chemicals that may cause allergy are being used in structure nails. In this case report two structure nail makers are described, who were diagnosed with occupational asthma in clinical studies. The studies included an inhalational exposure simulating the work. The causative agents of occupational asthma are apparently the acrylate compounds contained in the chemicals; use of these compounds has previously been linked with allergic contact dermatitis and asthma. Since the making of structure nails involves health risks, such work requires appropriate premises and personal protection.

  3. Aspergillus Sydowi Infection of Human Finger Nail

    Directory of Open Access Journals (Sweden)

    A K Barde

    1981-01-01

    Full Text Available A case of Aspergillus sydowi infection of left middle finger nail is described ′ The presence of fungal hypae with phialids and spores on direct microscopy as well as in culture, the colour of the sub-ungual mass of the nail resembling the colour of the fungus in, culture′ repeated isolations of A sydowi from the diseased tissue along with the absence of any established pathogenic species in the specimen are taken as evidences that this fungus was invading the nail tissue.

  4. Identification of ventrolateral intramedullary intervertebral disc herniation in a dog

    Directory of Open Access Journals (Sweden)

    Masato Kitagawa

    2012-09-01

    Full Text Available A 10-year-old male cross-breed dog was brought to Nihon University Animal Hospital with a history of acute onset of paralysis in the pelvic limbs 13 days previously. Magnetic resonance imaging revealed an intramedullary linear tract in the spinal cord at the thoracic vertebrae 12–13 region, which appeared hyperintense on T2-weighted images, but was hypointense and isointense on T1-weighted images when compared with normal parenchyma of the spinal cord. A hemilaminectomy was performed and a blob of what appeared to be fibrous tissue was found adhering to the surface of the dura mater. The diameter of the blob was about 4 mm. A durotomy was performed over the affected area and chondroid material was found within the spinal cord. Material from the nucleus pulposus penetrated the dura mater from the ventral aspect of the spinal cord in previously reported intramedullary intervertebral disc herniation cases, but, in this case, penetration occurred from the left ventrolateral aspect and progressed through to the right lateral aspect, forming a visible blob of what appeared to be fibrous tissue on the surface of the dura mater at the exit point. To the best of our knowledge, this was the first case report of an intramedullary intervertebral disc herniation originating from the ventrolateral aspect of the spinal cord in a dog.

  5. Surgical intervention for a pediatric isolated intramedullary spinal aneurysm.

    Science.gov (United States)

    Morozumi, Masayoshi; Imagama, Shiro; Ando, Kei; Kobayashi, Kazuyoshi; Hida, Tetsuro; Ito, Kenyu; Tsushima, Mikito; Matsumoto, Akiyuki; Tanaka, Satoshi; Machino, Masaaki; Ota, Kyotaro; Nishida, Yoshihiro; Ishiguro, Naoki

    2017-08-07

    To report the case of a pediatric patient with intramedullary spinal aneurysm. A 9-year-old boy presented with low back pain and subsequent gait disturbance. He had no history of trauma. After admission, MRI revealed an intramedullary spinal cord mass lesion surrounded by hemorrhage at the cervical-thoracic junction. Initial treatment was started with intravenous methylprednisolone and bed rest. Neurological deficit disappeared under careful observation for a few months. Surgical intervention was applied for diagnosis and resection of the mass lesion to prevent recurrent hemorrhage. Intraoperative ultrasound sonography helped to diagnose the lesion as a spinal cord aneurysm, prior to midline myelotomy. Monitoring of transcranial muscle evoked potentials helped to avoid spinal cord damage during surgery. There has been no evidence of spinal aneurysm on MRI for 3 years after surgery and no neurological deterioration. To our knowledge, this is a first report of an intramedullary spinal cord aneurysm at the cervical-thoracic junction in a pediatric patient. Careful observation after initial symptoms followed by surgical intervention was favorable in this case.

