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At least 649 records · Page 36Linked to original sources
PubMed2001

Complications of nail surgery: a review of the literature.

BACKGROUND: The realm of nail unit surgery encompasses the dermatologist as well as the hand surgeon. Nail surgery complications may include allergy to anesthetic, infection, hematoma, nail deformity, and persistent pain and swelling. OBJECTIVE: To review the pertinent literature regarding nail unit surgery complications. METHODS: A Medline literature search was performed for relevant publications. RESULTS: Nail unit surgery complications appear to be relatively infrequent. The majority of postoperative nail deformity complications result from nail matrix damage. CONCLUSION: Complications may be reduced to a minimum by preventive measures, such as careful patient selection, sterile technique, and gentle treatment of the nail matrix.

Humans↗
PubMed2001

Nail biopsy: indications and methods.

Nail biopsy is a safe and useful technique for diagnosis and management of many nail conditions. A basic understanding of nail anatomy and biology is a prerequisite for a successful nail biopsy. The patient must be adequately prepared and there needs to be excellent anesthesia and hemostasis. The type of nail biopsy depends largely on the location of the pathology in the nail unit. The techniques of nail biopsy by location in the nail unit and by lesion type are discussed.

Biopsy↗
PubMed2001

Nail unit matrix transplantation: a plastic surgeon's approach.

The growth of the nail is primarily from the nail bed and mostly from the germinal matrix component, and to some extent from the sterile matrix as well. The purpose of this article is to describe the approach and technique of a composite nail, nail bed, hyponychium, and perionychium transplant when the total nail and nail bed need reconstruction. A case is presented when a nail bed junctional nevus is excised and reconstruction with nail unit matrix transplantation and the result is shown.

Child↗
PubMed1991

"Yellow nail syndrome" and rheumatoid arthritis.

A nail dystrophy characterized by the slow growth of nails and their yellowish discoloration, the so-called yellow nail syndrome (YNS), has been associated with various conditions including rheumatoid arthritis (RA). We reviewed the histories of RA patients reported in the literature and our own cases. Most of the RA patients with YNS had been treated with the anti-rheumatic agents D-penicillamine and bucillamine. In non-treated patients, spontaneous YNS was very rare. However, pulmonary diseases, edema and other systemic complications were frequently observed in both drug-induced and spontaneous YNS associated with RA. Although the nail changes and systemic complications are probably due to different causes in drug-induced YNS, a careful search for systemic complications are necessary in patients who develop nail changes. The exact mechanism of nail growth retardation is not understood in patients with YNS, including those with drug-induced YNS. The nail changes in the latter were not associated with deficiencies of inorganic elements in either nails or sera.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1989

Nail changes in glandular disease.

There are a number of glandular disorders that can affect the nails. A listing of the diseases and their corresponding nail changes is shown in Table 2. It is imperative to be able to discern this possible etiology from others, such as trauma and shoegear. A good clue to systemic abnormalities affecting the nails is multiple nail involvement. When a glandular disorder is the source of nail pathology, the signs are very often nonspecific. Many pathologies produce similar nail changes, and singular nail changes may be caused by different pathologies. One must use extreme caution in trying to diagnose systemic pathologies from changes observed in nails.

Endocrine System Diseases↗
PubMed1981

[Trachyonychia: 20-nail dystrophy].

Trachyonychia (20-nail dystrophy) is described in four patients with clinical, histological, and scanning electron microscopy techniques. Trachyonychia is a polyetiological symptom: psoriasis vulgaris, lichen planus, alopecia areata, atopic dermatitis, 20-nail dystrophy of childhood, and severe nail dystrophy can all lead to trachyonychia-like nail changes. Nail bed biopsies are necessary for proper diagnosis. In our patients, lichen planus, or psoriasis were excluded clinically and histologically. Spongiotic dermatitis of nail matrix and nail bed with column-like parakeratosis within the nail plate are found in trachyonychia due to alopecia areata, atopic dermatitis, and in its idiopathic form.

Adolescent↗
PubMed1993

Merkel cells in ontogenesis of human nails.

