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At least 577 records · Page 32Linked to original sources
PubMed2002

Experimental tinea unguium model to assess topical antifungal agents using the infected human nail with dermatophyte in vitro.

Therapy for onychomycosis is difficult because a complete cure requires long-term treatment. Although strong systemic antifungal drugs are potent enough to achieve a cure, they often have side effects. Therefore, one approach is to develop a new topical antifungal drug to act directly on the nail tissue. In this study, we developed a new in vitro model for assessing antifungal activity using the human nail. An O-ring was fixed with silicon bond to the dorsal surface of the nail. An antifungal agent applied to the surface will penetrate the nail tissue. The ventral side of the nail was placed on an agar plate inoculated with conidia of Trichophyton mentagrophytes. Nail specimens were infected with the fungi from the agar, and a clear fungal colony formed on the agar surrounding the nail on the fifth day of cultivation. After 14 days, the fungal colony in the control groups was shown to be expanding over the entire nail. The fungal colony in the group treated with sodium pyrithione had disappeared. Although the in vitro antifungal activity of sodium pyrithione has poor potency among the agents used, it showed remarkable antifungal activity, as assessed by image analysis. This model enables one to evaluate the activity of a topical antifungal agent that has penetrated human nail tissue, and it may facilitate research on a topical agent for onychomycosis.

Adult↗
PubMed1985

Glycosylation of nail in diabetics: possible marker of long-term hyperglycemia.

Fingernail samples from 32 patients with diabetes mellitus and from 26 non-diabetics were analyzed in order to determine the protein glycosylation rate in nail. Nail glycosylation was assayed by the thiobarbituric acid reaction. Blood was taken from both diabetics and non-diabetics at the same time for measurement of hemoglobin glycosylation. In non-diabetics, the protein glycosylation in nail and glycosylated hemoglobin were found to be 8.35 +/- 2.7 nmol fructosamine/mg nail and 2.24 +/- 0.45 mumol fructosamine/g hemoglobin, respectively. In diabetics, however, there was an extremely high glycosylation in both nail protein and hemoglobin: 16.0 +/- 7.35 nmol fructosamine/mg nail and 5.17 +/- 1.17 mumol fructosamine/g hemoglobin (p less than 0.001 for both). A significant correlation was found between nail glycosylation and glycosylated hemoglobin in diabetics (r = 0.923, p less than 0.001). Also, there was a correlation between diabetic fasting blood glucose and protein glycosylation in nail (r = 0.947, p less than 0.001). Our findings show that it might be useful in the investigation of microvascular complications of diabetes mellitus to evaluate the possibility of nail glycosylation providing a stable long-term measure of tissue glycosylation.

Adolescent↗
PubMed1995

Nail abnormalities in nondermatologic patients: prevalence and possible role as diagnostic aids.

BACKGROUND: Nail changes have traditionally been used as diagnostic aids. Their usefulness in general and predictive value in particular, however, is not known. OBJECTIVE: Our purpose was to survey nail changes and to clarify the potential of nail abnormalities to diagnose nondermatologic diseases. METHODS: The fingernails of 567 patients admitted to general medical and surgical wards were examined. The point prevalence rates were calculated on the basis of a binomial distribution. The results were compared with the diagnosis with logistic regression analysis correcting for age and sex. RESULTS: The most common findings were absence of lunulae (22.9% [19.5% to 26.6%]), white nails or apparent leukonychia (11.8% [9.3% to 14.8%]), and red lunulae (5.1% [3.5% to 7.3%]). The following significant associations were noted: pulmonary disease and clubbing (odds ratio[OR] = 4.1, 95% confidence interval [CI] = 1.7 to 9.5), hematologic disease and brittle nails (OR = 4.6, 95% CI = 1.6 to 13.7), hematologic disease and Terry nails (OR = 8.7, 95% CI = 2.7 to 27.0), gastrointestinal disease and pincer nails (OR = 33.6, 95% CI = 3.7 to 307.3), and gastrointestinal disease and subjective complaints (OR = 2.7, 95% CI = 1.4 to 5.0). CONCLUSION: Several significant associations were identified, suggesting that nail abnormalities can be diagnostic clues in the diagnosis of chronic nondermatologic diseases. An association between pincer nails and gastrointestinal disease has not been previously described.

