Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “NAILS”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 415 records · Page 23Linked to original sources
PubMed1999

Dystrophic psoriatic fingernails treated with 1% 5-fluorouracil in a nail penetration-enhancing vehicle: a double-blind study.

BACKGROUND: Topically applied nail therapeutics need to permeate the nail plate to reach the nail bed or nail matrix and exert their potential beneficial effect at these locations to obtain a therapeutic benefit. So far only topically applied 5-fluorouracil on affected nails of psoriatic patients has been shown to produce a notable clearance. Vehicle formulations enhancing nail permeation processes are thought to increase the concentration of the active agent and therefore therapeutic efficacy, possibly enabling the use of a low concentration of the active agent thereby lowering the incidence of adverse effects. OBJECTIVE: This study was designed to verify whether a recently developed nail penetration enhancer in a lotion formulation, Belanyx((R)) (urea, propylene glycol), improves the efficacy of a low concentration of 5-fluorouracil (1%) in psoriatic fingernail lesions. METHODS: In a randomised, double-blind, left-right study the efficacy of 1% 5-fluorouracil in the Belanyx vehicle was compared to the vehicle preparation Belanyx in dystrophic fingernails of 57 psoriatic patients. Both preparations were applied in a once daily regimen for 12 weeks. Responses and adverse effects of one selected target nail were recorded at screening, at baseline and at weeks 2, 4, 8 and 12 of treatment with a final assessment at week 16: 4 weeks after the end of treatment. As parameter of efficacy was chosen the total nail area severity (NAS) score, consisting of the separate parameters nail pitting area, number of nail pits, subungual keratosis, onycholysis, oil spots and the various scores of overall improvement. RESULTS: The efficacy of 1% 5-fluorouracil in lotion and that of the vehicle in suppressing the parameters of dystrophy were shown to be similar at the end of treatment (p = 0.063) or follow-up (p = 0.130). Both preparations produced statistically significant improvements (p </= 0.05) for almost all assessed parameters after 12 weeks of treatment and after the 4 weeks of follow-up. For Belanyx lotion this applied to the nail pitting area, the number of nail pits, subungual keratosis, onycholysis and oil spots. The investigators' and patients' opinion of overall improvement of severity as well as the total NAS score of one target nail likewise showed a statistically significant improvement at the end of treatment and at the end of the observation period (p </= 0.05). With the 1% 5-fluorouracil lotion the same statistically significant improvements were obtained in all of the assessed symptoms with the exception of the number of pits and onycholysis at week 12 and week 16. Possible treatment-related adverse effects were established in 6 patients showing inflammation and infection (3 patients) or discoloration (5 patients); 3 patients on 5-fluorouracil lotion showed onycholysis. CONCLUSION: Addition of 1% 5-fluorouracil to the nail permeation enhancer Belanyx does not increase the efficacy of the active agent in psoriatic nail dystrophy of this study population. The obtained results also suggest that Belanyx lotion can be used in this indication since it has shown a favourable efficacy-safety ratio.

Adult↗
PubMed2000

[Experimental study of the primary stability of locked centro-medullary nailing of the humeral diaphysis].

PURPOSE OF THE STUDY: A clinical trial on the treatment of humeral shaft nonunions with locked nailing evidenced 5 failures among 13 cases. The circumstances leading to the nonunion, the patient's condition, and the nailing method were not found to have a predominant effect explaining this outcome. Inversely, clinical data suggested that abnormal mobility of the nonunion appeared to result from play in the assembly. To check this hypothesis, we measured primary stability in three nailing models using cadaver bones. MATERIALS AND METHODS: Three nailing models, Seidel (S), Russel-Taylor (RT) and ACE were tested, each on 5 cadaver specimens. A 1 cm segmental resection was made in the mid third of the humerus to simulate an unstable nonunion. The nailing was performed in accordance with the instructions furnished by the manufacturers. The nailed specimens were placed in a testing device which alternatively applied a rotation force around the longitudinal axis (+/- 0.5 Nm), an axial compression-traction force (+/- 20 N) and a transverse shear force applied at the level of the osteotomy (+/- 20 N). RESULTS: This study demonstrated an instability of the three nails when submitted to a rotation force or a shear force: 14 to 28 degrees and 1.6 to 3.4 mm respectively for the RT nail; 8 to 20 degrees and 1 to 3 mm for the S nail; 5 to 15 degrees and 1.7 to 3.2 mm for the ACE nail. The ACE nail appeared to be more stable when submitted to compression-traction force; the S nail accepted a 0.05 to 0.65 mm play which reached 9.7 mm for the RT nail. This instability appeared to result from play in the locking systems. DISCUSSION: These findings would demonstrate that these nailing systems cannot, in themselves, provide satisfactory primary stability. The experimentally evidenced instability would contribute, probably in association with locally unfavorable physiological or biological conditions, to the failure rate observed when nailing is used alone. CONCLUSION: The locking system for tested nails would have to be modified to eliminate play in the assembly before continuing their use for the treatment nonunion of the humeral shaft.

