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At least 55 records · Page 3Linked to original sources
PubMed2002

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

Intramedullary nailing is widely used for the operative treatment of femoral fractures. Recently, the biologic healing of fractures has become better understood from fundamental investigations. However, there has been no clinical comparison between the fracture healing process with these two fixation methods. The purpose of this study was to use radiographs to compare callus formation with two types of intramedullary nailing for femoral shaft fractures: reamed interlocking (IL) nails and Ender nails. Femoral shaft type A fractures (AO classification) were studied. Twenty-seven fractures were treated with reamed IL nailing, and 81 fractures were treated with Ender nailing. The callus area was calculated from the maximum cross-sectional area on the anteroposterior and lateral radiographs. The callus appeared at a mean of 3.9 weeks after surgery in the IL group, and at a mean of 2.8 weeks in the Ender group ( P < 0.05). In the IL and Ender groups, fracture healing was noted at a mean of 3.4 and 2.0 months, respectively. The mean area of callus formation in the IL and Ender nailing groups was 439.5 mm(2) and 699.4 mm(2), respectively ( P < 0.02). Ender nailing results in abundant callus, which forms at an earlier stage after the procedure than in patients treated with IL nailing. Dynamization at the fracture site is reported to increase external callus formation. Our results indicate that the elasticity of the fixation obtained with Ender nailing promotes callus formation.

Adolescent↗
PubMed2005

Treatment of nail psoriasis with 8% clobetasol nail lacquer: positive experience in 10 patients.

BACKGROUND: Treatment of nail psoriasis is difficult. Several topical therapies have been employed with poor results because drug penetration is limited in this localization. Recently, a new formulation containing 8% clobetasol-17-propionate in a colourless nail lacquer vehicle has shown good results in the control of nail psoriasis. OBJECTIVE: To determine the efficacy and safety of 8% clobetasol-17-propionate in a lacquer vehicle in nail psoriasis. METHODS: Ten patients with both nail bed and matrix psoriasis were included in the study. They were treated with a colourless nail lacquer containing 8% clobetasol-17-propionate that was applied once daily for 21 days and then twice weekly for 9 months. RESULTS: Within 4 weeks of therapy there was a reduction of all the nail alterations, including nail pain. Therapeutic response was directly related to the length of therapy. The nail parameters that responded best to therapy were onycholysis, pitting and salmon patches. Subungual hyperkeratosis and splinter haemorrhages on the other hand had moderate and poor improvement, respectively. The treatment was well tolerated in all of the patients and there were no local (i.e. atrophy and sobreinfection) or systemic secondary effects. CONCLUSIONS: The formulation containing 8% clobetasol-17-propionate is a safe, effective and cosmetically highly acceptable treatment for nail bed and matrix psoriasis.

Administration, Topical↗
PubMed2002

Diseases of the generative nail apparatus. Part II: nail bed.

Nail bed insults may affect the resultant nail product in a number of ways. If focal in nature, the severity and duration of the insult will determine the appearance of the nail product. Widespread insults may alter the size, shape or colour of the nail plate. Nail bed insults tend to present with more immediacy than nail matrical insults, as there is no need to wait until the nail grows out until the sign is obvious. We are less interested in the history of the event, than we are with the clinical sign being presented to us. Should treatment be required for focal nail bed insults, treatment is likely to be local and curative. Widespread nail bed insults may be associated with systemic diseases and if a result of local problems these may be difficult to treat.

Australia↗
PubMed2006

Knee pain after tibial nailing: the role of nail prominence.

