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At least 631 records · Page 35Linked to original sources
PubMed1998

Treatment of clavicular aseptic nonunion: comparison of plating and intramedullary nailing techniques.

OBJECTIVE: The aim of this retrospective study was to investigate and compare the effects of plating and intramedullary nailing in the treatment of clavicular aseptic nonunion. METHODS: Thirty-three consecutive patients with middle-third clavicular aseptic nonunions with previous nonoperative treatment were treated by plating (13 patients) and intramedullary nailing (20 patients) with supplementary cancellous bone grafting. The indications for such treatment were middle-third aseptic nonunions without previous operative treatment and with local pain or tenderness, deformity, or neurologic complaint. The choice of plating or intramedullary nailing was according to the surgeon's individual preference. RESULTS: Twenty-nine patients were followed for at least 1 year (range, 1-7 years; median, 3 years; plating, 11; intramedullary nailing, 18). The union rate was 81.8% (9 of 11) for plating and 88.9% (16 of 18) for intramedullary nailing (p = 0.35, Fisher's exact test). The union period was 4.0 +/- 1.3 months for plating and 4.1 +/- 1.1 months for intramedullary nailing (p = 0.80, unpaired Student's t test). The complication rate was 27.3% (3 of 11) for plating and 11.1% (2 of 18) for intramedullary nailing (p = 0.21, Fisher's exact test). There were no significant differences in other parameters. CONCLUSION: Intramedullary nailing may have a higher union rate with a lower complication rate than plating (p > 0.05). At least in common situations, it is not inferior to plating. Whenever possible, therefore, intramedullary nailing should be used preferentially to treat clavicular aseptic nonunion without previous operative treatment. Nevertheless, both techniques have relatively higher nonunion rates in the treatment of clavicular nonunion than in the treatment of other long-bone nonunions. Gentle handling of surrounding soft tissues to reduce bony fragments should be strictly executed.

Adult↗
PubMed1999

Cortical revascularization after reamed and unreamed intramedullary nailing in the rabbit femur: a microangiographic histometric analysis.

BACKGROUND: Intramedullary nailing leads to a reduction in cortical bone blood flow. The relative effect of reamed versus unreamed nailing on the degree of avascularity and on revascularization of the cortex remains controversial. We compared the effects of reamed versus unreamed intramedullary nailing on cortical revascularization and the time course for its recovery in the unfractured rabbit femur. METHODS: A total of 56 New Zealand white rabbits were used as experimental animals. Reamed nailings with Kirschner wire (diameter, 3 mm) were performed in the right femora (group R, n = 49), and unreamed nailings with Kirschner wire (diameter, 2 mm) were performed in the left femora (group UR, n = 49) of the same animals after a standard surgical procedure. Microangiography that used Indian ink was performed for each killed animal at one of seven postoperative time periods: 2 hours, 3 days, and 1, 2, 3, 4, and 5 weeks after surgery. The right femora and the left femora of seven rabbits were used as the postoperative day 0 controls of group R and those of group UR, respectively. We evaluated the vascularization ratio (VR) in cross-sections according to the following formula: VR = the number of enhanced vessels with Indian ink/total cortical vessels. Each cross-section was divided into an inner and outer half, which were in turn divided into quarters, so that the entire cross-sectional are is represented by eight regions. The VR was calculated for each regions and then comparison was made between group R and group UR at various time periods and areas. RESULTS: No statistically significant differences were observed in VR at any time period between group R and group UR in total cortical area and total periosteal side. However, on the total medullary side, the VR of group UR was significantly higher than that of group R at postoperative day 3 (p = 0.04). Statistically significant differences were observed between the VR on the periosteal side and that on the medullary side in both groups at all time periods aside from the 5-week period (p < 0.05). Revascularization of the cortex occurred 4 weeks after intramedullary nailing in both group R and group UR. CONCLUSION: The periosteal circulation was maintained better than the medullary circulation, irrespective of whether the canal was reamed or not. The present study failed to detect any statistically significant differences in cortical revascularization between reamed nailing and unreamed nailing. Thus, we concluded that reamed and unreamed nailing are not differentially advantageous in the unfractured rabbit femur, in terms of impairment of cortical blood supply.

Angiography↗
PubMed2003

Nail gun injuries in residential carpentry: lessons from active injury surveillance.