Aged↗
PubMed2002

Radiation exposure to surgeon and patient in intramedullary nailing of the lower limb.

Intramedullary nailing is probably the best method of treating long bone fractures in the lower limb. The operation is guided by fluoroscopy, for guide-wire insertion, fracture reduction and distal locking. No study so far has measured the scatter radiation to the patient's gonads during intramedullary, particularly femoral, nailing. The purpose here was to estimate the radiation hazard to the patients' gonads and surgeons' hands during intramedullary nailing for lower limb fractures. From April 1994 to June 1998, 184 consecutive patients had 224 nailings for lower limb fractures. Twenty-eight patients had Marchetti-Vincenzi nails and the rest had Russell-Taylor nails. There were 45 males and 40 females who had femoral nailing and 71 males and 28 females who had tibial nailing. The mean (range) age for femoral nailing was 56 (17-95.5) years and the mean age for tibia nailing was 44 (16.5-87.5) years. The average time of radiation when done by consultants was half that of middle-grade surgeons. The mean tibial nailing radiation time for the consultant was 0.56 min and for the middle-grade 1.28 min. The mean femoral nailing radiation time for the consultant was 0.52 min and for the middle-grade 1.61 min (P<0.05). The mean tibial and femoral nailing time were less for Marchetti nailing (P<0.05). Regular protection of the gonads of these patients is mandatory. This study shows that the radiation exposure for Marchetti-Vincenzi nailing is significantly less than for Russell-Taylor nailing. The overall radiation to patient gonads and surgeon hands was within acceptable limits.

Adolescent↗
PubMed1994

[Biomechanical studies of 9 tibial interlocking nails in a bone-implant unit].

Various different interlocking intramedullary nail designs are now available for the tibia the designs resulting from a different approaches to achieving stability for fracture fixation. During recent years small-diameter unreamed interlocking nails have been developed. So far there are no data on stiffness of different nail designs that can justify the use of certain nail types. We compared different nail types in the bone-implant complex (BIC) with reference to stiffness under axial load, bending and torsion of the BIC. We simulated comminuted mid-shaft fractures by a 2-cm defect osteotomy in paired human cadaver tibiae. We fixed each tibia with one of nine different interlocking nails (AO Unreamed Tibial Nail 9 mm [UTN9], AO Unreamed Tibial Nail 8 mm [UTN8], Russell & Taylor Delta Tibial Nail 9 mm [RTD], Russell & Taylor Reconstruction Tibial Nail 11 mm [RTR], Brooker & Wills Nail 11 mm [B-W], Grosse & Kempf Tibial Nail 11 mm [G-K], AO Universal Tibial Nail 11 mm [AOU], Klemm & Schellmann Tibial Nail 11 mm [K-S], Börner & Mattheck Tibial Nail 11 mm [B-M]) according to the manufacturers' recommendations. Each BIC was tested mechanically using a Zwick universal testing machine. Torque testing was performed with a maximum moment of 5 Nm in both directions. Maximum axial load was 1100 N. Four-point bending was done up to a moment of 66 Nm. For each implant bending and torque stiffness of the nail were calculated and compared with the test results obtained in the cadaver study. A P-value less than 0.05 (least significance difference test, ANOVA) was considered significant.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2004

Hereditary 'white nails': a genetic and structural study.