Adolescent↗
PubMed2004

Nail disorders in hemodialysis patients and renal transplant recipients: a case-control study.

BACKGROUND: There is one published case-control study of nail disorders in hemodialysis patients. The nail changes that occur in renal transplant recipients have not been investigated specifically. OBJECTIVE: The aim of this study was to determine prevalence rates of nail disorders in hemodialysis patients and renal transplant recipients, and to investigate whether these nail pathologies are related to hemodialysis and renal transplantation. METHODS: One hundred and eighty-two hemodialysis patients and 205 renal transplant recipients were screened for the presence of nail disorders. The findings in these groups were compared with findings in 143 healthy individuals. RESULTS: One hundred and twenty-seven patients (69.8%) in the hemodialysis group and 116 patients (56.6%) in the renal transplant recipients had at least one type of nail pathology. Absence of lunula, splinter hemorrhage, and half-and-half nails were significantly more common in the hemodialysis patients than in the renal transplant recipients. Leukonychia was significantly more frequent in the renal transplant recipients than in the hemodialysis patients and controls. CONCLUSION: Hemodialysis patients and renal transplant recipients have higher rates of nail disease than the healthy population. Renal transplantation may reduce the frequencies of splinter hemorrhage and half-and-half nails. Interestingly, leukonychia increases significantly after renal transplantation.

Adult↗
PubMed2006

Treatment of transverse overcurvature of the nail with a plastic device: measurement of response.

BACKGROUND: Transverse overcurvature of the nail is a painful condition that has been treated by conservative and/or surgical methods. OBJECTIVES: We sought to evaluate the efficacy of a plastic device for treatment of transverse overcurvature of the nail and to use a practical method (plaster mold) to evaluate follow-up of nail widening during and after treatment. METHODS: Twenty-five patients with transverse overcurvature of the nail were treated with placement of a plastic device. Pain assessment was done on a monthly basis. Nail improvement was evaluated through photographs and measurement of widening by plaster molds. RESULTS: Relief of pain could be determined in almost 100% of the cases in a 3-month period. Widening of overcurvature of the nail occurred in all cases. The plaster mold allowed a practical measurement of improvement in nail shape. CONCLUSION: The plastic device is an effective, safe, noninvasive, and inexpensive treatment option for overcurved nails. The plaster mold is a practical method to evaluate improvement in nail shape.

Braces↗
PubMed1997

Cosegregation of open-angle glaucoma and the nail-patella syndrome.

PURPOSE: To evaluate two families ascertained only for the presence of glaucoma in which both nail-patella syndrome and glaucoma occur in several generations and to determine whether the two diseases are genetically related. METHODS: Ophthalmologic examinations and orthopedic examinations were performed. DNA samples from family members were screened with a microsatellite repeat marker at the argininosuccinate synthetase (ASS) locus at 9q34, and linkage analysis was performed. RESULTS: Six patients with open-angle glaucoma were found among 13 patients with nail-patella syndrome in family UM:47. Seven patients with glaucoma were found among 11 patients with nail-patella syndrome in family UM:65. In both families, all individuals with glaucoma also had nail-patella syndrome. Two-point linkage analysis resulted in a lod score of 2.98 at a recombination fraction of 0.00 for open-angle glaucoma and nail-patella syndrome. CONCLUSIONS: Linkage results presented here provide strong evidence that the orthopedic and nail anomalies in these two families result from the same nail-patella syndrome locus that has been previously linked to markers at 9q34. These data provide indirect evidence for a possible glaucoma locus at 9q34 and do not allow us to distinguish whether the glaucoma is the result of the nail-patella syndrome mutation or whether there is a separate locus responsible for glaucoma in these families. These studies suggest a need for ophthalmologic examination of individuals with nail-patella syndrome.

Aged↗
PubMed2004

Five years' clinical experience with the unreamed humeral nail in the treatment of humeral shaft fractures.