UNLABELLED: We analyzed the relationship between knee pain after tibial nailing and nail prominence. We identified 70 patients in our trauma registry with healed fractures initially treated with intramedullary nails. Subjective pain and function were measured with visual analog pain scales and Lysholm knee scores at a mean of 20 months after fracture. These scores were compared with nail prominence measured on postoperative radiographs. More than 49% of patients had knee pain. Subjective knee pain was more common in women and patients with a smaller plateau width. Anterior nail prominence was associated with increased pain at rest. Patients with superior nail prominence had increased pain with kneeling and walking. Nail prominence correlated with increased knee pain. We think surgeons can decrease, but not eliminate, the severity of knee pain after tibial nailing by burying the tip of the nail as reflected on lateral radiographs. LEVEL OF EVIDENCE: Prognostic Study, Level II-1 (retrospective study). See the Guidelines for Authors for a complete description of levels of evidence.

Adult↗
PubMed2005

Trochanteric gamma nail and compression hip screw for trochanteric fractures: a randomized, prospective, comparative study in 210 elderly patients with a new design of the gamma nail.

OBJECTIVES: To compare the results between a new intramedullary Gamma nail and a compression hip screw in the treatment of trochanteric fractures. DESIGN: Prospective randomized. SETTING: Level 1 trauma center. PATIENTS: Two hundred ten consecutive patients older than 65 years with trochanteric femoral fractures. INTERVENTIONS: Treatment with a compression hip screw or a new design of the Trochanteric Gamma nail (180 mm in length with a mediolateral angle of 4 degrees and available only with a proximal diameter of 17 mm and distal diameter of 11 mm). MAIN OUTCOME MEASUREMENTS: Operative and fluoroscopy times, blood loss, functional outcome, complication rate, and failure of fixation. RESULTS: The Trochanteric Gamma nail was used in 104 patients and the compression hip screw in 106. The 2 groups were similar in terms of their preoperative data, with a median follow-up of 13.6 months (range 12-30). The results show no difference in operating time (P = 0.21), but the Trochanteric Gamma nail group had a significantly shorter fluoroscopy time (P = 0.006), and the number of patients transfused and the mean of units of blood transfused were significantly less in the Trochanteric Gamma nail group (P = 0.013, 0.046, respectively). Mortality within 12 months was similar in both groups (P = 0.83). All fractures were radiographically healed at the last visit. There was no difference in intraoperative and postoperative complications or rate of fixation failure between the 2 groups, and no case of secondary shaft fracture of the femur was encountered in this study. In the entire series, there was no difference in the functional outcome (P = 0.74), but the postoperative walking ability was better in those patients with unstable fractures who were treated with the Trochanteric Gamma nail (P = 0.017). CONCLUSIONS: The new Trochanteric Gamma nail is an effective method for the treatment of trochanteric femoral fractures in elderly patients. The indication for either Trochanteric Gamma nail or compression hip screw is similar in stable fractures, but we recommend the use of the Trochanteric Gamma nail for unstable trochanteric fractures.

Aged↗
PubMed1991

Nail is produced by the normal nail bed: a controversy resolved.

Nail thickness and mass (dry weight/unit surface area) of 21 toenails, removed from 19 patients after accidental injury, were measured over the mid point of the lunula, at the nail plate immediately distal to the lunula and at the distal end of the nail bed. Nail thickness increased from 43% of the final thickness over the mid-point of the lunula to 81% at its distal margin, the remaining increase in thickness being formed by the nail bed. The changes in nail mass were comparable. We conclude that ventral nail produced by the nail bed comprises about one-fifth of the terminal nail thickness and mass.

Adolescent↗
PubMed2003

Management of femur shaft fracture with close locked intramedullary nailing: comparison of Variwall and predrilled Kuntscher nail.