  6. Intramedullary wire fixation for unstable forearm fractures in children.

    Science.gov (United States)

    Altay, Murat; Aktekin, Cem Nuri; Ozkurt, Bülent; Birinci, Bariş; Ozturk, Akif Muhtar; Tabak, A Yalçin

    2006-10-01

    Displaced fractures of the diaphyseal forearm in children are often treated conservatively, but there is relatively high incidence of redisplacement, malunion and consequent limitation of function. This retrospective study was performed to determine means for minimalising the complications of intramedullary Kirschner (K)-wire fixation used in the treatment of unstable, diaphyseal forearm fractures by pointing out those which most frequently occur with this treatment choice. This treatment method was applied in 48 children with a mean age of 10.3 (range, 5-14) years. A limited open reduction to one or both bones was necessary for insertion of the intramedullary wire in 20 (40%) patients. Although 24 complications, such as pin site infection, loss of forearm rotation, superficial branch of radial nerve palsy, delayed union, nonunion, hardware migration, and K-wire penetration to the opposite cortex, were recorded in 18 patients, 46 patients (96%) had excellent or good, 1 patient (2%) had fair and 1 patient (2%) had poor outcome using the grading scheme adapted by Price. Except for the patient in whom the fracture was not united, the average union time was 6.3 weeks in children less than 10 years and 7.8 weeks in those above 10 years of age. Despite these minor complications, percutaneous intramedullary fixation with K-wires and proper technique is an appropriate, effective and safe operation for unstable diaphyseal fractures of the forearm in children who cannot be treated by closed manipulation.

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

    Science.gov (United States)

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

    2013-12-01

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

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

    Science.gov (United States)

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

    2016-12-01

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

  9. How to Stop Biting Your Nails

    Medline Plus

    Full Text Available ... Drug pricing and availability CVS dermatologic formulary restrictions Access to compounded medications Skin cancer and indoor tanning ... Diseases: A-Z index Skin, hair, and nail care Skin care Hair care / hair loss Injured skin ...

  10. How to Stop Biting Your Nails

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    Full Text Available ... Housing & travel Education Exhibit hall Mobile app 2018 Summer Meeting Legislative Conference Agenda Speakers Meet with your ... about your skin, hair, and nails Skin dictionary Camp Discovery Good Skin Knowledge lesson plans and activities ...

  11. 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.

  12. How to Stop Biting Your Nails

    Medline Plus

    Full Text Available ... guidelines Quality measures DataDerm Awards, grants, and scholarships Question of the Week Meetings and events 2018 Annual ... head About nails: More important than you think Questions lots of kids ask about their skin, hair, ...

  13. How to Stop Biting Your Nails

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    Full Text Available ... Not just on your head About nails: More important than you think Questions lots of kids ask ... 0; c Explore AAD Member resources Practice Tools Education Meetings & events Advocacy Public & patients AAD Resources For: ...

  14. How to Stop Biting Your Nails

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    Full Text Available ... the Week Meetings and events 2018 Annual Meeting Registration General information Housing & travel Education Exhibit hall Mobile ... your fingers and from your nails to your face and mouth. To help you stop biting your ...

  15. How to Stop Biting Your Nails

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    Full Text Available ... a dermatologist Why see a board-certified dermatologist? Home Public and patients Skin, hair, and nail care ... certified dermatologist . Explore AAD Member resources Practice Tools Education Meetings & events Advocacy Public & patients AAD Resources For: ...

  16. How to Stop Biting Your Nails

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    Full Text Available ... Camp Discovery Good Skin Knowledge lesson plans and activities Video library Find a dermatologist Why see a board-certified dermatologist? Home Public and patients Skin, hair, and nail care ...

  17. How to Stop Biting Your Nails

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    Full Text Available ... Bumps and growths Color problems Contagious skin diseases Cosmetic treatments Dry / sweaty skin Eczema / dermatitis Hair and ... and the side effects can be more than cosmetic. Repeated nail biting can make the skin around ...

