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PubMedDate not supplied

Mechanical study of the safe distance between distal femoral fracture site and distal locking screws in antegrade intramedullary nailing.

OBJECTIVE: To determine the safe distance for distal femoral fractures relative to the distal locking screws in antegrade intramedullary femoral nailing using a currently available titanium alloy nail design. DESIGN: Cyclic (fatigue) mechanical testing study. SETTING: Biomechanics laboratory. INTERVENTION: Intramedullary nailing of left synthetic fiberglass composite femora with type 32/33-C fractures at 1, 2, 3, and 4 cm from the more proximal of the distal locking screws. MAIN OUTCOME MEASUREMENT: The number of loading cycles to failure of the nail. RESULTS: A load level of 700 N through the femoral mechanical axis was validated as adequate to cause fatigue failure within 200,000 cycles in slotted stainless- steel nails. In the nonslotted titanium alloy nails, this load level caused failure in only 1 of 3 nails with a fracture at 2 cm from the more proximal of the 2 distal locking screws and in 2 of 3 nails with a fracture at 1 cm from the more proximal of the 2 distal locking screws. All of the other nails did not fail >1 million cycles. CONCLUSIONS: Under laboratory conditions, it is safe to assume that an antegrade titanium alloy nail will survive 1 million compression/bending cycles when the fracture is > or = 3 cm from the more proximal of the 2 distal locking screws.

Biomechanical Phenomena↗
PubMed2005

Subungual exostosis: a review of 16 cases focusing on postoperative deformity of the nail.

We reviewed the clinical features of 16 patients who underwent surgery for subungual exostosis, focusing on postoperative deformity of the nail. In 7 patients, the lesion did not destroy the nail bed and was excised with a fish-mouth-type incision. In 9 patients, the lesion destroyed the nail bed and was excised with a direct approach. In 5 of the 9 patients, artificial skin was applied after excision of the tumor because the defect of the nail bed was large. Good postoperative appearance of the nail was obtained by a fish-mouth-type incision when the tumor did not destroy the nail bed, although 2 patients had local recurrence. Onycholysis occurred postoperatively when the tumor destroyed the nail bed and the defect of the nail bed was large after excision of the tumor. Secondary nail bed reconstruction may be indicated in such cases with postoperative deformity of the nail.

Adolescent↗
PubMed1992

Pharmacokinetics of terbinafine in the nail.

Oral terbinafine is an effective therapy for dermatophyte onychomycosis, presumably because it reaches the infected areas of the nail rapidly and in fungicidal concentrations. For planning optimal clinical dosage regimes, it is necessary to know the rate of terbinafine movement through the nail plate, the concentrations achieved, and the persistence in the nail plate after stopping treatment. In a study of 12 patients receiving terbinafine at 250 mg/day for up to 48 weeks, measurement of terbinafine in distal nail clippings demonstrated that the drug was first detectable 3-18 weeks after starting therapy. A level of 0.25-0.55 ng/mg was quickly achieved and remained stable. Concentrations of terbinafine in distal clippings of unaffected nails were similar to those in affected nails. Although the average nail concentrations are within the fungicidal range for dermatophytes, the anatomy of an infected nail may result in relatively protected areas of infection. This results in the occasional persistence or recurrence of dermatophytic infection observed in some cases. However, the results of this study justify further trials of 'short-term' oral terbinafine therapy for onychomycosis. A current study is addressing the relationship of oral dosage to nail drug concentration and its later persistence in the nail plate.

Antifungal Agents↗
PubMed1994

Determinants of nail thickness and length.

The determinants of final nail thickness and length at its point of detachment at the onychodermal band were studied in 20 normal great toe-nails, removed after injury, by correlating measurements of nail thickness, taken at six anatomical points, with length of nail and its lunular (matrical) and ventral nail components. Final nail thickness at the onychodermal band was related to initial thickness of the proximal matrix, and independently to the lengths of the lunula and ventral nail, but not to final nail length. There was an increase in nail thickness with age, particularly in the first two decades; this appeared not to be due to a decrease in frictional loss of nail.