A prospective and comparative study of 44 cases of close locked static intramedullary (IM) nailing of Femur shaft fracture with two nailing systems was done. Comparing the cheap predrilled Kuntscher nail with standard but expensive Variwall nail of Biomet Company England, we found almost equal result in both groups regarding complications and healing of the fracture. Average healing time in Variwall and Kuntscher nailing were 16.4 and 16.1 weeks respectively, P value being in-significant. In Variwall nailing, stable fractures healed at the average of 13.5 weeks and unstable fractures at 17.2 weeks; open fractures at 18.4 weeks and close ones at 14.2 weeks; fractures due to Road Traffic Accident (RTA) at 16.3 weeks, gunshot injury at 18.6 weeks and fractures due to fall at 14 weeks. Similarly in Kuntscher nailing these figures were 14 and 16.7 weeks; 19.6 and 14.5 weeks; 16.6, 22 and 13 weeks respectively. Pre-drilled Kuntscher nail with good quality cortical screws for interlocking is recommended for any variety of femoral shaft fracture. It is cost effective, at the same time gives acceptable result as compared to standard interlocking intramedullary nail.

Adult↗
PubMed2007

The modified Nail Psoriasis Severity Index: validation of an instrument to assess psoriatic nail involvement in patients with psoriatic arthritis.

OBJECTIVE: Patients with psoriasis and psoriatic arthritis (PsA) commonly have nail involvement. There is no validated psoriatic nail assessment tool. Recently, investigators developed the Nail Psoriasis Severity Index (NAPSI). Beginning with NAPSI, our goal was to validate a psoriatic nail assessment tool for use in clinical trials, and investigate correlations between nail and other PsA features. METHODS: Fingernails of 29 patients with PsA were photographed and scored. Clinical data were collected. Using the original NAPSI, analysis revealed high interrater variability of nail scores. Twenty patients' photographs were regraded using the modified NAPSI (mNAPSI). RESULTS: The mNAPSI scores had excellent interrater reliability (Cronbach's alpha 0.98). Nail scores and physicians' global nail severity visual analog scores showed good inter- and intrarater correlations (Spearman's rho 0.85 and 0.90-0.99, respectively; p < 0.01). Several clinical measures correlated with nail scores. CONCLUSION: The mNAPSI demonstrated excellent interrater reliability and construct validity, and may be a valuable tool.

Adult↗
PubMed1996

Treatment of unstable tibial fractures with interlocking nail versus Ender nail: a prospective evaluation.

BACKGROUND: For unstable tibial fractures, there are many methods of surgical treatment. The efficacy of the Ender nail and the interlocking nail in the treatment of such fractures is examined. METHODS: One hundred and seven cases of unstable tibial shaft fractures were collected for the prospective study. Randomly, 61 tibia were fixed with interlocking nails and 46, with Ender nails. The mean follow-up period was 30.5 (23 to 40) months. The results of the different treatments were compared. RESULTS: In the group with interlocking nails, the average blood loss was 265 cc; operation time was 61 minutes; hospital days were 10.4; and union time was 15.1 weeks for closed fractures and 17 weeks for Winquist-Hansen type III and IV fractures. In the group with Ender nails, the average blood loss was 135 cc, operation time was 32 minutes, hospital days were 8.3 days, and union time was 17.6 weeks for closed fractures and 22.5 weeks for Winquist-Hansen type III and IV fractures. Student t-test revealed statistically significant difference between the groups in all of the data described above. However, treatment with the different nails showed no significant difference in results for open type I and II fractures. CONCLUSIONS: Ender nail still has its superior usefulness in some aspects of treatment of less comminuted unstable tibial shaft fractures, but for the more comminuted unstable tibial shaft fractures, the interlocking nail is undoubtedly better used.

Adolescent↗
PubMed1996

[Analysis of implantation-induced nail deformation and roentgen morphometric studies as the principle for an aiming device for distal interlocking nailing without roentgen image intensification].