BACKGROUND: Hereditary subtotal leuconychia is a rare nail disease. The gene(s) underlying this phenotype is (are) not known. Immunohistochemical and ultrastructural studies of nails are performed infrequently. OBJECTIVES: To perform genetic linkage analysis and to assess ultrastructure and soft/hard keratin expression in hereditary white nails. METHODS: We have analysed microscopically and ultrastructurally the white nails of a patient from a family in which the trait is inherited in an autosomal dominant manner as an isolated symptom. No skin lesions or hair abnormalities could be detected. Genetic linkage studies were performed on DNA samples obtained from several members of the affected family. A longitudinal surgical biopsy of the nail from a great toe was split in two parts. One part was fixed in formalin and processed for histopathology. Another part was further subdivided and embedded either in Epon, following fixation in 2% glutaraldehyde, or in Lowicryl K4M, after fixation in 3% paraformaldehyde. Dewaxed nail sections and Lowicryl ultrathin sections were also stained with various antikeratin antibodies. RESULTS: Genetic linkage studies of the family pointed to the disease gene mapping to the chromosomal 12q13 region. Genes mapping within this chromosomal region include the genes coding for type II (basic) cytokeratins and hard keratins. The nail matrix presented an abnormal hypergranulosis. The upper part of the nail plate, originating from the proximal nail matrix, had a nonhomogeneous lamellar appearance, with numerous intracellular 'lipidic' vacuoles and 'empty' spaces separating keratin filament bundles. These cells were progressively shed at the nail surface. The cell loss was compensated by hyperproliferation of the distal matrix and of the nail bed keratinocytes, with persistent marked parakeratosis and loose arrangement of keratin bundles. The distal matrix and the nail bed contributed equally to formation of the lower plate. This presented the characteristics of a tissue composed of soft keratins. Accordingly, there was virtually no labelling with the Hb1 antibody to a basic hard keratin in the white nail, whereas the labelling with AE3 antibody to all type II keratins and with KL1 recognizing suprabasal soft keratins was normal or even enhanced. CONCLUSIONS: Genetic linkage indicates that the gene defect underlying the leuconychia in the family studied resides on chromosome 12q13. As the type II keratins map within this chromosomal interval, it is possible that a mutation in one of these keratin genes may be a cause of the hereditary leuconychia. The white appearance of nails in this disease seems to be due to an abnormal keratinization of cells originating from the proximal nail matrix, leading to the presence of abundant intracellular vacuoles and to a lesser compactness of keratins.

Chromosome Mapping↗
PubMed2002

Nail cosmetics: allergies and irritations.

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.

Acrylates↗
PubMedDate not supplied

Biomechanical comparison of bending and torsional properties in retrograde intramedullary nailing of humeral shaft fractures.

OBJECTIVE: To establish whether the bending and torsional stiffness of an implanted nail are influenced by nail design and nail-bolt interface, this study compared two implanted retrograde nail systems: the AO/ASIF unreamed humeral nail (UHN) and the Russell-Taylor (RT) nail. DESIGN: Pair randomization. SETTING: Mechanical laboratory testing. SPECIMENS: Twelve pairs of freshly harvested cadaveric humeri. METHODS: Transverse fractures were simulated with a standardized midshaft osteotomy and a three-millimeter gap. Both nails were proximally and distally interlocked. The RT nail has a single interlock at its base and tip. The UHN has double interlocking both proximally and distally. The screw hole design of the RT nail features slots, whereas the UHN has round screw holes. MAIN OUTCOME MEASURES: Anteroposterior and mediolateral bending stiffness and torsional stiffness. RESULTS: The RT nail showed higher bending stiffness in anteroposterior and mediolateral bending. Large differences were seen in the torsional characteristics: for the first 30 degrees, the RT nail showed a much lower resistance against torsion than the UHN. Analysis of variance of stiffness at four, six, and eight newton-meters showed statistical significance (p < 0.0001). Torsional stiffness, defined as the slope of a straight line approximated to between 75 and 100 percent of the maximum torque, was very similar in both nails. CONCLUSION: The torsional differences between the two nail systems are attributable to the nail-bolt interface of the RT nail. This dynamic system allows a clinically relevant degree of movement. The greater resistance to rotatory forces of the UHN is explained by the fact that the interlocking at its tip and base creates a static rather than a dynamic system.

Biomechanical Phenomena↗
PubMedDate not supplied

Retrograde versus antegrade nailing of femoral shaft fractures.

