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At least 37 records · Page 2Linked to original sources
PubMed2003

Nail-splinting technique for ingrown nails: the therapeutic effects and the proper removal time of the splint.

BACKGROUND: An ingrown nail is a common disorder that occurs most frequently in the great toe and causes much discomfort in patients. Although many therapeutic methods have been described, most of them can lead to severe damage to the nail or to frequent relapses. The nail-splinting technique is known to be a noninvasive therapeutic method for treating an ingrown nail. OBJECTIVE: Our purpose was to access the recurrence rate of the nail-splinting technique and to determine the proper removal time of the splint from the ingrown nail. METHODS: Fifty-seven patients with ingrown nail were treated with the nail-splinting technique. Subjects were randomized into two groups. For group 1 (28 patients), the splint was removed splint 3 days after treatment, whereas for group 2 (29 patients), the splint was removed splint 2 weeks after treatment. All patients underwent a follow-up examination at 1, 2, and 4 weeks after treatment and were evaluated for tissue status and level of pain. After 1 year, we evaluated the rate of recurrence by means of a telephone interview with each patient. RESULTS: A low recurrence rate (8.7%) for the nail-splinting technique was observed in both groups (7.1% in group 1 vs. 10.3% in group 2). The tissue status and level of pain were found to improve with time, with no statistical significance between the two groups (P> 0.05). CONCLUSION: This study indicates that the nail-splinting technique constitutes a very simple and effective, noninvasive therapeutic method for treating ingrown nail. We suggest that the 3-day nail-splinting technique is the most useful when the nail is intact or has only a slight defect.

Female↗
PubMed2002

Anterior knee pain after intramedullary nailing of fractures of the tibial shaft. A prospective, randomized study comparing two different nail-insertion techniques.

BACKGROUND: Anterior knee pain is the most common complication after intramedullary nailing of the tibia. Dissection of the patellar tendon and its sheath during nailing is thought to be a contributing cause of chronic anterior knee pain. The purpose of this prospective, randomized study was to assess whether the prevalence or the intensity of anterior knee pain following intramedullary nailing of a tibial shaft fracture is reduced by the use of a paratendinous incision for the nail entry portal. METHODS: Fifty patients with a tibial shaft fracture requiring intramedullary nailing were randomized equally to treatment with paratendinous or transtendinous nailing. Twenty-one patients from both study groups were followed for an average of three years after nailing. After fracture union, all but two patients had elective nail removal through the same surgical approach as was used for the nailing. At the follow-up evaluation, the patients used visual analog scales to report their level of anterior knee pain and the impairment caused by that pain. The scales described by Lysholm and Gillquist and by Tegner et al., the Iowa knee scoring system, and simple functional tests were used to quantitate the functional results. Isokinetic thigh-muscle strength was also measured. RESULTS: Fourteen (67%) of the twenty-one patients treated with transtendinous nailing reported anterior knee pain at the final evaluation. Of these fourteen patients, thirteen were mildly to severely impaired by the pain. Fifteen (71%) of the twenty-one patients treated with paratendinous nailing reported anterior knee pain, and ten of the fifteen were impaired by the pain. The Lysholm, Tegner, and Iowa knee scoring systems; muscle-strength measurements; and functional tests showed no significant differences between the two groups. CONCLUSION: Compared with a transpatellar tendon approach, a paratendinous approach for nail insertion does not reduce the prevalence of chronic anterior knee pain or functional impairment by a clinically relevant amount after intramedullary nailing of a tibial shaft fracture.

Adult↗
PubMed1996

The treatment of the splitting nail with phenol alcohol partial nail matricectomy.

BACKGROUND: Split nails are a common problem originating in focal thinning of the nail matrix. OBJECTIVE: To determine if cosmetically acceptable results could be achieved utilizing phenol alcohol partial nail matricectomy in patients with split nails. METHODS: After proper anesthesia, the nail lateral to the split is avulsed followed by destruction of the corresponding portion of the nail matrix to prevent the avulsed nail from regrowing. RESULTS: Phenol alcohol partial nail matricectomy has proven to be a simple, effective, reproducible treatment with excellent cosmetic results for laterally located split nails. CONCLUSION: A simple nail procedure, widely used for ingrown nails, can be easily adapted for the definitive treatment of split nails.