With the development of interlocking nail systems especially designed for the upper arm, standards for the operative treatment of humeral shaft fractures have appeared to change. The trumpet-like shape of the medullary cavity does not allow stable splinting with a nail alone, and therefore the bone--nail complex is commonly stabilized with interlocking bolts. Between June 1996 and June 2001, 51 fractures of the humeral shaft were treated operatively at the BG Unfallklinik Ludwigshafen with the unreamed humeral nail (UHN; Synthes). All nails were inserted by the retrograde technique. Ninety-five percent of the patients showed excellent or good shoulder function at follow-up examinations. For elbow function, 91.4% of the patients showed excellent or good results. Three out of four patients with poor elbow function had suffered from an additional injury to the brachial plexus; one patient developed heterotopic ossification. Intraoperative complications were: one iatrogenic lesion of the radial nerve, two intraoperative shaft fractures, one split at the insertion point, and one supracondylar fracture. As implants we used 7.5 mm nails in 36 cases and 6.7 mm nails in 15 cases. Among the 47 patients undergoing follow-up examinations, we found two cases of non-union. All patients were pain-free. Thirty-seven patients were very satisfied, six satisfied and four dissatisfied with the therapy. Decisive criteria for the use of a new implant are a high safety standard and simple reproducibility; these appear to be fulfilled by retrograde nailing of humeral fractures with the UHN. Interlocking nailing with the UHN enriches the range of therapeutic options for humeral shaft fractures.

Adolescent↗
PubMed1999

Is routine removal of intramedullary nails justified.

This study investigates the outcome of 100 cases of lower limb intramedullary nail removal. 12 femoral and 25 tibial nails were removed for pain and 4 tibial nails for infection. For 22 tibial nails and 38 femoral nails there was no recorded indication. There where 3 operative complications, 2 abandoned procedures and 1 tibial fracture (nail extraction without prior removal of the distal locking screw). In 9 out of 16 cases anterior knee pain improved after tibial nail removal. 4 patients, previously asymptomatic, developed anterior knee pain following tibial nail removal. 40 patients who were discharged without crutches returned in pain and had to be given crutches to alleviate leg pain. 62 patients took a mean of 11 days sick leave. We conclude that all complications were avoidable. Intramedullary nail removal is safe. Patients with anterior knee pain should be told that their pain may persist and that knee pain may even arise. Most patients will require crutches and an average of 2 weeks away from work.

Adult↗
PubMed2001

Mechanical boundary conditions of fracture healing: borderline indications in the treatment of unreamed tibial nailing.

Unreamed nailing favors biology at the expense of the achievable mechanical stability. It is therefore of interest to define the limits of the clinical indications for this method. The extended usage of unreamed tibial nailing resulted in reports of an increased rate of complications, especially for the distal portion of the tibia. The goals of this work were to gain a thorough understanding of the load-sharing mechanism between unreamed nail and bone in a fractured tibia, to identify the mechanical reasons for the unfavorable clinical results, and to identify borderline indications due to biomechanical factors. In a three-dimensional finite element model of a human tibia, horizontal defects were stabilized by means of unreamed nailing for five different fracture locations, including proximal and distal borderline indications for this treatment method. The loading of the bone, the loading of the implant and the inter-fragmentary strains were computed. The findings of this study show that with all muscle and joint contact forces included, nailing leads to considerable unloading of the interlocked bone segments. Unreamed nailing of the distal defect results in an extremely low axial and high shear strain between the fragments. The results suggest that mechanical conditions are advantageous to unreamed nailing of proximal and mid-diaphyseal defects. Apart from biological reasons, clinical problems reported for distal fractures may be due to the less favorable mechanical conditions in unreamed nailing. From a biomechanical perspective, the treatment of distal tibial shaft fractures by means of unreamed nailing without additional fragment contact or without stabilizing the fibula should be carefully reconsidered.

Biomechanical Phenomena↗
PubMed2006

[Retrograde locked nailing of humeral shaft fractures: a prospective study of 58 cases].