Adolescent↗
PubMed2005

Nail biopsy: assessment of indications and outcome.

BACKGROUND: For years, nail biopsy has been shunned as a difficult and scarring procedure, which is seldom required in day-to-day practice. Only a few studies with a limited number of patients have been carried out to assess its utility in dermatology. METHODS: We studied 270 patients with nail disorders (both infectious and noninfectious). In 205 cases, the clinical diagnosis could be confirmed with the help of routine diagnostic aids, in the form of potassium hydroxide preparation, fungal culture, and biopsy of associated skin lesions. In the remaining 65 cases, various types of nail biopsies were carried out after ruling out contraindications to nail surgery. RESULTS: Overall, the histopathologic changes were found to be diagnostic in 63% of cases. Findings were more characteristic in infectious disorders of the nail unit. The diagnostic yield varied with the type of biopsy procedure. Side effects in the form of scarring and nail dystrophy were seen in 29.2% of the patients. DISCUSSION: Nail biopsy is useful, especially in cases with isolated nail involvement, an absence of skin lesions, and disorders such as twenty-nail dystrophy. It should be advocated in cases in which the routine diagnostic procedures fail to yield results. Proper selection of cases, choice of biopsy technique, and attention to the surgical procedure help in minimizing the side effects associated with the procedure. CONCLUSION: Nail biopsy was found to be a simple, safe, and useful procedure, especially in cases in which the clinical diagnosis is otherwise obscure.

Adult↗
PubMedDate not supplied

Reconstruction of the great toe ski-slope, sunken-nail deformity with a buried adipofascial flap.

Development of a ski-slope deformity following loss of the great toe nail plate is a problematic condition with few conservative or surgical options available. The condition becomes more difficult to treat when the distal, medial, and lateral labial nail folds are hypertrophied, creating the appearance of a sunken nail. We present a case of ski-slope, sunken-nail deformity following multiple attempts at chemical nail matrixectomy. The patient's persistent pain and deformity were managed through 1) nail plate avulsion and complete surgical excision of the germinal nail matrix, 2) remodeling of the distal phalanx, and 3) elevation of an adipofascial flap from the plantar tuft of the great toe, which was brought from plantar to dorsal and interposed between the dorsal aspect of the distal phalanx and the overlying nail bed in buried fashion. The combination of these procedures elevated the nail bed, which restored normal architecture to the great toe and relieved the pain associated with the chronic deformity. This case demonstrates a potential complication of a commonly performed procedure and a salvage technique useful for dealing with the resultant ski-slope, sunken-nail deformity.

Adult↗
PubMed2004

Biomechanical and clinical effects of adding interfragmentary wiring to locked nailing for humeral nonunions.

BACKGROUND AND PURPOSE: The use of locked nailing for the treatment of humeral nonunions is threatened by the potential of initial instability which may result in residual fracture gap and motion and is detrimental to fracture healing. This study investigated the biomechanical and clinical effects of adding interfragmentary wiring to reduce the initial instability in the treatment of humeral nonunion. METHODS: The biomechanical study compared the mechanical properties of 3 fixation methods: locked nail alone, with staple, and with interfragmentary wiring. Composite humeri were transected to simulate nonunion and were retrograde nailed. Nail-bone constructs were examined by non-destructive bending tests and destructive torsional tests. The initial instability, fixation stiffness and strength were measured and compared. The clinical study compared 21 nonunions treated by locked nailing alone and 30 nonunions treated by locked nailing with interfragmentary wiring. The indication for wiring was persistent nonunion gap or motion during operation. The union rate, time to union, functional recovery of the adjacent joints and the time for functional recovery were compared between the treatment groups. RESULTS: Biomechanically, in both bending and torsional tests, locked nailing with a staple or wiring resulted in significantly less initial instability than locked nailing alone. Test results for bending stiffness, torsional stiffness, or torsional strength did not differ significantly among the 3 fixation methods. In the clinical study, interfragmentary wiring had the advantage of providing tight nonunion compression, which was beneficial for nonunion healing and promoted early postoperative exercise. Patients treated with locked nailing with interfragmentary wiring had significantly shorter time to union and faster shoulder functional recovery (p < 0.05). CONCLUSIONS: Adding interfragmentary wiring was an effective and safe procedure in humeral nonunions treated with locked nailing.