  18. How to Stop Biting Your Nails

    Medline Plus

    Full Text Available ... Spending money to keep your nails looking attractive may make you less likely to bite them. Alternatively, ... Just knowing when you’re inclined to bite may help solve the problem. Try to gradually stop ...

  19. Yellow nail syndrome: a rarity in Indians?

    Science.gov (United States)

    Nair, V K; Sukumaran, P

    1996-01-01

    Reports of yellow nail syndrome have been few and far between. The classical triad of the syndrome has not been reported in Indian literature. We report a case of yellow nail syndrome in a forty-year-old male, who had yellowish-brown nails from birth. He developed lymphoedema of the legs at the age of twenty years and presented with pleural effusion at the age of forty years. Although a case of yellow nail syndrome has been reported from India, the classical triad of the syndrome is yet to be documented from our country. The condition may be missed because of the long time difference in presentation of different components of the syndrome and also because of the dark skin colour of Indians.

  20. 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 Video ... a dermatologist Why see a board-certified dermatologist? Home Public and patients Skin, hair, and nail care ...

  1. 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 ...

  2. How to Stop Biting Your Nails

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    Full Text Available ... likely to bite them. Alternatively, you can also cover your nails with tape or stickers or wear ... certified dermatologist . Explore AAD Member resources Practice Tools Education Meetings & events Advocacy Public & patients AAD Resources For: ...

  3. How to Stop Biting Your Nails

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    Full Text Available ... document.write(""); document.write(" Cart "); } else { document.write(" Sign in Cart "); } })(); AAD American Academy of Dermatology Excellence ... For some people, nail biting may be a sign of a more serious psychological or emotional problem. ...

  4. How to Stop Biting Your Nails

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    Full Text Available ... Nail biting typically begins in childhood and can continue through adulthood, and the side effects can be ... certified dermatologist . Explore AAD Member resources Practice Tools Education Meetings & events Advocacy Public & patients AAD Resources For: ...

  5. How to Stop Biting Your Nails

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    Full Text Available ... Conference Agenda Speakers Meet with your congressional district office Invite elected officials to your practice Life After ... a dermatologist Why see a board-certified dermatologist? Home Public and patients Skin, hair, and nail care ...

  6. Nails

    Science.gov (United States)

    ... benefits Become a member DermCare Team Professionalism and ethics My account Member directory Publications JAAD JAAD Case ... SkinPAC State societies Scope of practice Truth in advertising Public and patients SPOT Skin Cancer™ Community programs & ...

  7. 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.

  8. Controversies in the Treatment of Ingrown Nails

    OpenAIRE

    Eckart Haneke

    2012-01-01

    Ingrown toenails are one of the most frequent nail disorders of young persons. They may negatively influence daily activities, cause discomfort and pain. Since more than 1000 years, many different treatments have been proposed. Today, conservative and surgical methods are available, which, when carried out with expertise, are able to cure the disease. Packing, taping, gutter treatment, and nail braces are options for relatively mild cases whereas surgery is exclusively done by physicians. Phe...

  9. 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

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

    Science.gov (United States)

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

    2011-10-01

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

  11. Accelerated nail growth rate in HIV patients.

    Science.gov (United States)

    Sánchez-Moreno, Elisa C; Marioni-Manriquez, Selina; Fernández-Martínez, Ramón F; Moreno-Coutiño, Gabriela