Alcohols↗
PubMed2003

Observer agreement in recording the clinical signs of nail disease and the accuracy of a clinical diagnosis of fungal and non-fungal nail disease.

BACKGROUND: Onychomycosis is increasing in incidence. To date, no studies have examined the detection of abnormalities of the nail apparatus, nor the accuracy of a clinical diagnosis of onychomycosis and non-fungal nail disease. OBJECTIVES: To assess the agreement between and within different groups of observers in detecting signs of nail disease, and to obtain information regarding clinical diagnostic skills. METHODS: An observational study was performed. Nine observers, including dermatologists, mycologists, general practitioners and a dermatology clinical assistant, completed a questionnaire containing 21 clinical signs of nail disease during examination of nine patients, five with onychomycosis and four with non-fungal nail disease. Observers were additionally requested to suggest the most likely underlying diagnosis for the nail dystrophy. Mean pair observer agreement values were calculated for each of the clinical signs, between all observers and within groups of observers. The chance-corrected agreement index, kappa, was determined. From the clinical diagnoses given, the positive predictive value of a diagnosis of fungal and non-fungal nail disease was calculated. RESULTS: There was substantial between-observer agreement on only three clinical signs: abnormal nails on both hands, abnormal toenails and abnormal fingernails. More specific signs of nail disease such as onycholysis elicited weaker agreement. All observers showed accuracy in making a clinical diagnosis of fungal nail disease, with a mean positive predictive value of 0.91, compared with 0.77 for non-fungal nail disease. CONCLUSIONS: Our results showed that agreement between observers, in recording signs of nail disease, was generally poor. The clinical diagnosis of onychomycosis was highly likely to be correct, suggesting that other criteria are being employed by individuals in reaching the diagnosis.

Adult↗
PubMed1995

Intramedullary nailing and pulmonary embolism: does unreamed nailing prevent embolization? An in vivo study in rabbits.

Pulmonary embolism in reamed femoral nailing has been reported and discussed over recent years. Does an unreamed nailing technique with a solid nail prevent this rare but serious complication of intramedullary fixation? In an animal model in rabbits, we studied the pathophysiologic impact on pulmonary function and the impact on hemostasis of reamed and unreamed nailing of intact femora and tibiae, and of femoral fracture in relation to intramedullary pressure. No statistical difference of PaO2, PaCO2, and PCO2et was found in the femur whether a reamed or unreamed procedure was performed. Two of six animals with unreamed femoral nailing, one of six animal with reamed femoral nailing, and one of five animals with a femoral fracture fulfilled four of four or three of four criteria for embolization (increase of the difference of PaCO2 and PCO2et, decrease of PaO2, increase of blast cells in central-venous blood and bone marrow/fat in histologic section of the lungs and bone). Tibial nailing did not alter pulmonary function in either group. Intramedullary pressure was increased in all animals with perioperative impairment of pulmonary function (375 to 676 mbar). Analysis of the hemostatic results showed a significant difference of platelet activation in reamed versus unreamed nailing of the femur 1 hour after nailing (p < 0.01) and a significant decrease of fibrinogen and antithrombin III (p < 0.001/p < 0.01) in reamed femoral nailing. We conclude that unreamed nailing of the femur with a solid rod may also cause bone marrow embolization with alteration of pulmonary function as long as an important increase of the intramedullary pressure is generated during the nailing procedure.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2003

Induction of hard keratin expression in non-nail-matrical keratinocytes by nail-matrical fibroblasts through epithelial-mesenchymal interactions.