Biomechanical Phenomena↗
PubMedDate not supplied

Anterior knee pain after intramedullary nailing of a tibial shaft fracture: an ultrasound study of the patellar tendons of 36 patients.

OBJECTIVES: Chronic anterior knee pain is a common complication following intramedullary nailing of a tibial shaft fracture. The etiology of pain is often not known. This study sonographically examined the patellar tendons of patients with a nailed tibial shaft fracture. DESIGN: Prospective study. SETTING: University hospital. PATIENTS: Fifty consecutive patients with a nailed tibial shaft fracture were initially included in the study. Thirty-six of them could be measured at an average of 2.5 +/- 0.5 years after nail insertion (1.0 +/- 0.3 years after nail extraction). INTERVENTION: Reamed intramedullary nailing with 2 interlocking bolts at both ends of the nail (Grosse-Kempf-nail, Howmedica). MAIN OUTCOME MEASUREMENTS: The ultrasound investigation of the patellar tendons of the 36 patients. RESULTS: Twelve (33%) patients were painless and 24 (67%) patients had anterior knee pain at follow-up. With the reference to the mean difference in the thickness of the distal part of the patellar tendon in the operated limb versus nonoperated limb, the result was 1.4 +/- 1.1 mm in the chronic pain group and 2.6 +/- 2.5 mm in the painless group (P = 0.135, [95% confidence interval for the group difference = -0.4-2.8]). The corresponding values for the proximal part of the patellar tendon was 1.4 +/- 1.3 mm in the chronic pain group and 2.3 +/- 2.3 mm in the painless group (P = 0.251, [95% confidence interval for the group difference = -0.7-2.4]). There were no statistically significantly differences between study groups in the blood circulation of the patellar tendon or at the entry point, calcification of the patellar tendon, granulation tissue at the entry point, or occurrence of low echo areas in the patellar tendon. CONCLUSION: After intramedullary nailing of a tibial shaft fracture, patients with or without anterior knee pain show similar changes in the ultrasound investigation of their patellar tendons. Based on those findings, it does not appear to make any difference as to the approach used (paratendinous or transtendinous) for intramedullary nailing of the tibia.

Adult↗
PubMed1991

Fungal infections of the nail.

Onychomycoses represent the most frequently seen nail diseases and are the most difficult to treat of all skin mycoses. They are rare in children and increase in incidence with age. Most cases are caused by dermatophytes, in particular by Trichophyton rubrum, less frequently by T mentagrophytes and Epidermophyton floccosum. Molds may secondarily infect nails already diseased; however, some are probably capable of primary invasion of nail tissues. Yeasts, particularly Candida albicans, are mainly isolated from fingernails in chronic paronychia and onycholysis, and from nails in chronic mucocutaneous candidosis. Mixed infections by dermatophytes, molds, and/or yeasts are not uncommon. Probably, most fungi cannot infect a healthy nail organ, and only predisposing factors such as impaired blood circulation, peripheral neuropathy, diabetes mellitus, damage from repeated minor trauma, and limited immune defects as well as AIDS make the nail susceptible to fungal infection. Most onychomycoses are secondary to a mycosis of the adjacent skin. Distallateral subungual onychomycosis starts at the hyponychium spreading proximally to the nail bed and matrix. In proximal subungual onychomycosis, the fungus infects the cuticle and eponychium to reach the matrix where it becomes enclosed into the nail plate substance. Total dystrophic onychomycosis may result from either form or develop in chronic mucocutaneous candidosis. Superficial white onychomycosis is commonly a culture of T mentagrophytes on the surface of a toenail. Mycotic paronychia and onycholysis are usually due to C albicans. Clinically, onychomycoses have to be differentiated from noninfectious onychodystrophy, nail psoriasis, lichen planus unguium, and chronic nail eczema. Despite a considerable number of effective antifungal drugs, treatment has remained difficult because the predisposing factors are usually not amendable to therapy.