OBJECTIVE: To describe circumstances surrounding injuries involving nail guns among carpenters, calculate injury rates, identify high risk groups and preventive measures. METHODS: and setting: Active injury surveillance was used to identify causes of injury among a large cohort of union residential and drywall carpenters. Injured carpenters were interviewed by experienced journeymen; enumeration of workers and hourworked were provided by the union. The combined data allowed definition of a cohort of carpenters, their hours worked, detailed information on the circumstances surrounding injuries, and identification of preventive measures from the perspectives of the injured worker and an experienced investigator. RESULTS: Nail guns were involved in 14% of injuries investigated. Ninety percent of these injuries were the result of the carpenter being struck, most commonly by a nail puncturing a hand or fingers. The injury rate among apprentices was 3.7 per 200 000 hours worked (95% confidence interval (CI) 2.7 to 4.9) compared with a rate of 1.2 among journeymen (95% CI 0.80 to 1.7). While not always the sole contributing factor, a sequential trigger would have likely prevented 65% of the injuries from tools with contact trip triggers. CONCLUSIONS: Training, engineering, and policy changes in the workplace and manufacturing arena are all appropriate targets for prevention of these injuries. Use of sequential triggers would likely decrease acute injury rates markedly. Over 70% of injuries among residential carpenters were associated with through nailing tasks (such as nailing studs or blocks, trusses or joists) or toe nailing (angled, corner nailing) as opposed to flat nailing used for sheathing activities; this provides some indication that contact trip tools could be used solely for flat nailing.

Accidents, Occupational↗
PubMed2000

Proximal entry for intramedullary nailing of the tibia. The risk of unrecognised articular damage.

The risk of articular penetration during tibial nailing is well known, but the incidence of unrecognised damage to joint cartilage has not been described. We have identified this complication in the treatment of tibial fractures, described the anatomical structures at risk and examined the most appropriate site of entry for tibial nailing in relation to the shape of the bone, the design of the nail and the surgical approach. We studied the relationship between the intra-articular structures of the knee and the entry point used for nailing in 54 tibiae from cadavers. The results showed that the safe zone in some bones is smaller than the size of standard reamers and the proximal part of some nails. The structures at risk are the anterior horns of the medial and lateral menisci, the anterior part of the medial and lateral plateaux and the ligamentum transversum. This was confirmed by observations made after nailing 12 pairs of cadaver knees. A retrospective radiological analysis of 30 patients who had undergone tibial nailing identified eight at risk according to the entry point and the size of the nail. Unrecognised articular penetration and damage during surgery were confirmed in four. Although intramedullary nailing has been shown to be a successful method for treating fractures of the tibia, one of the most common problems after bony union is pain in the knee. Unrecognised intra-articular injury of the knee may be one cause of this.

Adult↗
PubMed2005

Reamed femoral nailing in sheep: does irrigation and aspiration of intramedullary contents alter the systemic response?

BACKGROUND: Reaming of the femoral canal has been demonstrated to introduce intramedullary contents into the circulation with subsequent pulmonary embolization. The aim of this study was to investigate whether this effect can be minimized by use of a reamer system that provides simultaneous irrigation and aspiration of intramedullary contents. METHODS: A unilateral lung contusion was created and intramedullary femoral nailing was subsequently performed in eighteen female skeletally mature Merino sheep. The animals were divided into three groups, of six animals each, to receive one of three types of treatment: reamed femoral nailing; reaming, irrigation, and aspiration; and unreamed femoral nailing. Blood samples were obtained and a bronchoalveolar lavage was performed at baseline, immediately after creation of the lung contusion, immediately after intramedullary nailing, and at four hours after surgery. Pulmonary permeability, polymorphonuclear leukocyte activity, and systemic hemostatic response were measured. Lung specimens were obtained for histological evaluation. RESULTS: At baseline and immediately after creation of the lung contusion, endothelial permeability was comparable among the three groups. At four hours postoperatively, pulmonary permeability was significantly higher in the group treated with reamed femoral nailing (urea/protein ratio; 256.7) than in the group treated with reaming, irrigation, and aspiration (urea/protein ratio, 91.5) and the group treated with unreamed femoral nailing (urea/protein, 110.64) (p < 0.05). The stimulatory capacity of the polymorphonuclear leukocytes was significantly decreased (p < 0.05) only in the group treated with reamed femoral nailing; the other two groups had no significant decrease postoperatively (p > 0.05). The D-dimer level at four hours postoperatively was significantly higher in the group treated with reamed femoral nailing than it was in the other two groups (p < 0.05). Histological examination showed that the grades of edema and polymorphonuclear leukocyte diapedesis were also highest in the group treated with reamed femoral nailing. CONCLUSIONS: It appears that, in the presence of a unilateral pulmonary injury, the systemic effects of intramedullary reaming of an intact femur can be minimized with use of a modified reamer design that simultaneously irrigates the canal and removes debris. Additional clinical validation of this reaming system is necessary.

