[A new nail for bone fractures].
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21 patients with humeral shaft nonunions were treated by retrograde nailing with the unreamed humeral nail. In all cases, we reamed the fracture site and performed a bone graft. Union of the fracture occurred in every case. The mean healing time was 4.2 (4-6) months. The range of motion of the shoulder and elbow was excellent in 14 patients, that of the shoulder moderate in 6 and poor in 1, and that of the elbow moderate in 7. The functional results were excellent in 13 patients, good in 5 and fair in 3. Given the good functional results in this series, retr grade locked nailing and bone grafting appears to be a good method for treating humeral shaft nonunions.
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Rotational deformity following intramedullary nailing may cause symptoms and require surgical correction by osteotomy. Reamed, locked intramedullary nailing may be performed, but concern about cortical blood supply and potential pulmonary dysfunction from reaming have led many surgeons to limit this and use smaller diameter nails. Slotted nails are commonly used but are less stiff in torsion than the newer unslotted nails, particularly at the lower diameters. We report two cases of recurrent femoral rotational deformity after using statically interlocked slotted intramedullary nails to correct existing femoral rotational deformities. These patients show that small diameter statically interlocked femoral nails with diminished bone-nail contact must be stiff enough in rotation to avoid potential recurrence.
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When acute exposure to fluoride is thought to be the cause of death, confirmation often depends on the analysis of some body fluid or tissue. The aim of this study was to evaluate the use of nails and the periosteal surface of bone as indicators of acute exposure to fluoride. Six groups of rats were given a single oral dose of fluoride (50 mg/kg body weight), while the control group was given deionized water. The rats were killed at 2, 4, 8, 16, 24, and 48 h after fluoride administration. Plasma and nails (the proximal halves) were collected and analyzed for fluoride with an ion-specific electrode after hexamethyldisiloxane-facilitated diffusion. A circular area of the femur (4.52 mm(2)) was etched with 0.5M HCl for 15 s, and, after the addition of a buffer, the solution was analyzed with an ion-specific electrode. Peak plasma concentration occurred at 2 h, followed by progressively declining concentrations. Peak nail fluoride concentrations occurred at 8 h. The mean nail concentrations at 8, 16, and 24 h were significantly higher than that of the control group. Bone surface concentrations were significantly higher than that of the control group at 4 h and thereafter. Thus, the proximal portion of nails and bone surface are suitable biomarkers for acute fluoride exposure in rats.
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