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At least 721 records · Page 40Linked to original sources
PubMedDate not supplied

Complications of titanium elastic nails for pediatric femoral shaft fractures.

Limited data exist about complications of titanium elastic nails (TNs) for femur fracture management in pediatric patients. Thirty-nine patients with 43 femoral shaft fractures were identified whose average age was 6.0 years. There were 21 complications (1 intraoperative, 20 postoperative) in 43 femur fractures (49%). There were two major postoperative complications: one septic arthritis after nail removal and one hypertrophic nonunion. Minor postoperative complications were pain at the nails in 13 extremities, nail erosion through the skin in 4, and one delayed union. There was an association between the prominence of TNs and nail pain or skin erosion. Fracture angulation and outcome were associated with the patient's weight and size of the nails implanted. Technical pitfalls exist with this implant and can be minimized by leaving less than 2.5 cm of nail out of the femur and by using the largest nail sizes possible.

Analysis of Variance↗
PubMed1992

Nail psoriasis.

Psoriatic nail involvement is common and accompanies skin lesions on the body surface. The occurrence of nail psoriasis has been reported in up to 50 percent of patients, including children, adults, and the elderly. The characteristics of psoriatic nails are pitting, discoloration, onycholysis, subungual hyperkeratosis, as well as crumbling and grooving of nails and splinter hemorrhages. There is no consistently effective treatment for psoriatic nail involvement; nails are difficult to treat and respond slowly to therapy. Corticosteroids, 5-fluorouracil, systemic agents such as photochemotherapy, oral retinoids, and methotrexate, and nail avulsion are among the therapeutic approaches utilized. We offer suggested measures whereby patients may benefit in the prevention and control of their nail psoriasis.

Humans↗
PubMed2005

Closed femoral nailing in lateral decubitus position without a fracture table: a preliminary report of fifteen patients.

BACKGROUND: The use of a fracture table is standard for closed intramedullary nailing of femoral fractures. Instead of a fracture table, some clinicians have successfully performed this operation in the supine position via manual traction. Here, we present our experience performing this operation in the lateral decubitus position without a fracture table. METHODS: From December 2001 to November 2002, we consecutively performed closed intramedullary femoral nailing in 15 patients with low comminuted femoral shaft fractures in the lateral decubitus position without a fracture table. We used manual or joystick traction to approximate the fracture fragments and introduced a guide pin. A reaming procedure was done with serial reamers of increasing diameters to reduce the fracture fragments. Then, the nail was inserted along the guide pin. RESULTS: Six femora underwent Küntscher nailing and nine femora underwent interlocking nailing. Nine procedures were completed via joystick traction and six were completed via manual traction only. All fifteen procedures were completed without any changes in the other operative methods. The mean operation time was 55 minutes for Küntscher nailing and 118.3 minutes for interlocking nailing. The average union time was 5.8 months with 100% union. CONCLUSIONS: For low comminuted femoral shaft fractures, using manual or joystick traction in the lateral decubitus position without a fracture table is an alternative in closed femoral intramedullary nailing.

Adolescent↗
PubMed1990

[Fluoride level in human nails and its significance].

Bone tissue investigation provides the best indicator for fluorine saturation of the organism. However, the intravital bone biopsy--as an invasive method, is not applicable in prophylactic studies. Thus, attention was focussed on the nails that constitute an easily accessible material being able to reflect the chronic accumulation of fluorine in the organism. In the actual paper it has been endeavoured to find out the routes, on which fluorine is deposited in the nails, if there is any dependence between the fluorine content in the nails and the age of the studied subjects, and whether the concentration of fluoride in the nails depends on the fluctuation of this element in the environment, and which of the parameters exert influence upon it. The performed investigations permitted the following conclusions to be drawn: 1. The nails furnish a readily accessible material for studying fluorine saturation in the organism. 2. Fluorine may be accumulated in the nails on internal pathway through circulatory system, and from outside--by means of direct absorption. 3. Since relatively high content of fluoride has been revealed in the nails of the youngest children, they should be protected against further supply of fluorine compounds from outside. 4. In the areas not polluted by fluorine compounds there is a lack of statistically significant dependence between the content of fluoride in the nails and the age.