Animals↗
PubMed1991

Effects of intramedullary reaming and nailing of rat femur. A mechanical and chemical study.

This study was undertaken to explore the association between mechanical and chemical effects of intramedullary reaming and nailing. The right femora of 80 rats were reamed and nailed with steel nails. Forty rats were evaluated from 3 days to 24 weeks postoperatively. The other 40 rats had the nail removed after 12 weeks, and they were then followed from 3 days to 24 weeks after nail extraction. Evaluation consisted of in vivo strain recording, geometric measurements, mechanical three-point bending test, and chemical analyses of hydroxyproline and calcium contents. Reaming and nailing caused immediate weakening of the bone as measured by in vitro mechanical tests, but within 3 weeks the mechanical properties were fully restored, whereas in vivo strain remained reduced throughout the experimental period in rats with nails. Removing the nail increased in vivo strain to a level close to that of the intact femur. Remodeling of the bone resulted in greater external anteroposterior diameter, cross-sectional area, area moment of inertia, and amount of hydroxyproline and calcium in the operated on femur as compared with the intact side. This indicates that the repair processes resulted in greater bone mass of the operated on femur than of the intact femur. Thus, there is evidence that nailing techniques effectively assist tissues by repair and remodeling.

Animals↗
PubMed1989

Intramedullary nailing with reaming to treat non-union of the tibia.

The records of fifty-one patients who were treated by intramedullary nailing with reaming for non-union of the tibia were retrospectively reviewed. The fractures had been treated initially by closed reduction and immobilization in a cast, external fixation followed by immobilization in a cast, fixation by pins incorporated in a plaster cast, minimum internal fixation and immobilization in a cast, dynamic compression plating, or intramedullary nailing with or without reaming. After the initial treatment had failed, intramedullary nailing with reaming was done to gain union. Although closed nailing of the tibia was preferred, in thirty-three patients, the site of the non-union was opened to improve alignment by performing an osteotomy or to remove failed hardware. Bone grafts from the iliac crest were used in ten patients, and a fibular ostectomy or osteotomy was done in thirty-three. Of thirty-four open fractures (fourteen grade I, seven grade II, and thirteen grade III), eight were infected at the time of intramedullary nailing. The average time of the diagnosis of a non-union was 9.6 months; the average length of follow-up after nailing was twenty months. In forty-nine (96 per cent) of the fifty-one patients, tibial union occurred at an average of seven months postoperatively. Complications included persistent infection (three patients), acquired infection after intramedullary nailing with reaming (three patients), fracture of the nail that necessitated an additional operation (two patients), shortening of more than one centimeter (two patients), malrotation of more than 15 degrees (one patient), peroneal palsy (one patient), and amputation (one patient). When used to treat non-union of the tibia, intramedullary nailing with reaming can produce union as effectively as other alternatives, while enabling the patient to function more normally without external immobilization or walking aids.

Adolescent↗
PubMed1980

[Locking of the intramedullary nail in the medullary cavity of the tibia (author's transl)].

Whether or not an effective locking of the medullary nail in transverse direction is achieved after medullary nailing of the tibia, is a moot point in literature. Researchers agree, however, that the essential locking of the nail occurs on the longitudinal axis of the nail. The authors conducted studies with strain gauges measuring the expansion and introduced together with the nail in order to obtain information on the elastic performance of the nail in transverse and longitudinal direction. The curves plotted from the data obtained, present a typical appearance. After the tibia has been properly reamed, a medullary nail of the AO is subjected to both elastic transverse compression as well as slight longitudinal bending after nailing. In case of excessive reaming the transverse elastic effect is only slight. If, on the other hand, reaming is not effected wide enough, the bone may burst open or the nail may undergo plastic deformation.

Biomechanical Phenomena↗
PubMed1984

A new method for external fixation with single crystal alumina ceramic screw nail and its biomechanical study.

Through the use of the Hoffmann external fixator, we have recognized the importance of strength of fixation between the screw nail and the bone in the external fixation and have fully realized the necessity of an affinity of the screw nail to the soft tissue at the thrusting site of the screw nail. We made a screw nail for external fixation with single crystal alumina ceramic on an experimental basis and after its basic test of strength, tried its clinical application by the Hoffmann external fixator. When this screw nail was used, it was found difficult to fix the screw nails thrusted in each different direction by the Hoffmann external fixator because of the small elasticity of the sapphire screw nail itself. However when the screw nails were fixed by force, a great stress concentration occurred in them or the bone around them and this caused their breakage and loosening. To protect this, we have developed a new external fixator which enables to hold, connect and fix each screw nail at the individual thrusting positions and directions and is therefore completely universal to each plane.