OBJECTIVES: To compare union rates and complications of retrograde intramedullary nailing of femoral shaft fractures with those of antegrade intramedullary nailing. DESIGN: Retrospective. SETTING: Level I trauma center. PATIENTS: Two hundred eighty-three consecutive adult patients with 293 fractures of the femoral shaft who underwent stabilization with antegrade or retrograde inserted femoral nails were studied. There were 140 retrograde nails and 153 antegrade nails. Twelve fractures in twelve patients were excluded (three in patients who died early in the postoperative period, three in patients because of early amputation, four in patients who were paraplegic, and two in patients who fractured through abnormal bone owing to metastatic carcinoma), leaving 134 fractures treated with retrograde nails and 147 treated with antegrade nails. One hundred four femurs treated with retrograde nails (Group R) and ninety-four femurs treated with antegrade nails (Group A) had sufficient follow-up and served as the two study groups. The average clinical follow-up was twenty-three months (range 6 to 66 months) for Group R and twenty-three months (range 5 to 64 months) for Group A. Both groups were comparable with regard to age, gender, number of open fractures, degree of comminution, mode of interlocking (i.e., static or dynamic), and nail diameter (p > 0.05). INTERVENTION: Retrograde intramedullary nails were inserted through the intercondylar notch of the knee, and antegrade nails were inserted through the pirformis fossa using standard techniques. MAIN OUTCOME MEASURES: Union, delayed union, nonunion, malunion, and complication rates. RESULTS: After the index procedure there were no significant differences in healing or incidence of malunion between Group R and Group A (p > 0.05). Healing after the index procedure occurred in ninety-one (88 percent) of the femurs in Group R and in eighty-four (89 percent) of the femurs in Group A. In Group R, there were seven delayed unions (7 percent) and six nonunions (6 percent). In Group A, there were four delayed unions (4 percent) and six nonunions (6 percent). Healing ultimately occurred in 100 (96 percent) femurs from Group R and in ninety-three (99 percent) femurs from Group A. In Group R, there were eleven malunions (11 percent), and in Group A, there were twelve malunions (13 percent). When patients with ipsilateral knee injuries were excluded, the incidence of knee pain was significantly greater for Group R patients (36 percent) than for Group A patients (9 percent) (p < 0.001). When patients with ipsilateral hip injuries were excluded, the incidence of hip pain was significantly greater for Group A patients (10 percent) than for Group R patients (4 percent) (p < 0.05). CONCLUSIONS: Retrograde and antegrade nailing techniques provided similar results in union and malunion rates. There were more complications related to the knee after retrograde nailing and more complications related to the hip after antegrade nailing.

Adolescent↗
PubMedDate not supplied

Entry point soft tissue damage in antegrade femoral nailing: a cadaver study.

INTRODUCTION: Little attention is paid to insertion site morbidity associated with antegrade femoral nailing. However, residual peritrochanteric pain after nailing is not uncommon. Additionally, the end branches of the medial femoral circumflex artery (m.f.c.a.) supplying the femoral head are in close proximity to the insertion site of the nail, and the occurrence of avascular necrosis of the femoral epiphysis after nailing in adolescents is rather frequent. OBJECTIVE: The aim of this study was to assess iatrogenic soft tissue injuries at the site of nail insertion. MATERIALS AND METHODS: Nailing with a reamed AO universal femoral nail was performed on sixteen adult cadavers followed by dissection of the proximal part of the femur to assess possible damage to the soft tissues. Three entry portals were defined. (A) entry portal lateral to the junction of the neck and the greater trochanter; (B) entry portal at the base of the greater trochanter anterior to a line along the longitudinal axis of the femoral neck; and (C) entry portal at the base of the greater trochanter posterior to a line along the axis of the femoral neck (at the piriformis fossa). RESULTS: In Group A, partial avulsion of the piriformis and the obturator internus tendon were present in four and in one of five specimens, respectively. Group B showed injuries to the piriformis tendon in two and to the gluteus minimus tendon in one of four cases. In Group C, partial avulsion of the piriformis, obturator internus, and obturator externus tendon were encountered in five, six, and two of seven specimens, respectively. Anterior branches of the ramus profundus of the m.f.c.a. within the synovial fold were damaged in all of these cases. CONCLUSION: To select the best nail entry portal, the ease of nail insertion must be weighed against the resulting soft tissue damage at the site of insertion. The nail entry portal at the piriformis fossa, although geometrically ideal and most recommended, causes the most significant damage to muscle and tendons as well as to the blood supply to the femoral head. Therefore, even if reported only once, the occurrence of avascular necrosis of the femoral head after nailing in adults is a possible complication of this nail entry portal. The authors therefore prefer to avoid this entry portal in every case. The nail entry portal anterior to the longitudinal axis of the femoral neck, as in group B, although better with respect to the soft tissue damage, has the worst geometric and biomechanical disadvantages. The results of the current study favor the nail entry portal lateral at the greater trochanter as in Group A, which is equal to the entry portal B with respect to the soft tissue damage but allows introduction of the nail into the medullar cavity without difficulties.

Bone Nails↗
PubMed1995

A comparison of reamed and unreamed nailing of the tibia.