    2017-05-01

    Many factors have been noted to alter the growth rate of both finger and toe nails, some with harder evidence than others. Infectious diseases are among the ones reported as slowing the growth rate. However, on previous studies we noticed that patients living with HIV and onychomycosis could be cured without the use of antifungal therapy, only with the immunological improvement provided by the combined antiretroviral therapy, and we wanted to prove that the growth rate is also increased in this group and thus probably contributes to the cure of onychomycosis. This was an observational, descriptive, and prospective study. We marked with a scalpel the nail plate of the first finger of the non-dominant hand and the same foot, and measured the nail growth in the subsequent medical appointments with a magnifying glass and a millimetric scale. Thirteen patients completed the study, and were paired with healthy controls by age and gender. After performing Mann-Whitney U test, our results showed statistical significance among both groups, showing that patients with HIV have faster nail growth rates than those in the HIV negative group. There is little data on HIV nail growth rate to compare our results, but what we see in the clinical practice is that this group of patients shows a faster nail growth rate, as has also been reported for longer eyelashes, and this could be an important factor in the cure rates of onychomycosis. © 2017 The International Society of Dermatology.

  12. Lateral drug diffusion in human nails.

    Science.gov (United States)

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

    2014-12-01

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

  13. 3D Computer graphical anatomy study of the femur: a basis for a new nail design.

    Science.gov (United States)

    Schmutz, Beat; Kmiec, Stanley; Wullschleger, Martin E; Altmann, Martin; Schuetz, Michael

    2017-03-01

    Current intramedullary nails with a radius of curvature (ROC) of 1500-2000 mm sometimes cause distal anterior cortical encroachment. Furthermore, clinical data indicate that the proximal nail end is too long for some Asian patients. The objective of our study was to develop a comprehensive 3D measurement protocol that measures both the anatomy of the canal and the proximal region. The protocol was used to obtain measurements from Caucasian and Asian (Japanese and Thai) specimens. A total of 90 3D bone models representative of hip fracture patients were reconstructed from CT data. RapidForm 2006 was used to generate the reference geometries required for determining radius and angulation of shaft antecurvature as well as measurements of the proximal anatomy. Multiple linear regression analyses were used to determine the relative contribution of height, age, ethnicity, gender, and body side on the total variance. The mean ROC in the natural 3D antecurvature plane was 885 mm overall, 974 mm in Caucasians and 787 mm in Asians. Height, age, ethnicity, gender, and body side significantly predicted ROC (R = 0.53, p = 0.000). The mean values of anteversion measurements for Asians (Japanese: 22.1°; Thai: 22.7°) were significantly larger than those of the Caucasians (14.5°; p = 0.001). There was virtually no difference (p = 0.186) between the measurements pertaining to the length of the proximal nail end between Caucasian and Asian samples. There was no significant difference between the mean neck-to-shaft angles (Caucasian: 126°; Japanese: 128.2°; Thai: 125.7°; p = 0.198 for Asians vs Caucasians). The developed comprehensive anatomical 3D measurement protocol could serve as standardised approach for anthropometric studies in the future. Our data suggest that the ROC of current nail designs should be reduced from between 1500 and 2000 to 1000 mm to achieve an improved fit for the investigated population.

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

    Science.gov (United States)

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

    2004-03-01

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

  15. Evaluation of nail lines: Color and shape hold clues.

    Science.gov (United States)

    Lipner, Shari R; Scher, Richard K

    2016-05-01

    Nail lines are a common presenting finding. A thorough inspection of the fingernails and toenails is an integral part of the complete physical examination. An understanding of basic nail anatomy and familiarity with several basic types of nail line enable the clinician to diagnose and treat nail disorders and to recognize underlying systemic diseases, as each type of nail line has a particular differential diagnosis. The authors review leukonychia striata (white lines), longitudinal melanonychia (brown-black lines), longitudinal erythronychia (red lines), and nail-plate grooves (Beau lines). Copyright © 2016 Cleveland Clinic.

  16. Complications of the Bailey-Dubow elongating nail in osteogenesis imperfecta: 34 children with 110 nails

    NARCIS (Netherlands)

    Janus, G. J.; Vanpaemel, L. A.; Engelbert, R. H.; Pruijs, H. E.