PURPOSE OF THE STUDY: Appropriate treatment for humeral shaft fractures remains a debated issue. Among the classical osteosynthesis techniques proposed, closed nailing was adapted to the humerus rather late, using the anterograde method. Use of retrograde nailing, which spares the rotator cuff, is more recent. The purpose of this study was to report outcome in 58 humeral shaft fractures in adults treated using the universal humeral nail between January 2000 and December 2003. MATERIAL AND METHODS: This work was limited to recent shaft fractures in adults with non-pathological bones. The fractures included were all situated between the insertion of the pectoralis major and a point situated 2 cm above the apex of the olecraneum fossa. The series included 58 patients with 58 humeral shaft fractures. All fractures were closed except four (Gustilo type I and II). Two patients presented preoperative radial paralysis which was not considered to be a contraindication for retrograde locking nailing. The paralysis recovered in both patients, after neurolysis performed during the nailing procedure in one. Osteosynthesis was performed without opening the fracture focus under fluoroscopic control using a static locking nail inserted retrograde in patients in the supine position. RESULTS: There were two early deaths unrelated to the method. Healing was obtained in the surviving patients within fifteen weeks on average. Bone healing was primary in 53 patients and after secondary compression in three. At last follow-up, shoulder motion was normal in 88% of patients and elbow motion in 91%. The Rommens functional score was good in 84%. Complications included three cases of spontaneously regressive postoperative radial paralysis, three cases of reflex dystrophy including two which regressed, and two cases of humeral palette fracture requiring surgical osteosynthesis. The proximal screws were removed in six patients because of pain or migration. To date, implants have been removed in three patients without problem. There were no infections. CONCLUSION: Retrograde insertion of this nail facilitates treatment of humeral shaft fractures by allowing immediate joint motion and the advantages of closed reduction: no infection, no late bone healing requiring conversion to another method of fixation. The residual technical problems concern proximal nailing and nail introduction.

Adolescent↗
PubMed2003

Intramedullary nails: some design features of the distal end.

Intramedullary nails are used to stabilise fractures of the proximal femur. The nail acts by transferring loads from the proximal fraction to the rest of the femoral shaft. The way in which this occurs depends to a large extent on the design of the distal end of the nail. This is not dissimilar to the situation with regard to load shedding (or load transfer) from the femoral component of a total hip replacement. A finite element model of a fractured femur with either a neck or a subtrochanteric fracture is set up to investigate the effects of nail length, nail distal stiffness and material stiffness on the structural behaviour of the system. Specifically what is considered is the influence of these parameters on the stress across the fracture and the normal pressure that the nail exerts on the endosteum of the femoral diaphysis. It is found that a longer nail could produce higher contact stress between the tip of the nail and the endosteum. Also, this contact stress is reduced when the distal region of the nail is made more flexible either by incorporating longitudinal slots or by using a material with a lower modulus of elasticity.

Bone Nails↗
PubMed2000

Keratin expression in the normal nail unit: markers of regional differentiation.

Differentiation within the nail unit was examined using a range of antikeratin monoclonal antibodies including the recently described antibody LHTric-1, specific to the acidic hair-type keratin Ha1. Keratinocytes of the nail matrix, nail bed and the digit pulp were characterized by different patterns of keratin expression. Nail matrix was the sole site of expression of Ha1, which colocalized in suprabasal matrix epidermis with epidermal keratins K1 and K10. Small amounts of K17 were found at the apex of the matrix in some cases. K6 and K16 were found where the epidermal surface folds forwards to become the ventral aspect of the proximal nail fold. The nail bed was distinguished by the absence of hair-type keratin Ha1 and the absence of markers of cornified epidermis and mucosal differentiation K1/K10 and K4/K13, respectively, while K6, K16 and K17 were detected. The basal keratin conformation marker, LH6, was expressed suprabasally throughout the nail bed. This complement of keratins exists in the nail bed in the absence of notable proliferative activity, and suggests a state of minimally developed differentiation which may be afforded by the physical or biological properties of the overlying nail. Keratins, K6, K16 and K17 were all found in the digit pulp in limited amounts, possibly in association with the epidermal component of the eccrine duct. The simple epithelial keratins, K7, K8 and K18, were found in small amounts in the specimens from younger individuals, mainly in epibasal cells of the apex of the matrix and in putative Merkel cells.