The availability of unreamed interlocked nails for fixation of tibia fractures has raised the issue of what effect reaming the intramedullary canal has on the clinical outcome after tibial nailing. A retrospective review was performed of all tibial fractures treated with interlocking nailing at the authors' institution over the past 5 years in order to compare reamed and unreamed nailing. Forty-five nailings were identified of which 38 had adequate follow-up information to be considered healed or non-united at 1 year. Thirteen reamed and 23 unreamed tibial nailings were followed to healing; there were 6 nonunions. The unreamed nailings had lower average operative times and lower average estimated blood loss, although the results did not reach statistically significant levels. There was a statistically significant difference in healing times, with unreamed nailings taking an average of 242 days to heal while reamed nailings took 158. This difference held for subgroups such as isolated tibia fractures, closed tibial fractures, and high-energy tibial fractures. Six non-unions occurred, one in a reamed nailing and five in unreamed nailings. Malunions occurred in four reamed nailings and six unreamed nailings, most often in distal third fractures, interlocked on only one side of the fracture. Patellofemoral complications were more common in unreamed nailings. Although this study is limited by retrospective, nonrandom design, it raises questions about the routine use of unreamed nailing with regard to healing potential and other postoperative complications. Further study is warranted.

Adolescent↗
PubMed2000

Treatment of humeral shaft delayed unions and nonunions with humeral locked nails.

OBJECTIVE: To report experience with use of humeral locked nails in treating humeral delayed unions and nonunions. The following techniques yielded encouragingly good results: static locking, short-to-long segment nailing, bone grafting, fracture compression, and minimal surgical trauma. DESIGN AND METHODS: A total of 41 consecutive patients with 13 delayed unions and 28 nonunions were treated with humeral locked nails. Delay from trauma to surgery averaged 4.2 months for delayed union and 15.5 months for nonunion. The average age of patients was 50.2 years; average follow-up time was 23.2 months. There were 7 proximal-third fractures, 21 middle-third fractures, and 13 distal-third fractures. The antegrade approach was used for 13 fractures and retrograde for 28. Open nailing was performed in 39 fractures and closed nailing in 2. If the fracture motion was still present after nail insertion, axial compression of the fracture site was specially applied. Bone grafting was performed in the fractures with open nailing. Thirty-four fractures were nailed with 8-mm nails, and 7 fractures were nailed with 7-mm nails. RESULTS: With a single operation, all but two patients achieved osseous union in, on average, 5.6 months. One of these two patients eventually gained union after another surgery with fracture compression along the original nail and concurrent bone grafting. The second patient, undergoing hemodialysis for chronic renal failure, had persistent nonunion. At follow-up, for patients with antegrade nailing, all but four patients had less than 20 degrees limitation of shoulder abduction. For patients with retrograde nailing, all but two had less than 10 degrees limitation of elbow motion. Only the patient with persistent nonunion had continual pain and significant impairment of arm function. CONCLUSIONS: Humeral locked nailing seems to be effective for humeral delayed unions or nonunions. It may be an acceptable alternative for fractures unsuited for plate fixation, such as those with comminution, osteoporosis, or a severely adhered radial nerve.

Adult↗
PubMed2006

Interobserver reliability of the Nail Psoriasis Severity Index.

BACKGROUND: Because the Psoriasis Area and Severity Index (PASI) does not consider the severity of nail disease, a scale that assesses the extent of involvement of psoriatic nails is needed. A new grading system, the Nail Psoriasis Severity Index (NAPSI) has been proposed. AIMS: The purpose of this study was to assess the interobserver reliability of NAPSI. Methods. The nail features of 25 patients with psoriasis with nail involvement were evaluated and graded by three dermatologists for total NAPSI scores and nail scores. The quadrants of all nails were examined for the presence of matrix and bed features. Total NAPSI score (0-160) of patients and nail score (0-32) of the individual nails were calculated. Interobserver reliability assessments were performed by computing intraclass correlation coefficients (ICC; two-way mixed model, consistency definition). RESULTS: The ICC((3,1)) results for total NAPSI score and nail score were found to be 0.781 and 0.649, respectively. The ICC((3,1)) for nail-bed and nail-matrix features were 0.869 and 0.584, respectively, in the total NAPSI scoring system, and 0.705 and 0.603, respectively, in the nail scoring system. CONCLUSION: Moderate to good agreement of scoring with the NAPSI was determined among the observers in this study. Our results suggest that scoring for nail-bed features seems to be more reliable than scoring for nail-matrix features.

Adult↗
PubMed1997

Interlocking intramedullary nailing with and without reaming for the treatment of closed fractures of the tibial shaft. A prospective, randomized study.