    1999-01-01

    The Bailey-Dubow nail, inserted in the femur or tibia of 34 children with osteogenesis imperfecta (OI), was studied retrospectively. Comparing the various groups of OI, no significant difference was found. Location of the nail (tibia or femur) did not influence the complication rate significantly.

  17. Is minimally invasive application by intramedullary osteosynthesis in comparison with volar plating real benefit in the treatment of distal radius fractures?

    Directory of Open Access Journals (Sweden)

    Martin Vlček

    2014-05-01

    Full Text Available Purpose of the study: Can minimally invasive intramedullary osteosynthesis of distal radius fractures provide better therapeutic results than multidirectional locking plates. Retrospective study of 68 patients operated for distal radius fractures, 18 were treated with intramedullary X-screw (XSCR fixation and 50 with the multidirectional angle-stable plate system (APTUS. The evaluation at 1-year follow-up included functional status of the wrist and hand, and radiographic findings. In the XSCR group, the functional outcomes of the treated extremity did not achieve values comparable with those of the uninjured side in any of the parameters measured. The radiographic findings did not meet the requirements of successful healing due to failure to restore an anatomical volar tilt in 22.2% cases. In the APTUS group, comparable values of the injured and the uninjured side were achieved in radial deviation, ulnar deviation, pronation, supination and grip strength. The radiographic criteria of successful healing were met by all fractures treated by locking plate osteosynthesis. Implant migration associated with secondary displacement of bone fragments was recorded in 33.3 % of the XSCR patients and only in 4.0 % of the APTUS patients. The overall evaluation show that intramedullary osteosynthesis does not produce better treatment outcomes compared with plate osteosynthesis in indicated types of fractures.

  18. A novel intramedullary nail for use in the treatment of supramalleolar malunion and nonunion: A preliminary report of three cases

    Directory of Open Access Journals (Sweden)

    Fatih Küçükdurmaz

    2016-10-01

    Conclusion: In our patient series, adequate fixation following correction of the deformity was seen. Although the number of the cases are limited this study provides encouraging results regarding the outcome of new IMN system in use of supramalleolar deformities.

  19. Yellow Nail Syndrome With Dramatic Improvement of Nail Manifestations After Endoscopic Sinus Surgery

    Directory of Open Access Journals (Sweden)

    Yu Hosokawa

    2017-07-01

    Full Text Available Objectives: Yellow nail syndrome (YNS is a rare disease of unknown cause characterized by the triad of yellow nails, respiratory manifestations, and lymphedema. Although several therapies for YNS have been reported, there is no common consensus in the treatment. In this case report, we present a case of 56-year-old woman with YNS, whose nail manifestation was dramatically improved after endoscopic sinus surgery for the treatment of chronic rhinosinusitis. Methods: Endoscopic sinus surgery involving middle meatal antrostomy was performed for the case of YNS with chronic rhinosinusitis and bronchiectasis resistant to antibacterial drugs. Results: A month after the surgery, the patient’s nails eventually showed dramatic improvement. Conclusions: Otorhinolaryngologists should recognize that chronic rhinosinusitis can be a symptom of YNS, and that the aggressive treatment including surgical approach for chronic rhinosinusitis may be a useful in the control of nail manifestation in YNS.

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

    Science.gov (United States)

    Haneke, E

    2014-04-01

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

  1. Efficacy of Nail Brace Treatment For Ingrown Na

    Directory of Open Access Journals (Sweden)