While working to develop a distal locking device, we analyzed distal nail position with reference to nail deformation and a radiographic-morphometric investigation. The amount and the direction of implant deformation in unslotted stainless steel unreamed tibial nails (Synthes) were analyzed. Measurement of implant deformation (3 translations, 3 angles) in the center of the distal transverse locking hole was performed with a 3D magnetic motion tracker system before and after nail insertion. Unreamed tibial nails (diameter 8 mm, n = 10; diameter 9 mm, n = 10) were inserted in paired human cadaver tibiae. The results showed lateral translations of -4.5 +/- 3.5 mm (mean and standard deviation, range 14.3 mm) and dorsal translations of -7.8 +/- 5.8 mm (mean and standard deviation, range 19.2 mm). Rotational deformations around the longitudinal axis of the nail were 0.3 +/- 0.7 degree (mean and standard deviation, range 2.4 degrees). The results showed, that a simple aiming arm, mounted on the proximal nail end, alone or even in combination with a large working channel (e.g. 10 mm in diameter), was not adequate to the aiming process. A radiographic-morphometric analysis was subsequently performed in 40 tibiae after experimental (n = 20) or clinical (n = 20) implantation of nails 8 mm and 9 mm in diameter. These measurements showed a relatively constant distance between the upper distal transverse hole and the anterior aspect of the tibia (average 12.3 mm and only a narrow range (7.6 mm). These data were the basis for the development of an aiming technique that exploits the relatively constant distance between the distal nail hole and the anterior aspect of the tibia. This aiming device is set at a distance of 12.3 mm from the anterior cortex, and the fine tuning is finally resolved by the use of a "working channel' 10 mm in diameter.

Biomechanical Phenomena↗
PubMed1994

[Intramedullary pressure in the femur during boring and nailing with modern compression interlocking nails--risk of fat embolism?].

Fat embolism syndrome occurs in only 0.9-4% of patients with long bone fractures and especially with intramedullary nailing. Earlier publications have shown that intramedullary manipulation, e.g. reaming and nailing, can produce high pressures of up to 1 bar. The design of the new non-slotted interlocking compressions nails seems to increase the pressure in the femoral cavity. We measured the intramedullary pressure during reaming of the marrow cavity and insertion of compression nails (OSTEO), using cadaver femora and a piezo pressure transducer. We simulated a proximal fracture and performed 30 drilling and 20 nailing procedures. On average we detected a maximum pressure of 0.26 bar during drilling and 0.63 bar during nailing. During reaming the pressure increased when the reamer had passed the narrow diaphysis and reached the metaphysis. When the tried to enlarge the femoral canal by pushing and pulling the reamer repeatedly we measured high pressure peaks. During nailing we detected short impulses lasting a few milliseconds. The results show that the new compression nail do not produce higher intramedullary pressure than slotted nails. It is possible to avoid a dangerous pressure level by using a careful operative technique.

Biomechanical Phenomena↗
PubMed2003

Longitudinal nail biopsy: utility in 20-nail dystrophy.

BACKGROUND: Twenty-nail dystrophy (TND) is an inflammatory disorder of the nail unit. It is frequently encountered in childhood and is believed to be a common clinical manifestation of several nail pathologies. Varying associations and histopathologic features have been reported previously. OBJECTIVES: To evaluate the clinical and histopathologic profile of TND and the utility of longitudinal nail biopsy (LNB) for the same. METHODS: Thirty-two consecutive patients with TND were screened clinically. The histopathologic features of skin and longitudinal nail biopsies were also evaluated. The efficacy of nail unit biopsy was thereby assessed. RESULTS: Young males in the 10- to 20-year-old age group were most commonly affected (52%). Alopecia areata was the most commonly associated dermatosis (22%). LNB revealed a specific diagnosis of either psoriasis or lichen planus in 52% of the cases, whereas the rest showed nonspecific histologic changes (spongiotic trachyonychia). Scarring was a major risk associated with LNB, as evident in 28% of the patients studied. CONCLUSIONS: These data reveal the clinical profile and common associations of TND. They also confirm the diagnostic utility of nail biopsy in TND patients and advocate this procedure in cases in which the clinical diagnosis is otherwise obscure. However, it cannot be recommended in the routine evaluation of patients with a relatively benign disorder such as TND. Furthermore, nail biopsy is proven to be a relatively simple and useful procedure.

Adolescent↗