One hundred and fifty-two patients who had 154 closed fractures of the shaft of the tibia were prospectively randomized to management with interlocking intramedullary nailing either with or without reaming. Thirteen patients who had been randomized to treatment without reaming were switched to the group that had reaming because of technical reasons; these patients were excluded from the analysis of the results. An additional five patients were lost to follow-up. Thus, seventy-two patients (seventy-three fractures) who had been managed with nailing with reaming and sixty-three patients (sixty-three fractures) who had been managed with nailing without reaming were available for follow-up at an average of twelve months (range, three to thirty-three months) postoperatively. The two groups were similar with regard to demographics and the configurations of the fractures. The average total duration of the procedures performed without reaming was eleven minutes shorter than that of the procedures done with reaming (p = 0.0013). The duration of fluoroscopy was not significantly different between the two groups (p = 0.35, Mann-Whitney test). The average estimated blood loss was identical for the two groups. Seventy fractures (96 per cent) that were treated with nailing with reaming and fifty-six (89 per cent) that were treated with nailing without reaming united without the need for an additional operation (p = 0.19). Because of the small sample size, the study has insufficient power (34.7 per cent) to detect this difference if it is real. There was only one deep infection, which developed after nailing without reaming. The nail fractured after one procedure with reaming. A screw fractured after two procedures with reaming and after ten without reaming (p = 0.012); multiple screws fractured after three procedures in the latter group. Malunion occurred after three nailing procedures with reaming and after two without reaming. Four malunions were of very proximal fractures and one was of a very distal fracture. Seventeen screws and twenty-four nails were removed after nailing with reaming, and twenty screws and nineteen nails were removed after nailing without reaming; neither of these prevalences was significantly different between the two groups (p = 0.27 and 0.89; chi-square test). We concluded that there are no major advantages to nailing without reaming as compared with nailing with reaming for the treatment of closed fractures of the shaft of the tibia. There was a higher prevalence of delayed union and breakage of screws after nailing without reaming.

Adult↗
PubMed2000

[Tibial fracture with intact fibula treated by reamed nailing].

PURPOSE OF THE STUDY: The main difficulties encountered in the orthopedic treatment of leg fractures with intact fibula are reduction of the tibial and an unusually high rate of varus unions and non-unions. The aim of this retrospective study was to assess the outcome after reamed nailing of tibial fractures with an intact fibula. MATERIAL AND METHOD: Between 1986 and 1997, 38 fractures of the tibia with an intact fibula were treated by first intention centromedullar nailing. There were 28 men and 10 women, mean age 28 years, with a single fracture in 25 cases. There were 25 motor vehicle accidents (17 two-wheel, 8 four-wheel), 5 sports accidents, 2 home falls, and 6 others. Fracture of the tibial diaphysis was associated with a homolateral femoral fracture in 7 cases, 7 fractures were open (7 type 1, 2 type 2, 1 type 3), 7 fractures were associated with abrasive skin lesions. Using the AO classification, the tibial fracture was type A in 26 cases, type B in 11, and type C in 1. The fracture was in the middle third of the tibia in 21 cases, the distal third in 15 and in the proximal third. Grosse and Kempf nails were used exclusively. Static nailing was used in 27 cases, dynamic nailing in 8, and the nail was not locked in 3 cases. Nails of diameter 9 to 13 were implanted after reaming 1 mm more. RESULTS: The fracture gap increased during the reaming in 5 patients; 2 patients had to undergo a secondary aponeurectomy due to a postoperative compartment syndrome and had no further sequela. Consolidation was achieved after the first intention treatment in 30 patients, after dynamization in 6. A non-union in 2 patients was also successfully managed with new nailing and dynamization. Delay to consolidation was a mean 175 days (range 60 - 480). Transverse fractures consolidated more rapidly (mean 122 days). At last follow-up (minimum 1 year), active knee and ankle mobility were normal in all patients. Nineteen patients complained of pain at the site of the nail insertion, evaluated at 1 on a 10-point analogie scale by 10 of them and at 2 by the 9 others. Eight out of 10 patients felt cure had been achieved 5 months postoperatively. DISCUSSION: These rapidly obtained clinical results and the relatively low rate of non-union (5 p. 100) should be attributed to the reamed nailing technique. We discuss the frequency of tibial fractures with intact fibula and the underlying circumstances. The lack of patent fibular fracture does not signify the fibula is intact. Trauma-induced tibio-fibular dislocation (1 case in our series) can occur. A review of the literature emphasizes the frequency of non unions and misalignment after orthopedic treatment. The most widely used surgical technique is reamed nailing. This technique has the inconvenience of possible pain at the insertion site which usually disappears after ablation of the nail and also a compartment syndrome where reaming is a possible aggravating factor. CONCLUSION: Nailing is a reliable technique for the treatment of tibial fractures with an intact fibula. Weight bearing should be encouraged as early as possible. The indication for a locked nail depends on the anatomic type of the tibial fracture and its localization. Immediate weight bearing should be recommended. Strict surveillance allows dynamization with fibulotomy in case of late consolidation. Prospective randomized studies comparing nailing with other therapeutic methods are needed to confirm these data.