    Fatma Gülru Erdoğan

    2010-06-01

    Full Text Available Background and Design: Ingrown nail is a common, painful health problem. Various conservative and surgical methods have been defined for treatment of ingrown nails. In this study we aimed to evaluate the efficacy of nail brace treatment which is a cheap conservative treatment, recurrence percentages after nail brace treatment and risk factors for recurrence. Material and Method: Thirty-two female and 19 male patients with the complaint of ingrown nail aged 14-73 with a total of 73 nails are included to the study. Silver nitrate has been applied every 3-7 days to patients with granulation tissue. Nail brace application has been stopped in patients with granulation tissue once the granulation tissue has subsided and complaints have subsided, in patients without granulation tissue as their complaint was over during weekly controls in first month and monthly controls thereafter. Results: Ninety-eight point six percent of patients having ingrown nail (72/73 benefited from brace treatment. In 12 nails out of 71, recurrence has been established, in 59 nails follow-up without recurrence continues. Two nails have not been reached for followup after the first 3 month relief. Assessing patients treated with nail brace for recurrence, no significant difference was detected between recurrent and non-recurrent groups according to stage of ingrown nail, presence of granulation tissue, nail thickness, angle of nail curve, age, gender, presence of hyperhydrosis, duration of treatment and total force applied. Conclusion: Nail brace application has been found effective for pain relief and as treatment in patients with ingrown nails and no statistically significant predictive factor has been found in terms of recurrence after treatment

  2. Drug delivery to the nail following topical application.

    Science.gov (United States)

    Murdan, Sudaxshina

    2002-04-02

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

  3. A quantitative method for measuring forces applied by nail braces.

    Science.gov (United States)

    Erdogan, Fatma G

    2011-01-01

    Nail bracing is a conservative method used for ingrown nails; however, lack of objective measurements limits its use for various nails. Double-string nail braces with extra metal springs were applied to 12 patients with 21 chronic, thick, and overcurved ingrown nails. Force was measured with a force gauge meter. Treatment was stopped once patients stood on their tiptoes and walked in shoes pain free without braces. A force gauge meter was also used on a model nail to show the forces applied by various nail braces and to compare their pulling forces. After 6 to 10 months of treatment, all of the patients were pain free; 600 to 1,000 centi Newtons of force were applied to the nails. As the width of the nail increased, so did the force. Braces exert more force on larger nails, which may shorten treatment durations. By measuring forces, it may be possible to standardize force and duration of treatment according to variables such as nail thickness, nail width, angle of ingrown nail, and duration of symptoms.

  4. Current Management and Treatment Modalities for Intramedullary Spinal Cord Tumors.

    Science.gov (United States)

    Juthani, Rupa G; Bilsky, Mark H; Vogelbaum, Michael A

    2015-08-01

    Intramedullary spinal cord tumors are rare central nervous system tumors with unique challenges due to the eloquence of the surrounding tissue. Their treatment and prognosis is largely dependent on tumor histology and patient functionality. The introduction and advancement of microsurgical techniques have made surgery the mainstay of treatment for intramedullary tumors. Tumors that are well demarcated (e.g., ependymomas, hemangioblastomas) can be resected for cure, while more infiltrative tumors (e.g., high-grade astrocytomas) are typically managed with biopsies or limited resections in order to minimize the significant risk of damage to the spinal cord. The use of more aggressive surgical resection for astrocytoma is controversial but may have an increasing role in select cases. The use of intraoperative neurophysiologic monitoring and intraoperative ultrasound may help guide the extent of surgery while minimizing damage to normal tissue. Advances in MRI technology have greatly aided the diagnosis and preoperative planning of intramedullary tumors. Further advances in intraoperative MRI may make this a useful tool in guiding extent of resection. Preoperative functional status is the most important predictor of neurologic outcome, while histology and extent of resection are the most important predictors of progression-free survival. The use of adjuvant radiation and chemotherapy is dependent on patient age and histology but is largely reserved for high-grade tumor histologies or systemic involvement. Children are particularly at risk of radiation-induced injury, and these cases may benefit from more focused stereotactic radiation where necessary. Further studies are needed to support new surgical strategies minimizing destabilization and to investigate new forms of adjuvant therapy to minimize toxicity.