Adult↗
PubMed1994

[Differential indications for intramedullary nailing of the tibia with the reamed and unreamed technique].

The principle of unreamed intramedullary nailing in tibial fractures is theoretically convincing: regarding the almost fully maintained endosteal blood supply, this concept of biological osteosynthesis implies a lower rate of postoperative complications such as non- or malunion and infection. In our clinic, 89 patients underwent intramedullary nailing of the tibia since August 1988 using the "AO-Universal-Nagel" in 63 and the Russell-Taylor unreamed nail in 26 cases. With primary data (type of fracture and grade of soft tissue injury) being comparable, we found an almost identical rate of infection for both techniques. In RT nailing, however, rates were significantly higher for non- or malunion (AO 10.3%, RT 27.6%) and implant complications such as interlocking screw or nail breakage (AO 6.2%, RT 17.2%). Thus indicating less mechanical stability, for RT- nail we allowed full weight bearing after 6-8 weeks only, whereas for AO-nail this was performed approximately 14 days p. op. after satisfying soft tissue conditions had occurred. Subsequently, this worse mechanical properties of an unreamed nail mean loss of comfort for patients, which is not fully equalized by biological advantages in all cases. We therefore champion a differentiated indication for the unreamed technique, determined by the grade of soft tissue injury: treatment of Gustilo type II and III a and b open tibial fractures by either primarily performing biological osteosynthesis or early changing from external fixation. Finally, unreamed nailing has been established as monorail procedure treating defect fractures by means of segmental transport.

Adult↗
PubMed1995

Intramedullary nailing after external fixation of the tibia.

Intramedullary nailing after external fixation of fractures of the tibia has high complication rates including nonunion and infection. The authors review the literature regarding this technique and refine the indications for secondary IM nailing. The report distinguishes between sequential secondary nailing and reconstructive secondary nailing. Sequential secondary nailing, as defined, is done by protocol and is planned from the onset of treatment. The technique includes only a short period in the external fixator, a planned interval between removal of the frame and placement of the IM nail, and specific exclusion criteria. This technique essentially uses the external fixator as a temporary traction device while the soft tissue envelope is reconstructed. Reconstructive procedures, as defined, are not done by protocol and not planned from the onset of treatment. Patients are usually in the external fixator for extended periods of time. The indications are variable and include delayed union, nonunion, malunion, and infected nonunion. The authors conclude that when done by protocol sequential IM nailing is safe and effective. Reconstructive IM nailing, however, has strict contraindications that include: a history of or an active infection of the pin tract, wound, or bone; the presence of an open wound or pin tract; and the presence of a ring or halo sequestrum. Yet reconstructive secondary procedures can be effective in healthy individuals if the soft tissue envelope is completely reestablished, if antibiotics are administered preoperatively, and the nail is placed without reaming.

Adult↗
PubMed1998

Retrograde nailing of humeral shaft fractures.

The use of intramedullary nailing in the upper extremity is still controversial. Those who have experience with antegrade nailing have either great enthusiasm or strong criticism for the procedure. Criticism of the procedure is because of the trauma that can occur to the rotator cuff and possible impingement syndrome, which can occur after antegrade nail insertion. The technique of retrograde nail insertion with the unreamed humeral nail is described in detail. In a series of 190 retrograde nailings performed in a prospective multicenter study, the most frequent intraoperative problems were fissure or avulsion at the entry portal (n = 8; 4.2%) and secondary radial nerve palsy (n = 8; 4.2%). All radial nerve palsies recovered spontaneously. Sixty-eight patients were followed up until the fractures healed. There were five (7.4%) bone healing problems. Four of five could be solved with use of the unreamed humeral nail in a second operative procedure, whereas the fifth bone healing problem required plate osteosynthesis. Function of the shoulder and elbow joint was excellent in 89.7% and 88.3% of the patients, respectively. Retrograde humeral nailing is a safe and reliable procedure if done properly. It is a valuable stabilization technique for acute and pathologic fractures and for pseudarthrosis. Bone healing problems after unreamed humeral nailing must be analyzed individually, but they can be treated with the same implant in combination with cancellous bone grafts, reaming, additional hardware, or intrafragmentary compression.

Adolescent↗
PubMed1962

"Ingrown" nails and other toenail problems--surgical treatment.