Antifungal Agents↗
PubMed1990

Mechanics of intramedullary nails for femoral fractures.

Biomechanical studies were carried out to assess the function and performance of intramedullary (IM) nails for femoral fractures. An appropriately sized femoral IM nail with a radius of curvature of about 109 cm would most closely match the anterior bow of most human femora. A number of parameters can interact to result in bursting of the femur during insertion of the nail. These include mismatch in curvature of the nail and femur, high stiffness in bending, and poor location of the starting hole. An anatomic starting position for the IM nail is just medial to the greater trochanter and anterior to the pyriformis recess. Moving anterior to the midline of the femur significantly increases the potential for bursting the femur during insertion of the nail. Other factors can decrease the force of insertion of the IM nail in the femur. These include overreaming, shortening the axial length of the fracture component, and use of a nail of lower bending rigidity. IM-nail-fixed femoral shaft fractures with locking bolts can be expected to have about 75% the rigidity of the intact femur in bending and can support about 400% of normal body weight (= 70 kg). Slotted IM nail/femur constructs have only about 3% the rigidity of the intact femur in torsion, while an unslotted (closed) section implant produces constructs with about 50% the rigidity. The distal locking bolts increase the torsional rigidity and maximum axial load capacity of the construct, and reduce the potential for shortening and the residual deformation upon release of a torsional load. Two distal bolts reduce the toggle of the nail in the femoral shaft.(ABSTRACT TRUNCATED AT 250 WORDS)

Biomechanical Phenomena↗
PubMed1988

Intramedullary fixation of subtrochanteric fractures with the Williams Y-nail: report of three cases.

Küntscher Y-nailing is indicated for unstable proximal fractures of the femur in the elderly (5-7,10). The Williams modified Y-nail is an interlocking Y-nail that was designed to extend the indications beyond those of the Küntscher Y-nail. The Williams Y-nail was employed in three cases of subtrochanteric and subtrochanteric-intertrochanteric fractures, including one case in which there was an ipsilateral femoral shaft fracture. This procedure requires reaming and interlocking which are not performed in classic Küntscher Y-nailing. At follow-up (14-month minimum), each patient had a good clinical result and radiographic healing. Leg length shortening (maximum, 1.5 cm) occurred in two of three cases, primarily as a result of the failure to employ either a proximal or a distal interlocking screw. No other deformities have been observed. Williams Y-nailing can extend the indications of the Küntscher Y-nail to include rotationally unstable subtrochanteric fractures and associated ipsilateral femoral shaft fractures. The increased technical demands of the Williams modified Y-nail warrant cautious use depending upon the complexity of the fracture. Used properly, the Williams Y-nail may reduce the incidence of rotational and leg length deformities often experienced with other commonly used devices for unstable subtrochanteric and ipsilateral trochanteric-diaphyseal fractures of the femur.

Aged↗
PubMed1985

Nail surgery.

Competence in nail surgery requires a full understanding of the anatomy and structural relationship of the parts of the nail unit. A further facility to delineate the nail components allows the dermatosurgeon to approach the nail unit surgically and to correct any of its parts. This review has been an attempt to introduce the principles of nail surgery and analyze in depth four office nail surgical techniques. The techniques of nail plate avulsion, nail bed and matrix biopsy, matricectomy, and lateral wall excision are the most commonly used surgical modalities of the nail. These four techniques will give the dermatosurgeon the tools to treat most surgical nail problems.

Bandages↗
PubMed1996

[The Staca nail-plate in the treatment of trochanteric fractures].