  5. Thoracic intramedullary epidermoid cyst-timely fashion diagnosis and treatment.

    Science.gov (United States)

    Babayev, Rasim; Abbasov, Bahadur; Ekşi, Murat Şakir

    2015-05-01

    Epidermoid cysts are composed of stratified squamous epithelium, which develop from inclusion of ectodermal tissue remnants entrapped during primitive neural tube closure period between the 3rd and 5th weeks of gestation. Intramedullary epidermoid cysts (IEC) are very rare in childhood. Eleven cases have been reported previously. Even though it is a rare entity, early diagnosis with timely fashioned surgical treatment has a great influence on patients' symptoms, especially if there are myelopathic findings. In this case report, we demonstrate this fact with a demonstrative clinical case and review radiological, pathological, and surgical perspectives with literature review.

  6. Managing Chemotherapy Side Effects: Skin and Nail Changes

    Science.gov (United States)

    N ational C ancer I nstitute Managing Chemotherapy Side Effects Skin and Nail Changes “I was glad to learn that most skin and nail problems go away after treatment. For now, my nurse told me about ...

  7. Efficacy of Nail Brace Treatment For Ingrown Na

    National Research Council Canada - National Science Library

    Fatma Gülru Erdoğan; Münevver Güven; Atilla Halil Elhan

    2010-01-01

    .... In this study we aimed to evaluate the efficacy of nail brace treatment which is a cheap conservative treatment, recurrence percentages after nail brace treatment and risk factors for recurrence...

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

    Science.gov (United States)

    Nieradko-Iwanicka, Barbara

    2017-01-01

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

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

    Science.gov (United States)

    ... activities, such as playing a musical instrument or chewing gum Apply a bitter tasting lacquer to nails to ... Nail tic disorders: Manifestations, pathogenesis and management. Indian Journal of Dermatology, Venereology and Leprology. 2017;83:19. ...

  10. Squamous cell carcinoma of the lateral nail fold.

    Science.gov (United States)

    Figus, A; Kanitkar, S; Elliot, D

    2006-04-01

    The digital nail complex is occasionally involved by squamous cell carcinoma. The published literature has either been indiscriminating of the site of origin of this tumour within the nail complex or has concentrated attention on the nail bed as the site of pathology. Tumours originating in the lateral nail fold can be clearly differentiated from those of the nail bed itself. This study identifies six cases of squamous cell carcinoma arising in the lateral nail fold. While surgical convention remains to amputate the digital tip for squamous cell carcinoma of any part of the nail complex, the dermatological literature identifies that local surgery can be curative for these tumours, when presenting early and without bone involvement, although offering no discussion of reconstruction. Reconstruction is desirable and methods of achieving this following local excision of lateral nail fold tumours are illustrated in this series.

  11. Comparative Anatomy of Mouse and Human Nail Units

    OpenAIRE

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

    2013-01-01

    Recent studies of mice with hair defects have resulted in major contributions to the understanding of hair disorders. To use mouse models as a tool to study nail diseases, a basic understanding of the similarities and differences between the human and mouse nail unit is required. In this study we compare the human and mouse nail unit at the macroscopic and microscopic level and use immunohistochemistry to determine the keratin expression patterns in the mouse nail unit. Both species have a pr...

  12. [Pincer nail. Conservative correction by attachment of a plastic brace].

    Science.gov (United States)

    Effendy, I; Ossowski, B; Happle, R

    1993-12-01

    In three women, pincer nail deformity of the big toes was successfully treated by means of commercially available plastic braces. The nail plate was first flattened with an electrically driven dermatological grinder, and pliant braces were then stuck transversely on the nail plate to counteract the overcurvature. Within 3-6 months the nail growth was normalized in two cases and almost completely normalized in the third.

  13. 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

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

    Science.gov (United States)

    Brückner, Michael; Unger, Martin; Spies, Markus

    2016-08-01

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

  15. 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.