Epithelium in the nail matrix is different from that at other body sites, in terms of clinical and histological appearance. Hard keratins are exclusively expressed in the nail matrix and bed and the hair apparatus, and hard keratin is considered a differentiation marker of these sites. Whether the expression of hard keratin in non-nail-matrical keratinocytes could be induced by nail-matrical fibroblasts was examined. Skin equivalents were constructed in three ways; ventral keratinocytes (from the ventral side of the digit) were cocultured with ventral fibroblasts (group A), ventral keratinocytes were cocultured with nail-matrical fibroblasts (group B), and nail-matrical keratinocytes were cocultured with ventral fibroblasts (group C). Immunohistochemical examinations with anti-hard keratin antibody (HKN-7) revealed hard keratin expression in groups B and C. HKN-7-positive cells were distributed continuously in the entire epithelial strata or in the suprabasal layer in group B, whereas HKN-7-positive cells were distributed spottily in group C. This study indicates extrinsic hard keratin induction in non-nail-matrical keratinocytes by nail-matrical fibroblasts and suggests that non-nail-matrical epidermal grafts may be effective in the treatment of deepithelized nail injuries. In addition, it is possible that lost nails could be reconstructed with grafts of "tissue-engineered" nail equivalent.

Antibodies, Monoclonal↗
PubMed2006

[Effect of urea nail lacquer on nail quality. Clinical evaluation and biophysical measurements].

BACKGROUND: Urea is a well-known humectant. The aim of our study was to evaluate the in vivo effect of 10% urea lacquer on nail quality. METHODS: 60 healthy probands with brittle nails were included in a randomized, controlled study. The nail lacquer was applied once (n=30) or twice daily (n=30) on one hand for 28 days, while the other hand served as untreated control. Assessments included clinical evaluations and bioengineering measurements. RESULTS: Application of the nail lacquer was well-tolerated and led to a significant clinical improvement of nail surface morphology, nail plate consistency, reflection of the nail plate surface, appearance of the cuticle and the nail fold. Sonographic nail density was slightly increased. No relevant changes were found in nail thickness and transonychial water loss. CONCLUSIONS: Nail lacquer containing urea improves the cosmetic appearance of fingernails.

Adult↗
PubMed1983

Treatment of nail bed avulsions with split-thickness nail bed grafts.

Experimental studies with squirrel monkeys indicated the feasibility of split-thickness grafting of segments of the nail bed. Thin grafts, when taken from the nail bed, achieved excellent take over of the avulsed areas. Thirty-one patients with avulsion of segments of the nail bed were treated with split-thickness nail bed grafts. The injured nail bed had sufficient residual nail bed to serve as a donor site in 24 patients. The remaining seven patients required split-thickness grafts from the lateral one third of the great toe. Of the 31 treated nail beds, there was a total of five deformities in which there was either nonadherence of the nail or irregularity of the nail surface. Twenty-six had nails with no deformity. No deformities occurred in the graft donor area. The split-thickness nail bed graft offers the advantage of frequent availability of tissue on the same injured digit and the absence of donor site deformity, whether on the same injured digit or a donor great toe.

Animals↗
PubMed2003

Open exchange locked nailing in humeral nonunions after intramedullary nailing.

Humeral nonunions after cannulated intramedullary nailing have been difficult to reconstruct. In the current study, 23 consecutive patients were treated by open exchange locked nailing with bone grafting. There were 16 men and seven women with a mean age of 46.2 years. The nonunions followed humeral locked nailing in eight patients, Seidel nailing in 13, and Küntscher nailing in two. The average nonunion time was 14.7 months. The nonunions, located at the proximal (1/3) in four humeri, middle (1/3) in 15, and distal (1/3) in four, were antegrade nailed in 10 and retrograde nailed in 13. Nineteen had 8-mm nails and four had 7-mm nails. Supplementary wiring was used in 19 patients. The average followup was 21.4 months. With one surgery, all but one patient (96%) achieved osseous union in, on average, 16.3 weeks. One patient with chronic renal dialysis had persistent nonunion and an osteolytic supracondylar fracture. Other complications included one postoperative radial nerve palsy, one brachial artery injury, and one wire infection. At followup, all patients with solid union had excellent or satisfactory recovery of shoulder function. The average postoperative Neer score (90.7) was significantly better than the average preoperative score (68.5). Two patients had losses of elbow motion of 10 degrees and 20 degrees, respectively. This study shows that humeral nonunion after cannulated intramedullary nailing can be treated effectively by open exchange locked nailing with bone grafting. Supplementary wiring can compress the nonunion and facilitate bone healing.

Adult↗
PubMed2005

Tibiotalocalcaneal arthrodesis with a retrograde intramedullary nail: a biomechanical analysis of the effect of nail length.