Appropriate office treatment for "ingrown" or deformed toenails can bring quick and lasting relief. The principle is the removal of the portion of the nail that irritates. For mild problems, a buried nail corner or spur may be successfully trimmed away without anesthesia. More extensive infection requires a nerve block anesthetic of the toe and removal of a wide triangle of deformity with nail edge and the mass of heaped up granulations. Chronic or recurrent infection is often associated with some abnormality of the nail. It usually saves time and suffering in the long run to remove a third or so of the width of the nail together with its matrix or "root." Sharp dissection is relatively easy and far more dependable than other methods of removal or destruction of the matrix. The matrix of the entire nail can be removed just as easily to eliminate such problems as the grossly thickened nail of onychogryphosis.

Anesthesiology↗
PubMedDate not supplied

Transonychial water loss in healthy and diseased nails.

The objective of this study was to determine the transonychial water loss (TOWL) in both healthy and affected nails in different diseases and to compare it with the transepidermal water loss (TEWL). TOWL was measured by a new evaporimetric method: Plasticine was used to fix the protection cover of the evaporimeter probe to the nails. The TOWL behaved contrary to the TEWL. Affected nails in patients with atopic eczema (p <0.01), psoriasis (p<0.05) and onychomycosis (p<0.001) showed a significantly lower TOWL than did nails of healthy test subjects. The decrease in TOWL in diseased nails in comparison to healthy nails could be due to the formation of a stratum granulosum in atopic, psoriatic or fungus-affected nails, as this layer is normally absent in healthy nails.

Adolescent↗
PubMed1998

Acquired malalignment: a complication of lateral longitudinal nail biopsy.

We report the development of malalignment of the nail following lateral longitudinal biopsy of the nail unit in seven subjects. The lateral biopsies were in excess of the routine 3 mm diagnostic biopsy performed for investigation of a nail dystrophy, being indicated for excision of focal pathology. Deviation of the distal nail towards the side of excision might be accounted for by one or both of two mechanisms. First, the matrix might become skewed by the unilateral loss of a ligamentous structure extending from the lateral ligament of the distal interphalangeal joint. Second, there may be a reduction of embedding of nail in the lateral nail fold on the operative side in spite of a thorough lateral nail fold reconstruction. This reduction may result in an unopposed inward force from the remaining nail fold.

Adult↗
PubMed1996

Sea urchin granuloma of the nail apparatus: report of 2 cases.

The authors report 2 cases of sea urchin granuloma of the nail apparatus resulting in permanent nail deformity. Both patients developed periungual and subungual nodular lesions 1-2 months after sea urchin spine injuries in the Mediterranean sea. The affected nails showed periungual nodules associated with splitting of the nail plate distal to the nodules. Surgical excision of the nail lesions required the removal of a large amount of nail matrix that resulted in permanent nail plate dystrophy. Histopathology revealed typical foreign-body granulomas in the nail dermis.

Adult↗
PubMed1992

Wet working conditions increase brittleness of nails, but do not cause it.

The incidence of brittle nails is higher in women than in men. Repeatedly a suspected cause for the higher incidence of brittle nails in women is the frequent exposure to water. This study was aimed at clarifying whether wet working conditions increase the incidence of brittle nails in women and men in a similar degree. We determined the incidence of brittle nails in 511 persons in professions that involve frequent hand contact with water. The data were compared to those of a large, non-selected control group. 50% of the female probands showed the sign of brittle nails (control group: 30.4%, p less than 0.05). Only 13.5% of the male test persons of this study had brittle nails; the difference to the control group (13.2%) was not significant. It is discussed that in women the bridges between nail corneocytes are possibly weaker than in males as a constitutional characteristic. Accordingly, frequent alternating periods of hydration and drying increase the incidence of brittle nails particularly in women.

Adolescent↗
PubMed1992

A double-blind study of superficial radiotherapy in psoriatic nail dystrophy.

In a double-blind controlled study, superficial radiotherapy (SRT) was given to psoriatic fingernails as three fractionated doses of 150 cGy (90 kV, 5 mA, 1.00 mm aluminium filter). The treated nails demonstrated a significant fall in scoring on a clinical rating scale 10 and 15 weeks after therapy (mean scores = 4.4 and 4.6 respectively) when compared with a mean pretreatment score of 5.5 at week 0 (p less than 0.0001 and p less than 0.05 respectively); the treated nails also showed significant clinical improvement when compared with the sham-treated nails at weeks 10 and 15 (p less than 0.05). Mean nail thickness in treated nails 15 weeks after therapy was significantly thinner (mean thickness = 0.75 mm) than that of sham-treated nails (0.88 mm, p = 0.005), but the difference was not significant at week 20. The rate of linear nail growth was unaffected. SRT appears to confer a definite albeit temporary benefit on psoriasis of the nails at this dosage.

Adult↗