PURPOSE OF THE STUDY: The Staca nail-plate (SNP) is 32 years old. This implant was created by Descamp and Kerner from Nice in 1964. This study evaluates the experience with the SNP in two Orthopaedic Departments from Metz and Nancy Regional Hospitals, between January 1989 and July 1991. MATERIAL AND METHODS: This is a clinical and radiological retrospective study. Out of the 175 patients, 152 were reviewed at 3 months and 127 at more than 9 months. The radiological assessment was made by measuring the post-operative cervical angle, the position of the nail within the femoral neck, the inter-fragmentary distance and the distance between nail and femoral head cartilage. 175 trochanteric fractures (119 women and 56 men) had osteosynthesis with the SNP. The mean age was 79 years (range: 36 to 96 years). Only 29 patients were free of general associated pathology. The fracture was always traumatic. The right femur was involved in 97 cases. Following the Ender classification there were 87 stable and 88 unstable fractures (59 complex pertrochanteric, 19 inter and sub-trochanteric and trochantero-diaphyseal). RESULTS: Post-operative reduction was anatomical in 66 per cent and satisfactory in 89 per cent of cases. In three cases there was an acetabular protrusion of the nail, in two cases there was a varus reduction and fixation and in six cases the plate was not fitting correctly the diaphysis. The average per-operative blood-loss was 300 cc. There was one per-operative death and eight early post-operative deaths. Sitting was allowed 24 hrs, after surgery in 94 per cent of patients. 68 per cent of patients started walking within the first 15 days after surgery. There were 37 per cent general complications, mainly respiratory and urinary infections, but also 2 deep-vein phlebitis, with pulmonary embolism and death. 17 post-operative hematoma were noted, out of which two required surgery. The general mortality reached 15 per cent in three months and 22 per cent in nine months. 70 per cent of the patients were free of pain at 3 months and 78 per cent at 9 months, 65 per cent being able to walk without crutches. Nail acetabular protrusion was observed in 16 cases (3 in early post-operative period, 8 within three months and 2 between the third and the ninth month). The protrusion was related to the nail positioning in 11 out of the 16 cases. This complication required SNP removal in 7 cases, replacement of the SNP in 3 cases and total hip arthroplasty in two cases. Correct nail length assessment is the important step in order to avoid protrusion and has to take into account the interfragmentary distance after reduction (if any). A good per-operative nail impaction is mandatory. CONCLUSION: Compared to other implants (THS, DHS, Gamma-nail, Ender), the SNP gives comparable results and a stable fixation. The SNP is a reliable implant. The most common complication in our series is protrusion which required reintervention in 6.8 per cent of the cases. Currently we avoid this complication by a good per-operative nail impaction.

Adult↗
PubMed2001

[Callus development after bored and unbored femoral interlocking nailing. An experimental study].

This was a prospective randomized baboon animal study, the study protocol was approved by the ethical committee according to the international guidelines for animal research projects. In 8 animals a midschaft femoral osteotomy was stabilized with reamed femoral interlocking nailing and in 8 animals by unreamed locked femoral nailing. Polychrome sequence bone labeling was done 5 weeks postop. with calcein-green, 8 weeks postop. with xylenol-orange and 10 weeks postop. with oxytetracycline. 10 weeks postop. the animals were sacrificed, the femurs explanted and planimetric and epifluorescence histomorphometric evaluation of serial transverse sections were done. In planimetric histomorphometric evaluation in unreamed femoral nailing a mean endostal callus formation was recorded with 28.0 +/- 9.9 mm2 per section and in reamed femoral nailing with 11.5 +/- 5.0 mm2 (p < 0.001). Periostal callus formation was recorded in the unreamed group with 238.7 +/- 87.1 mm2 per section and in the reamed group with 142.1 +/- 71.9 mm2 (p < 0.001). In epifluorescence histological evaluation endostal as well as periostal callus formation was more extensive and earlier after unreamed than reamed femoral nailing. Endostal callus formation was found in all animals after unreamed femoral nailing, and was present in 2 out of 8 specimen in the reamed group. Also 1 out of 8 animals in the reamed group developed a non-union. Unreamed femoral nailing with low diameter interlocking nails proved to be safe regarding bone healing in this experimental model with obvious advantages both in amount and time course of callus formation compared to reamed femoral nailing. Based on this results unreamed femoral nailing techniques can be recommended for femoral fractures.