BACKGROUND: Fatigue fractures of the tibia have been observed at the level of the proximal end of the nail after successful tibiocalcaneal arthrodesis with a retrograde intramedullary device. MATERIALS: To study the effect of nail length, five matched pairs of cadaver tibiae were instrumented with strain gauges and potted in methylmethacrylate from a level 3 cm proximal to the distal medial malleolus to simulate a successful tibiocalcaneal arthrodesis. A standard length (15 cm) ankle arthrodesis nail and an identical longer device terminating in the proximal tibial metaphysis were inserted in each paired tibia using appropriate technique. The strain of the posterior cortex of the tibia was recorded under bending moments of up to 50 Nm for each intact specimen after nail insertion and after proximal locking of the nail. The nails were then exchanged between the specimens of the same pairs and the experiment was repeated to insure uniformity. RESULTS: The standard length locked nail increased the principal strain of the posterior cortex of the tibia at the level of the proximal screw holes 5.3 times more than the locked long nail (353 and 67 microstrains), respectively. This stress concentration was not observed when the proximal extent of the nail terminated within the proximal tibial metaphysis. CONCLUSION: A successful tibiocalcaneal arthrodesis with a standard length locked intramedullary nail creates stress concentration around the proximal screw holes that may be responsible for the fractures observed clinically. This study supports the use of a "long" retrograde locked intramedullary nail for tibiocalcaneal arthrodesis in patients with systemic or localized osteopenia.

Aged↗
PubMed2006

Nail penetration of sertaconazole with a sertaconazole-containing nail patch formulation.

BACKGROUND AND OBJECTIVE: Sertaconazole, an imidazole antifungal drug, has been proven to have broad and potent antifungal activity. In the present study, the pharmacokinetics of sertaconazole nail patches, developed for treatment of onychodystrophy and onychomycosis, were investigated in healthy volunteers. The objective of the study was to investigate the penetration of sertaconazole into the nail and plasma and the residual sertaconazole concentration in patches after 1 week of application onto the nails. METHODS: In a double-blind study, 16 healthy adults were treated with a 2.2 cm2 nail patch containing sertaconazole 3.63 mg and another patch containing no antifungal agent, which were placed on the left and right thumbnail of each subject, respectively (or vice versa), in a randomized order. The treatment period was 6 weeks and the patches were replaced weekly. Nail clippings, used nail patches, and blood samples were investigated to determine sertaconazole concentrations. RESULTS: Sertaconazole was detected in all sertaconazole-treated nail samples with mean concentrations of >100 microg/g, which exceeds the minimum inhibitory concentrations (MICs) for all relevant fungi in this context. Measurements of the residual dose in the patches suggested that 16-71% of the active ingredient had penetrated into the nail. No plasma sertaconazole concentrations could be detected. CONCLUSION: By virtue of their positive influence (occlusion) on water and lipid metabolism in dystrophic nails, nail patches should have beneficial therapeutic effects in onychodystrophic conditions. Addition of the antifungal agent sertaconazole adds broad-spectrum antimicrobial activity. In this study, the concentrations of sertaconazole in the nails were shown to be well above the MIC values for pathogenic fungi relevant to onychomycosis. No systemic absorption of the active ingredient was detectable, which should exclude unwanted systemic effects of the drug.

Administration, Topical↗
PubMed2004

A randomized comparison of nail surface remanence of three nail lacquers, containing amorolfine 5%, ciclopirox 8% or tioconazole 28%, in healthy volunteers.

This randomized, investigator-masked study compared the remanence on the nail surface of commercially available antimycotic nail lacquers containing amorolfine, ciclopirox and tioconazole. The lacquers, to which a coloring agent was added, were applied randomly to the left and right thumbnails and great toenails of 10 healthy volunteers. Volunteers were asked to wash their hands under standardized conditions at 30, 60 and 90 min after product application and to take at least one shower during the study. Photographs were taken immediately after drug application and at 30, 60 and 90 min, i.e., immediately after each hand washing, and then at 8 and 24 h. Photographs of treated toenails were taken at 0, 8 and 24 h. Photographic image analysis allowed automatic calculation of the proportion of nail surface remaining covered by the different nail lacquers over time and after washing. In addition, clinical visual assessment was made to determine the degree of the nail surface covered by the nail lacquers over time. It was demonstrated that at 24 h after product application, remanence of amorolfine nail lacquer on the thumbnails was significantly higher than that of ciclopirox (p < 0.05) and that of tioconazole on the thumb- and toenails at each time point up to 8 h after product application (all p < 0.05). Clinical observation showed that 30 min after application, the tioconazole nail lacquer had still had not completely dried. Amorolfine nail lacquer was shown to be more resistant than ciclopirox and tioconazole nail lacquers to chemical trauma from soaps and to mechanical aggressions from the immediate nail environment.