Digital skin of human fetuses is known to contain a particularly high concentration of Merkel cells. Using antibodies against the simple epithelial cytokeratins (CK) 18 and 20, which are sensitive and specific Merkel cell markers, we studied immunohistochemically the main adnexal structure of digital skin, the nail anlage, in human fetuses (9-22 weeks of gestation) for the presence of Merkel cells. As early as week 9 some clustered Merkel cells were detected in the early matrix primordium. In specimens of week 12-15, abundant Merkel cells were found in the nail anlagen, particularly in the epithelium of the proximal nail-fold and the dorsal and ventral side of the apex region. In contrast, Merkel cells were essentially absent from the epithelium of the ventral matrix (surface-near portion), lunula and nail bed. Correspondingly, in these region, the adjacent dermis contained hardly any nerve fibres, whereas such fibres, as detected by neurofilament antibodies, were quite numerous adjacent to the proximal nail-fold epithelium. At week 22, the Merkel cell number in the nail anlage had decreased, and in adult nail matrix such cells were very rare. No Merkel cells were found in the dermal tissue surrounding the nail anlage while finger-tip skin of week 15, and particularly of week 22, exhibited single Merkel cells in the upper dermis next to clusters of such cells in the glandular ridges. We also found that Merkel cells were negative for CK 17.(ABSTRACT TRUNCATED AT 250 WORDS)

Gestational Age↗
PubMed1978

[Anatomical and biomechanical considerations for medullary nailing (author's transl)].

By using X-ray films of 390 adult femurs and 15 cadaveric femurs of Japanese origin, and by measuring successive cross-sections the authors have made morphological and statistical analyses of the shape of the femoral medullary canal. These studies suggest new dimensions for the diameter of the reamer and the amount of contact area between nail and inner cortex. Furthermore it was found that the physiological antecurvature of the femur on the lateral view does not correspond with the prebending of the OA-nail. The authors made some mechanical experiments on four types of nails which are widely used today. As a consequence of these studies, the authors developed a new elastic nail for trial (Okayama-nail). This new type of nail greatly increases the area of contact with the inner femoral cortex. Obviously this nail satisfies better all of Kuentscher's originally mentioned requirements an intramedullary nail.

Adolescent↗
PubMed2002

[Unusual removal of a Küntscher nail after 35 years].

A 68 year old patient with persistent feeling of sickness and increasing pain in the left forearm was seen. A complex both bone fracture of the distal forearm shaft had been stabilized with Küntscher nails in radius and ulna 35 years ago. The loose ulna nail had been removed after ten weeks. Reosteosynthesis twelve months later with a Küntscher nail and cerclages had led to osteomyelitis and persistent bone defect, possibly caused by galvanic reaction between the different alloyies. A lymphocyte transformation test with nickel sulphate confirmed an allergic reaction and supported the indication to late implant removal. After exposure of the nail's end by a short approach a sufficient take over of power to the implant was reached by a coupling pole. Extraction was stopped after two centimetres by a blockage of the nail. Widening the entry of nail and drilling its whole notch by means of a Kirschner wire using the radiolucent ruler and by the repeated extraction and reinsertion led finally to the complete removal of the nail. Whereas local pain is disappeared three month after removal presenting bland local findings the general condition is improved slowly. Already Küntscher described the blockage of his nail after a short distance extraction. In addition to a number of not always successful means of extraction this method is described for the first time.

Adult↗
PubMed1982

Penetration in trochanteric fractures of the femur treated with rigid nail plates.

One hundred and twelve trochanteric fractures have been analysed. A Jewett nail-plate was used in 81 patients and a Thorton nail-McLaughlin plate in 31. Penetration of the nail into or through the hip joint was the only complication studied in detail. It occurred in 41 cases: 31 (38 per cent) with the Jewett nails and 10 (33 per cent) in the other group. Both groups are comparable in that the nail-plate acts as a single rigid unit and the nail/plate angle varied, but the overall incidence of migration of the nail was similar. All the 112 cases were reviewed as one group. Penetration was more common in comminuted unstable types of fracture, in those poorly fixed, and in the older patients. Sixteen (14 per cent) well-fixed fractures showed penetration. It appears that one important additional reason for penetration in this series was the rigidity of the device and the poor quality of the bone. The incidence of nail penetration in comminuted unstable fractures of the femur might be reduced by using methods of fixation other than rigid nail-plates.

Aged↗
PubMed2006

What is the function of nail biting: an analog assessment study.

OBJECTIVE: To compare the frequency of nail biting in 4 settings (interventions) designed to elicit the functions of nail biting and to compare the results with a self-report questionnaire about the functions of nail biting. DESIGN: Randomised allocation of participants to order of conditions. SETTING: University Psychology Department. SUBJECTS: Forty undergraduates who reported biting their nails. INTERVENTIONS: Left alone (boredom), solving maths problems (frustration), reprimanded for nail biting (contingent attention), continuous conversation (noncontingent attention). MAIN OUTCOME MEASURES: Number of times the undergraduates bit their nails. RESULTS: Nail biting occurred most often in two conditions, boredom and frustration. CONCLUSION: Nail biting in young adults occurs as a result of boredom or working on difficult problems, which may reflect a particular emotional state. It occurs least often when people are engaged in social interaction or when they are reprimanded for the behavior.