Animals↗
PubMed2000

Pharmacoeconomic analysis of ciclopirox nail lacquer solution 8% and the new oral antifungal agents used to treat dermatophyte toe onychomycosis in the United States.

BACKGROUND: Recently a novel topical nail lacquer, ciclopirox solution 8%, has been approved for the treatment of onychomycosis. OBJECTIVE: This was undertaken to determine the most cost-effective treatment for the treatment of dermatophyte onychomycosis of the toes in the United States in 2000. METHODS: The nature of the problem was defined. The drug comparators were ciclopirox nail lacquer, terbinafine, itraconazole (pulse), itraconazole (continuous), fluconazole, and griseofulvin. A decision analytic model that reflected the manner in which pedal tinea unguium is managed was produced. Studies that have evaluated the efficacy of the nail lacquer and the oral antifungal agents for this indication were identified. Appropriate studies were used in a meta-analysis to determine the mycologic and clinical response rates when the drug comparators are used for the treatment for toe dermatophyte onychomycosis. For each drug comparator a cost of regimen analysis was carried out. This is the sum of the drug acquisition cost, the cost of medical management, and the cost of managing adverse effects. Next, the expected cost of management was calculated, disease free days were determined, and a sensitivity analysis was conducted. RESULTS: For each comparator the meta-analytic average mycologic cure (MC) rate and clinical response (CR) rates were: ciclopirox nail lacquer (MC: 52.6 +/- 4.2%, CR: 52.4 +/- 9.0%), griseofulvin (MC: 41.1 +/- 20.4%, CR: 33.7 +/- 14.1%), itraconazole (continuous) (MC: 66.3 +/- 4.2%, CR: 70.3 +/- 4.2%), itraconazole (pulse) (MC: 70.8 +/- 5.7%, CR: 73.6 +/- 4.6%), terbinafine (MC: 77.2 +/- 4.0%, CR: 75.3 +/- 2.9%), and fluconazole (MC: 65.6 +/- 7.1%, CR: 66.5 +/- 11.7%). The cost of regimen for the drug comparators was: ciclopirox nail lacquer $325.2, griseofulvin $1413.1, itraconazole (continuous) $1410.2, itraconazole (pulse) $811.7, terbinafine $890.1, and fluconazole $966.8. The cost/mycologic cure rate and expected cost/expected symptom free day were, ciclopirox nail lacquer ($618.2, 1.69), griseofulvin $3438.2, 5.3), itraconazole (continuous) ($2126.9, 3.52), itraconazole (pulse) ($1146.4, 2.01), terbinafine ($1153.0, 2.14), and fluconazole ($1473.7, 2.10). The relative cost-effectiveness was ciclopirox nail lacquer 1.00, itraconazole (pulse) 1.19, fluconazole 1.24, terbinafine 1.27, itraconazole (continuous) 2.08, and griseofulvin 3.13. Sensitivity analysis indicated that ciclopirox nail lacquer was a cost effective alternative compared with the oral regimens of terbinafine, itraconazole (continuous), and griseofulvin when clinical response rate was used as the primary efficacy parameter. CONCLUSION: Ciclopirox nail lacquer solution 8% is a recent addition to the armamentarium of therapies available to the physician and patient for the treatment of onychomycosis. The nail lacquer is a cost effective agent compared with the oral antifungal therapies, terbinafine, itraconazole, fluconazole, and griseofulvin.

Administration, Oral↗
PubMed2003

Nail gun injuries among construction workers.