Adult↗
PubMed1995

[Multifascicular intramedullary nailing of the forearm].

PURPOSE OF THE STUDY: Purpose of the study was to present the advantages of intramedullary nailing of long bones for treatment of fractures of the forearm. These advantages are 1) preserving the fracture-hematoma and 2) non exposure of bone. This technique is based on the technique of bundle nailing developed by Hackethal (1959). MATERIAL AND METHODS: In a 16-year period we performed Hackethal bundle nailing in 94 patients with 159 fractures. Hackethal developed the nailing procedure named after him in 1959. The rationale of Hackethal nailing is based on elastic jamming, which can only be achieved by following four rules: jamming of the nails in the cortical window, jamming then in the waist of the medullary cavity, spreading the bundle of nails in the metaphysis and filling up the conus of the medullary cavity with short nails. We confined Hackethal nailing to closed and first-degree open fractures of the midshaft of the forearm. If closed reduction and nailing were impossible, we performed a plate fixation (AO). Second- or third-degree open fractures were treated with external fixators. RESULTS: In 62.8 per cent patients surgery was performed within the first 8 hours following admission. We used two or three nails passing the fracture and one short nail. Except for 1 case, in which a cast was necessary, we achieved rotational stability. On average, the nails were removed after 11.5 months. The healing and complication rates were assessed by follow-up examination of 77 patients. The results were excellent and good in 75.3 per cent patients, satisfactory 14.3 per cent and poor in 10.4 per cent. Complications consisted of a 0.74 per cent infection rate (osteitis), 2.2 per cent non-union, 1.5 per cent with a synostosis, 0 per cent refracture and 2.2 per cent migration of nails, combined with tendon rupture. We have seen 1 case with metallosis. DISCUSSION: There are four important benefits of this treatment. First with this principle bone healing is achieved after 2.6 month, but with the plate fixation it lasts 7.5 month. Second, the rate of non-union goes down from almost 6 per cent to 1.5 per cent. Third, the postoperative infection rate is reduced (0.74 per cent) and fourth joint motion is preserved. Our bad results are mainly caused by the polytraumatic conditions of some patients. CONCLUSION: In conclusion with our confined spectrum of indications Hackenthal nailing is a low-risk method, which leads to rotational stability and early bone healing.

Adult↗
PubMed2004

Nail beauty.

Nail beauty depends firstly upon nail health. It is a truism to say that a beautiful nail is always a healthy nail. In addition, there are subjective and evolving aspects of nail beauty which are related to fashion. The texture of the nail affects its appearance and function. Soft or brittle nails are fragile. This results in unattractive longitudinal and horizontal splitting. Fragility is encouraged by wet work and excessive nail manicuring, especially by the removal of nail cosmetics. Critical to the aesthetic appeal of the nail is its shape. Most pleasing are nails are those that conform to the 'magic' ratio, in which the nail's length is approximately equal to its breadth, especially for the thumbs. The role of nail decoration and nail art in nail beauty is a subjective and evolving question of fashion.

Journal Article↗
PubMed2000

[Failure of locked centro-medullary nailing in pseudarthrosis of the humeral diaphysis].