Adult↗
PubMed2005

Soft tissue injury related to choice of entry point in antegrade femoral nailing: piriform fossa or greater trochanter tip.

Intramedullary nailing through the piriform fossa results in some cases in loss of abduction strength and persistent pain. Nail insertion at the tip of the greater trochanter may be favourable. The aim of this study was to assess (possible) iatrogenic injury to the abductor and external rotator musculature, branches of the superior gluteal nerve and branches of the MFCA in relation to the two different entry points. In 10 fresh human cadaver femurs, five unreamed femoral nails (UFN) were inserted through the piriform fossa and five AO prototype nails (AFN) through the trochanteric tip. The iatrogenic injury at each nailing procedure was assessed. Various muscles and tendons, branches of the MFCA along with the hip joint capsule were injured or largely at risk during nail insertion through the piriform fossa. Most of these structures were not exposed during insertion through the trochanteric tip. The reported clinical morbidity after nailing through the piriform fossa may find its origin in direct soft tissue injury and may be reduced by choosing a lateral nail entry point.

Aged↗
PubMed2006

Prospective study of the clinico-radiological outcome of interlocked nailing in proximal third tibial shaft fractures.

BACKGROUND: Almost 9% of tibial shaft fractures occur in the proximal third of the bone. In order to address the problems of mal-alignment and late loss of fixation, all the specific surgical techniques described in the literature were used in nailing these fractures in our study. METHODS: From December 2001 to December 2003, 45 consecutive patients with fracture of the proximal third of the tibial shaft underwent nailing. The clinico-radiological outcome of these cases and the complications encountered were analysed. RESULTS: The average time to knee mobilisation and partial weight-bearing walking was 3.2 days. The fractures had united at an average of 4.3 months. At the last follow up, the average lower extremity functional score was 96%. There were seven cases of malunion (15.56%), with three valgus and four apex anterior angulations. Delayed union necessitated open bone grafting in three cases, at an average of 6.3 months. At 8 months, one patient with delayed union experienced nail breakage across the weakest point, i.e. the dynamic screw hole. He underwent reamed exchange nailing and, 3 months later, the fracture had united. CONCLUSION: Meticulous intramedullary nailing of fractures of the proximal third of the tibial shaft, using all current surgical principles and techniques, has excellent clinico-radiological outcome and is relatively safe. We recommend a nail similar to a Sirus nail, but with a more proximal bend of the nail and no dynamic interlocking screw hole.

Adolescent↗
PubMed2005

Development of a locking femur nail for mice.

We herein report on a novel locking intramedullary nail system in a murine closed femur fracture model. The nail system consists of a modified 24-gauge injection needle and a 0.1-mm-diameter tungsten guide wire. Rotation stability was accomplished by flattening the proximal and distal end of the needle. Torsional mechanical testing of the implants in osteotomized cadaveric femora revealed a superiority of the locking nail (3.9+/-1.0 degrees rotation at a torque of 0.9 Nmm, n=10) compared to the unmodified injection needle (conventional nail; 52.4+/-3.2 degrees, n=10, p<0.05). None of the implants, however, achieved the rotation stability of unfractured femora (0.3+/-0.5 degrees, n=10). In a second step, we tested the feasibility of the in vivo application of the locking nail to stabilize a closed femoral midshaft fracture in C57BL/6 mice. Of interest, none of the 10 animals showed a dislocation of the locking nail over a 5-week period, while 3 of 4 animals with conventional nail fracture stabilization showed a significant pin dislocation within the first 3 days (p<0.05). Mechanical testing after 5-weeks stabilization with the locking nail revealed an appropriate bone healing with a torque at failure of 71.6+/-3.4% and a peak rotation before failure of 68.4+/-5.3% relative to the unfractured contralateral femur. With the advantage that closed fractures can be fixed with rotation stability, the herein introduced model may represent an ideal tool to study bone healing in transgenic and knockout mice.

Animals↗
PubMed2005

Squamous cell carcinoma of the lateral nail fold.