Cell Differentiation↗
PubMed2002

Nail involvement in pemphigus vulgaris.

BACKGROUND: Involvement of the nail unit in pemphigus vulgaris (PV) is thought to be rare. OBJECTIVES: To determine the frequency of nail changes among patients with PV. METHODS: Nail changes were recorded in patients with PV and were analysed retrospectively. Biopsies were taken from the nail bed and nail matrix for histological and immunofluorescence observations. Microscopic (potassium hydroxide) examination and fungal culture were performed. RESULTS: Nail changes were present in 30 of 64 (47%) patients with PV. Sixteen patients had onychomycosis and 14 had nail changes due to PV. These included onychomadesis, discoloration, deformity, onychorrhexis, onycholysis, subungual haemorrhage, subungual hyperkeratosis and paronychia. Onychomycosis affected fingernails and toenails, but changes due to PV occurred only in fingernails, most commonly on the thumb and index finger. No connection was found between the patient's occupation and nail involvement, and there was no correlation with the severity or duration of PV. In a control group of 64 patients of similar sex and age, only two had non-specific fingernail changes. CONCLUSIONS: Nail changes in PV may be more frequent than previously thought.

Adolescent↗
PubMed2006

Deformity correction by external fixation and/or intramedullary nailing in hypophosphatemic rickets.

BACKGROUND: There are many modalities of treatment for complex lower extremity deformity in hypophosphatemic rickets. We evaluated the outcomes of deformity correction using an external fixation and/or intramedullary nailing in hypophosphatemic rickets. PATIENTS AND METHODS: 55 segmental deformities (20 femora, 35 tibiae) from 20 patients were examined retrospectively. There were 9 children and 11 adults. Distraction osteogenesis was used in 28 segments and acute deformity correction in 27. External fixation was applied in 24 segments, intramedullary nailing in 6, and external fixation and intramedullary nailing in 25. RESULTS: There were 18 major and 13 minor complications in 26 of 28 segments with distraction osteogenesis, and 13 major and 10 minor complications in 19 of 27 segments with acute correction. Recurrent deformity or refracture occurred in 10 of 21 segments with distraction osteogenesis by external fixation only, 4 of 6 with acute correction by intramedullary nailing, and 1 of 25 with distraction osteogenesis or acute correction by external fixation and intramedullary nailing. Nail-related complications occurred in 3 of 6 with intramedullary nailing and 2 of 25 with external fixation and intramedullary nailing. INTERPRETATION: External fixation and intramedullary nailing can be recommended to prevent complications during or after deformity correction in hypophosphatemic rickets.

Adolescent↗
PubMedDate not supplied

Biomechanical comparison of stainless steel and titanium nails for fixation of simulated femoral fractures.

Flexible intramedullary nails are commonly used to treat femoral fractures in children. This study evaluated the biomechanical differences between stainless steel and titanium nails when securing transverse and comminuted fractures in a synthetic femur model. Retrograde flexible stainless steel and titanium nails placed in a divergent "C" pattern were mechanically tested, and axial rotation and compression stiffness were analyzed with a two-way ANOVA. Rotational stability was significantly greater for titanium nails than stainless steel nails for both fracture patterns. Axial compression stiffness was significantly greater for titanium nails than stainless steel nails for both fracture patterns. There was no statistical difference between materials for axial "failure" load that produced 5 mm of shortening. Titanium intramedullary nails were more stable than stainless steel nails in torsion and axial compression. Both materials stabilized simulated fractures at levels beyond physiologic non-weight-bearing loads without permanent deformation.

Biomechanical Phenomena↗
PubMed1992

Intramedullary nailing of the femoral shaft: a prospective, randomized study.