PURPOSE OF THE STUDY: The aim of this work was to assess results after treatment by nailing of nonunion of the humeral shaft. In particular, we focused on consolidation and factors predictive of failure. MATERIAL AND METHOD: A prospective study was conducted in 13 consecutive patients presenting aseptic nonunion of the humeral diaphysis. There were five cases after orthopedic treatment and eight cases after internal fixation. Two patients had iterative nonunions. Locked nailing was performed with three successive types of nails: the Seidel nail in four cases, the Russel Taylor nail in seven, and the ACE nail in two. Anterograde nailing was used for the first three cases and retrograde nailing for the others. All patients were followed regularly in our department. Last follow-up was one to seven years after nailing. RESULTS: Five nonunions (38%) did not consolidate after locked nailing. Consolidation was achieved in the other patients after four to 18 months. The anatomic result was good in these patients. Between the success and failure groups, there was no significant difference in age, gender, type of fracture, first intention treatment, delay from fracture to nailing, type or diameter of the nail, surgical access or not to the fracture site during nailing, or duration of complementary fixation. Anterograde nail insertion, used in our first three patients in this series, appeared to affect shoulder function. The retrograde route was used in other patients and did not appear to have any impact on the elbow itself or the elbow region. DISCUSSION: This clinical study was unable to identify clinical factors explaining failures but did provide several arguments suggesting that defective primary stability of the initial fixation could be incriminated in the failures. CONCLUSION: Centromedullary locked nailing is a simple technique with potential for resolving difficult problems of nonunion. Good functional outcome can be obtained when consolidation is achieved. Rather than abandoning this technique, it would be advisable to conduct further research to determine what factors are determinant in its failures.

Adult↗
PubMed2001

[Intramedullary fixation of humerus shaft fractures. An analysis of complications of 2 implants with special reference to outcome after management with the unreamed humerus interlocking nail].

INTRODUCTION: Operative treatment of humeral shaft fractures has gained a new impetus with the development of intramedullary interlocking systems for the humerus. Because of the anatomical structure of the humeral marrow cavity, a regular jamming of nail into bone is not to be expected, so that the stability of these systems needs to be achieved through an interlocking mechanism. Among the commercially available interlocking nailing systems the unreamed humeral nail (UHN) and the Seidel-nail (SHN) can be regarded as the standard implants. DESIGN: In a retrospective study comparing two groups of patients, each treated with one of the two systems, problems and advantages, as well as disadvantages were analyzed, and the complications inherent in the systems examined. PATIENTS: Between 1988-1992, 47 patients with humeral shaft fractures were treated with a Seidel interlocking nail: 25 acute and 18 pathological fractures as well as 4 non-unions (Group 1). Between 1997-1999, 34 patients with humeral shaft fractures were treated with the unreamed humeral nail (UHN). A total of thirty-five (n = 35) nailings (30 acute and 4 pathological fractures, as well as one re-osteosynthesis after emergence of a non-union) were carried out. Three primary palsies of the radial nerve ensued: two with loss of sensitivity, and one complete paralysis (Group 2). METHODS: Based on pre- and postoperative X-rays and follow-up examinations, the healing process and complications inherent in each of the systems were evaluated. RESULTS: Intra-operative complications of Seidel-nailing (Group 1) were seen in 5 cases: failure of the proximal target device in 2 (4.2%) cases; the breaking of the long screwdriver during the distal locking in 1 (2.1%) case; blockade of nail-insertion due to the spreading distal lamellas in 1 (2.1%) case; in 1 (2.1%) case it was impossible to find the imbus of the distal locking screw with the screwdriver. Incorrect surgical technique resulting in further fragmentation of the shaft required revisions in 2 (4.2%) cases. In 3 cases (6.4%), the insertion of the nail was insufficient, so that an impingement resulted. In 12 cases, postoperative complications after Seidel-nailing resulted: 3 (6.4%) radial nerve palsies, of which 2 (4.2%) were transitory; 3 (6.4%) infections; in 3 (6.4%) cases, loosening of the locking bolt inserted in the frontal plane; in 1 (2.1%) case, loosening of the distal spreading screw. The system failed in treating 2 (of 4) non-unions, whereas successful ossification and repair occurred in all acute fractures. In Group 2 (UHN) the acute fractures of 33 cases healed without complications. Intra-operative complications of the unreamed nail: in 2 cases (5.6%), failure of the target devices resulted in malpositoning of interlocking screws. The following intra-operative complications of the retrograde technique were observed: burst of a fragment at the insertion site in 1 case (2.8%); intra-articular positioning of the most proximal interlocking screw in another case (2.8%). Postoperative complications of the unreamed nail: breaking of a proximal and a distal interlocking screw in 1 case (2.8%), which had no influence on the healing progress. In 1 case (2.8%) both proximal interlocking screws came loose and a non-union ensued. After re-osteosynthesis with the same technique, bony repair was achieved. CONCLUSION: The possibilities of operative methods in treatment of humeral shaft fractures are enhanced by intramedullary interlocking systems. Comparing with the Seidel nail, the unreamed humeral nail (UHN) has two advantages: it can be inserted anterogradely as well as retrogradely, and it provides the possibility of compressing the fracture, resulting in a high rotational stability. Due to these results, the application of the UHN is recommended.

Adult↗