The digital nail complex is occasionally involved by squamous cell carcinoma. The published literature has either been indiscriminating of the site of origin of this tumour within the nail complex or has concentrated attention on the nail bed as the site of pathology. Tumours originating in the lateral nail fold can be clearly differentiated from those of the nail bed itself. This study identifies six cases of squamous cell carcinoma arising in the lateral nail fold. While surgical convention remains to amputate the digital tip for squamous cell carcinoma of any part of the nail complex, the dermatological literature identifies that local surgery can be curative for these tumours, when presenting early and without bone involvement, although offering no discussion of reconstruction. Reconstruction is desirable and methods of achieving this following local excision of lateral nail fold tumours are illustrated in this series.

Adult↗
PubMed2005

A biomechanical study on flexible intramedullary nails used to treat pediatric femoral fractures.

Flexible intramedullary nails have been indicated to treat femoral fractures in pediatric patients. The purpose of this study was to examine the stability of simulated transverse fractures after retrograde intramedullary flexible nail fixation. Various nail diameter combinations were tested using composite femurs in bending, torsion, and a combined axial/bending test where a vertical compressive force was applied to the femoral head. The cross-sectional percent area fill of the nails within the femurs was also determined. In 4 point bending, the greatest repair stiffness was 12% of the intact stiffness. In torsion, the greatest stiffness was 1% of the intact stiffness for either internal or external rotation. The greatest repair stiffness was 80% of the intact stiffness for a compressive load applied to the femoral head. Nail combinations with single nail diameters greater than 40% of the mid-shaft canal width, as measured from an AP radiograph, prevented the fracture from being reduced and left a posterior gap. Flexible intramedullary nails may be of value in the treatment of pediatric femoral fractures, but care must be taken to insert nails that are correctly sized for the canal and to protect the healing fracture from high torsional and bending loads.

Biomechanical Phenomena↗
PubMed2001

The Marchetti-Vicenzi elastic locked nail for the treatment of femoral shaft fractures: a review of 100 consecutive cases.

A total of 100 hundred femoral fractures in 97 patients were treated with the Marchetti-Vincenzi universal bundle elastic nail; six of the fractures were open. Closed fractures were classified according to AO and Winquist; open fractures were classified according to Gustilo. A total of 91 fractures united (average 12 weeks) and six led to non-union. There were two deep and one superficial infections. In three cases, the secondary nails protruded from the anterior cortex of the femoral condyle; in two cases intraoperatively and in the third case 2 months postoperatively, due to severe osteoporosis. The cylindrical part of the nail did not fail, whereas all the secondary nails failed in one patient as well as one secondary nail in another patient at the level of the fracture; these two cases exhibited non-union. We consider the absence of distal screws the major advantage of this particular nail, followed by position of the entry point and the limited reaming. We believe that the absence of a pin guide is a disadvantage. The elasticity of the nail has a positive effect in certain cases while in other cases it acts negatively, resulting in a relatively high proportion of non-unions as in our series. Therefore our conclusion is that this nail is not appropriate for the treatment of femoral shaft fractures.

Adult↗
PubMed2001

The fatigue strength of small diameter tibial nails.

This study was performed to evaluate the fatigue strength of commonly used small diameter tibial nails. Five types of small diameter tibial nails (7 mm aap Biorigid Nail, 8 mm aap Biorigid Nail, 8 mm Ace UTN, 8 mm RT Tibial Nail, 8 mm Synthes UTN) with a sample size of 30 implants (six samples of each nail type) were tested with a new modular testing system. One module of the testing system was removed, simulating a 55-mm distal tibial defect, to induce maximum loading on the distal portion of the implant and locking bolts. The average yield strengths were obtained from static, single cycle tests and revealed an average static ultimate load of 1072 N (aap7), 1820 N (aap8), 1812 N (Ace), 1942 N (R&T), and 1543 N (Syn). The fatigue limits were evaluated by cyclic, sinusoidal loading and revealed a fatigue strength of 750 N (aap7), 1092 N (aap8), 906 N (Ace), 971 N (R&T), and 771 N (Syn) to endure 500000 cycles. Our results showed that the solid tibial nails fractured in the testing device in the same manner and location as they do in the clinical series. This study showed that all the small diameter tibial nails tested are obviously able to transmit loads of more than average body weight. The fatigue strength of the implants is relatively high, which means that patients without bone defects could be mobilised with full weight bearing as tolerated by pain. However, according to the results of this study, early mobilisation with full weight bearing in a normal gait cycle can not be suggested in patients with segmental tibial fractures or fractures with defect zones.

Biomechanical Phenomena↗