  16. NAIL-PATELLA SYNDROME: A CASE REPORT | Wammanda ...

    African Journals Online (AJOL)

    An otherwise healthy 33 days old girl, displaying features of the Nail-Patella syndrome is reported. This rare autosomal dominant disorder is characterised by nail and bone abnormalities, with nail hypoplasia or dysplasia and absent or hypoplastic patella as essential features for the diagnosis. The patient had bilateral ...

  17. 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...

  18. Hendersonula Toruloidea Infection of Human Skin and Nails

    Directory of Open Access Journals (Sweden)

    S M Singh

    1980-01-01

    Full Text Available Four cases of skin and nail infection by Hendersonula toruloidea are described from India. Infections were confined to the feet which showed scaling and dystrophic nails. The presence of brown hyphae with knobbled swellings in the nail tissue and repeated isolation of H. toraloidea in pure culture are taken as evidence that this fungus was invading the tissues.

  19. Intramedullary spinal cord metastasis from colonic carcinoma presenting as Brown-Sequard syndrome: a case report

    LENUS (Irish Health Repository)

    Kaballo, Mohammed A

    2011-08-02

    Abstract Introduction Intramedullary spinal cord metastasis is very rare. The majority are discovered incidentally during autopsy. Most symptomatic patients present with rapidly progressive neurological deficits and require immediate examination. Few patients demonstrate features of Brown-Séquard syndrome. Radiotherapy is the gold-standard of therapy for Intramedullary spinal cord metastasis. The overall prognosis is poor and the mortality rate is very high. We present what is, to the best of our knowledge, the first case of Intramedullary spinal cord metastasis of colorectal carcinoma presenting as Brown-Séquard syndrome. Case presentation We present the case of a 71-year-old Caucasian man with colonic adenocarcinoma who developed Intramedullary spinal cord metastasis and showed features of Brown-Séquard syndrome, which is an uncommon presentation of Intramedullary spinal cord metastasis. Conclusion This patient had an Intramedullary spinal cord metastasis, a rare form of metastatic disease, secondary to colonic carcinoma. The metastasis manifested clinically as Brown-Séquard syndrome, itself a very uncommon condition. This syndrome is rarely caused by intramedullary tumors. This unique case has particular interest in medicine, especially for the specialties of medical, surgical and radiation oncology. We hope that it will add more information to the literature about these entities.

  20. [The value of electromyography in differentiating intramedullary tumor from inflammatory demyelinating disease of cervical region].

    Science.gov (United States)

    Wang, Hongfen; Chen, Zhaohui; Ling, Li; Shang, Aijia; Qiao, Guangyu; Cui, Fang; Yang, Fei; Huang, Xusheng

    2014-06-01

    To investigate the value of needle electromyography (EMG) in differentiating intramedullary tumor from inflammatory demyelinating disease of cervical region. Patients hospitalized in the Chinese PLA General Hospital from March 2008 to June 2013 with abnormalities on MRI of cervical vertebra and preliminary diagnosed as intramedullary tumor or inflammatory demyelinating disease of cervical region were enrolled in the study. Electrophysiological examination was performed before any treatment. Pathological findings were analyzed and prognosis was evaluated in all the subjects. A total of fifty-five patients were enrolled in the study with 33 cases of inflammatory demyelinating disease and 22 cases of intramedullary tumor defined by the postoperative pathological findings. In all the 33 cases with demyelinating disease, only one case (3.03%) presented as neurogenic damage by needle EMG. While in all the 22 cases with intramedullary tumor, needle EMG revealed neurogenic damage in 15 cases (68.18%) and the spinal segments of muscles with neurogenic damage were all within the spinal lesions demonstrated by MRI. The diagnostic sensitivity of EMG for intramedullary tumor was 68.18% and the diagnostic specificity was 96.97%, while the diagnostic sensitivity and specificity for intramedullary tumor by the medical history, symptoms and signs were 59.09% and 75.76% respectively. Needle EMG might play an important role in distinguishing intramedullary tumor from inflammatory demyelinating disease of cervical spinal cord.