Adult↗
PubMed1990

The repair of nail deformities with the nonvascularized nail bed graft: indications and results.

Twenty-four cases of nonvascularized nail bed grafting to correct nail deformities were reviewed. The highest success rate in improving the appearance of the deformed nail, 86%, was achieved when the split-thickness nail bed graft of sterile matrix was used to correct a nail deformity caused by a sterile matrix injury; the same procedure used to correct a nail deformity caused by a germinal matrix injury had a 0% success rate. Donor site morbidity occurred in 25% of split-thickness nail bed grafts and 100% of full-thickness nail bed grafts. The split-thickness nail bed graft of sterile matrix, if used in properly selected patients, will consistently improve the appearance of the deformed nail.

Adolescent↗
PubMed2003

Nail regeneration by elongation of the partially destroyed nail bed.

Patients with partially destroyed fingernails tend to hide them, and such patients often do not find help because fingernails are considered of little functional value. To improve the aesthetic appearance of such nails, a simple excision of the destroyed nail matrix can stimulate the growth of the residual healthy matrix and regenerate the nail. Prerequisite is a healthy nail residue of at least the lunula. An excision of an en bloc, crescent-shaped, full-thickness scar, 5 mm at its greatest width and extending from one lateral nail fold to the other, increases the length of the nail plate. Together with the matrix, the nail will grow about 4 mm distally. A second crescent-shaped excision 1 to 2 months later will further lengthen the nail until it has gained full length. Normal nail growth was achieved in 11 patients who had partially scarred nail beds after mycosis or trauma.

Humans↗
PubMed1991

Successful use of topical vitamin E solution in the treatment of nail changes in yellow nail syndrome.

A double-blind controlled study was performed on a patient with long-standing yellow nail syndrome to investigate the potential beneficial role of topical vitamin E solution for the nail changes seen in this disorder. Three nails received active solution containing DL-alpha-tocopherol in dimethyl sulfoxide; three nails received dimethyl sulfoxide only; and the remainder were untreated. After 6 months of therapy, the three nails treated with active solution showed marked clinical improvement and a corresponding increase in nail growth rates. Dimethyl sulfoxide alone produced a small increase in nail growth rate and slight clinical improvement. Active solution was then applied to all of the nails for a further 6 months, resulting in clinical improvement and increased nail growth rates in the remaining nails. These beneficial effects require further study.

Administration, Topical↗
PubMed2002

Enhanced human nail drug delivery: nail inner drug content assayed by new unique method.

The purpose of this study was to develop an assay method of the human inner nail plate and to compare nail drug penetration by a penetrating enhancing formulation (the test carrier formulation). The test carrier and saline formulations were tested using radiolabeled urea, ketoconazole, and salicylic acid. After twice dosing daily for 7 days on human nail plates, the under inner section of the nail plate was assayed for absorbed drug content using a unique drilling/removal system. Results show that the weight-normalized radioactivity contents of three chemicals in the inner intermediate nail plate center in the carrier formulation were two fold higher than those from saline (p < 0.05). Total radioactivity recovery of dosed [(14)C]-salicylic acid was 89 +/- 2% in the carrier formulation and 88 +/- 5% in saline. In saline formulation, salicylic acid showed greater binding to the outer nail, making it less bioavailable for the inner nail area. This didn't occur with carrier formulation. In conclusion, topical treatment of nail diseases such as onychomycosis is not yet sufficiently effective, likely because of minimal drug penetration into the inner nail plate where the disease perpetuates. The assay system has the unique characteristic of being able to assay the inner part of the nail where the disease resides.

Absorption↗