Pneumatic nail guns greatly increase worker productivity and are extensively used in wood frame building construction, with especially high use in residential construction. One surveillance report of nail gun injuries in Washington State has been published; however, other literature consists largely of case reports and case series in trauma journals. The major objective of the current study was to investigate the occurrence of nail gun-associated injuries among construction workers and to identify preventable work-related factors associated with these injuries. Nail gun-related injuries occurring among a cohort of 13,347 carpenters in Ohio who worked union hours during the time period January 1, 1994, until September 30, 1997, were identified by matching the cohort with workers' compensation claims made to the Ohio Bureau of Workers' Compensation. We also analyzed workers' compensation claims for North Carolina Home Builders Association members for the period July 1996-November 1999 to identify nail gun-related injuries. Analyses included stratified analyses of claims by nature and body part injured, calculation of nail gun injury rates, and analyses of free text descriptions of injuries. Overall, nail gun injuries were responsible for 3.9 percent of workers' compensation claims with 8.3 percent to 25.5 percent of claims involving paid lost work time. The overall rate of nail gun injuries (cases per 200,000 work hours) was 0.33 in North Carolina and 0.26 in Ohio, reflecting the greater concentration of wood frame construction workers in the North Carolina population studied. Higher rates of injury were observed for carpenters in North Carolina and among residential carpenters in Ohio. The predominant body part injured was the hands/fingers, with 80 to 89 percent of injuries being nail punctures. Analyses of free text information for puncture injuries found approximately 70 percent of injuries to occur during the framing/sheathing stage of construction. Our data suggest that approximately 69 percent of puncture injuries may be due to an inadvertent gun discharge or misfire, preventable in large part by the use of sequential triggers. Worker training and education also are important components of nail gun injury prevention.

Accidents, Occupational↗
PubMedDate not supplied

Prospective comparison of retrograde and antegrade femoral intramedullary nailing.

OBJECTIVE: To prospectively compare the results, function, and complications of antegrade and retrograde femoral nailing for femoral shaft fractures. DESIGN: Prospective, randomized. SETTING: Urban Level 1 trauma center. PATIENTS: One hundred consecutive femoral shaft fractures. Fifty-four nails inserted retrograde and forty-six inserted antegrade. INTERVENTION: Ten-millimeter antegrade or retrograde nail inserted for a femoral shaft fracture after reaming. OUTCOME MEASUREMENTS: A comparison of the outcomes after antegrade and retrograde nailing of the femur. Data were collected for analysis on comminution, set-up and starting point times, open grade, location of fracture, injury severity score, body mass index, time to union, knee pain and motion, hip and thigh pain, and nail to intramedullary canal diameter difference. A linear regression model was employed. RESULTS: Knee motion was 120 degrees in all but one knee in each group. The antegrade nailed femurs healed faster than those treated retrograde (A = 14.4, R = 18.1 weeks, p = 0.0496). More patients required dynamization for union in the retrograde insertion group (17 percent versus 5 percent, p = 0.10, NS). In a linear regression model, a nail-to-canal-diameter difference and retrograde nailing had an association with an increased time to union. Knee pain was equal in both groups; however, thigh pain was higher in the antegrade group (p = 0.0108). All of the antegrade nailed femurs healed (100 percent), and 98 percent (one nonunion) of the retrograde femurs healed after secondary procedures. CONCLUSIONS: Both antegrade and retrograde nailing yielded high union rates. Each insertion technique has its own advantages and disadvantages. The two insertion modes appear to be relatively equal for the treatment of femoral shaft fractures.

Adult↗
PubMed1989

Treatment of dermatophyte infection of the finger- and toe-nails with terbinafine (SF 86-327, Lamisil), an orally active fungicidal agent.

We report on the use of a new orally active fungicidal agent, terbinafine (SF 86-327, Lamisil) in the treatment of patients with dermatophyte onychomycosis. Twenty patients with toe-nail, and 10 with finger-nail infection received 250 mg of terbinafine daily: finger-nail infections were treated for 6 months and toe-nail infections for 12 months. All 24 patients who completed the course of therapy achieved mycological cure, as did two subjects who dropped out of the trial. All but two patients had clinically normal nails at the end of the study period. The mean time for mycological cure was 12.5 weeks for finger-nail infection, and 24 weeks for toe-nail infections. The time for a clinical cure with normal nails was 20.5 weeks for finger-nail infection, and 44 weeks for toe-nail infection. An exacerbation of pre-existing dyspepsia occurred in three of the six patients who did not complete the trial but there were no other significant adverse reactions.

Administration, Oral↗