We conducted a prospective, randomized study on 84 consecutive patients with 88 acute, traumatic femoral shaft fractures using 32 Grosse-Kempf nails, 29 Russell-Taylor nails, and 27 Synthes nails. Although total operative times and proximal and distal locking times were similar for the three groups, the procedure was faster with the Grosse-Kempf nail. Three proximal fractures could not be locked with the Synthes nail. At first follow-up, we found no significant difference in terms of pain, limp, range of motion, or time to union; however, we removed fewer Synthes nails to resolve patient complaints of pain. Three delayed unions were attributed to fracture distraction. We conclude that all three nails are suitable for the treatment of almost all femoral shaft fractures. A careful analysis of intraoperative technique and instrumentation indicates that all three nails can be used safely and easily once experience is gained. Clinical outcome is similar regardless of the nail chosen.

Adolescent↗
PubMed2006

Intramedullary fixation of tibial shaft fractures using an expandable nail: early results of 54 acute tibial shaft fractures.

OBJECTIVE: To evaluate and present our experience using the expandable nail system for the treatment of acute tibial shaft fractures. DESIGN: Retrospective study. SETTING: Two level-1 trauma centers-University teaching hospitals. METHODS: Fifty-four consecutive patients were treated by this nail system for acute tibial shaft fracture. Two nail diameters were used, 8.5 mm and 10 mm. Operation, hospitalization and healing times, reaming versus nonreaming, isolated versus multiple injuries, and reoperations were recorded and analyzed statistically. RESULTS: Follow-up was obtained either until fracture healing or for a minimum of 1 year with an average of 14 months (12 to 24). All fractures healed in an average time of 72 days (21 to 204). The average healing times for patients treated with 8.5-mm and 10-mm nails were 77.2 days (27 to 204) and 63.4 days (21 to 121), respectively. Average operative time was 103 minutes (40 to 185) if reamed and 56 minutes (30 to 80) if unreamed. Average healing times were 65.4 days (21 to 190) if reamed and 79.5 days (42 to 204) if unreamed. There were 11 complications (20.4%) related to the nailing: 3 deep infections, 2 superficial infections, 2 bone shortenings of 1 cm secondary to nail protrusion in the knee, 1 compartment syndrome, 1 fracture propagation, 1 distal malalignment, and 1 delayed union. Hardware was removed in 6 patients (3 infections, 2 patients' request and 1 protrusion into the knee), and 1 additional patient underwent exchange nailing due to a delayed union. CONCLUSIONS: The expandable nail offers the theoretical advantages of improved load sharing and rotational control without the need for interlocking screws. This study demonstrates satisfactory healing and alignment for the treatment of tibial shaft fractures using this device. However, caution must be exercised when using this nail in cases of significant comminution and in cases where the fracture pattern involves the more proximal or distal aspect of the tibial shaft.

Adult↗
PubMed1998

Treatment of humeral shaft fractures with humeral locked nail and comparison with plate fixation.

OBJECTIVE: To report the experience of a newly devised humeral locked nail in treating acute humeral shaft fractures and to compare its effectiveness with that of plate fixation. DESIGN AND METHODS: Data were collected on 48 acute humeral shaft fractures in 48 consecutive patients treated with humeral locked nails and compared with retrospective data on 25 fractures in 25 other patients treated with dynamic compression plates. The operation time, amount of blood transfusion, time to union, complications, and functional recovery were recorded and compared. The average follow-up time was 20.5 months for the nail group and 33.3 months for the plate group. Student's t test and Fisher's Exact Test were used for statistical analyses. RESULTS: Locked nailing had significantly shorter operation time and less blood transfusion than did plate fixation, 68 versus 93 minutes and 0 versus 102 mL, respectively. Eventual union was achieved among all in the nail group and among all but one in the plate group. Union rate and time to union were not significantly different. In the plate group, three fractures had complications: one with implant loosening and nonunion, one with deep infection, and one with postoperative radial nerve palsy; the nail group had no complications. The difference in complication rates was statistically significant. In the nail group, one varus malunion and one intraoperative comminution occurred, without adverse consequences. Functional recovery was essentially the same in both groups for uncomplicated fractures. CONCLUSIONS: Humeral locked nailing offered a less invasive surgical technique and more favorable treatment results than did plate fixation. Correct nailing direction, precise surgical techniques, less bulky hardware, and stable transfixing screws are the keys to a successful treatment. Further prospective, randomized comparative study is warranted.

Adult↗