Adolescent↗
PubMed1989

Ultrasound structure of the human nail plate.

The structure of the normal human nail plate is described using an ultrasound scanner (20 MHz A). Postmortem studies, including examination of nail plate biopsy specimens before and after desiccation, were performed and compared with in vivo structures. Two compartments could be identified in the nail, ie, a dry and superficial compartment with the ultrasound velocity of 3103 m/s and a humid and deeper compartment with an ultrasound velocity of 2125 m/s. The ultrasound velocity of the entire nail was 2459 m/s, and the water content was 35% wt/wt. Underneath the nail, echoes from the nail bed were seen. Ultrasound was concluded useful for noninvasive measurement of nail thickness and examination of internal nail structure.

Adult↗
PubMedDate not supplied

[The pincer-nail syndrome--a rare differential diagnosis of finger end joint-/nail involvement].

A 55-year-old patient who clinically presented with a Heberden arthrosis and gryphosis of the second and fourth finger nails of the left hand was admitted to our outpatient department under the tentative diagnosis of psoriatic arthritis. Nature of nail damage and combination of clinical findings suggested the diagnosis of a pincer-nail syndrome. The pathogenesis of this rare disease is not yet clear. Its complete clinical picture includes gryphosis of finger and toe nails in combination with acroosteolytic shortening of the end-phalanx and destructive arthrosis of the terminal joints of toes and fingers. Since deformation of the nail, which sometimes includes inflammation of the nail bed, may cause marked pain, surgical intervention with excision of the nail and, if necessary, revision of the nail bed has to be performed in most cases.

Arthritis↗
PubMed1988

The effect of nail polish on pulse oximetry.

A randomized, blind study examined the effect of nail polish color on measurement of oxygen saturation by pulse oximetry. Fourteen adult volunteers had blue, green, purple, black, and red nail polish applied to their finger nails. A strip-chart recording of oxygen saturation (Nellcor N100) was made in room air and later interpreted in a blinded fashion. The absorption spectra of the five polishes were determined by spectrophotometry. The spectra of nine other nail polishes and three intravenous dyes also were examined. Black, blue, and green nail polish significantly lowered oximeter readings of oxygen saturation. Blue and green produced greater decreases than purple and red; black produced an intermediate decrease. Some but not all nail polishes absorbed light at the wavelengths used by the pulse oximeter (660 nm and 940 nm). The degree of artifactual desaturation correlated best with the difference between absorbance at 660 nm and absorbance at 940 nm (r = 0.95). Spectrophotometric absorbance data suggest that other colors may interfere with pulse oximetry. On the basis of spectrophotometric data, brown-red nail polish was predicted to interfere with oximetry; subsequent pulse oximetry measurements confirmed the prediction. Nail polish should be removed routinely before pulse oximetry monitoring.

Adult↗
PubMed1986

Biomechanical performance of locked intramedullary nail systems in comminuted femoral shaft fractures.

The biomechanical properties of commercially available locked nail systems designed for use in comminuted femoral shaft fractures were compared and evaluated. Ender nails as well as three forms of interlocking nails, Brooker-Wills (B-W), Klenm-Schellman (K-S), and Grosse-Kempf (G-K), were implanted in cadaver femora. The femora were tested in torsion, bending, and axial loading to failure. Two fracture models were tested--a 3 cm subtrochanteric defect and an 8 cm midshaft defect. Results of the testing revealed the three interlocking nails to be comparable to each other and superior to Ender nails in bending and torsion. However, the distally bolted locked nails (K-S, G-K) resisted significantly higher loads than either the distally bladed locked nail (B-W) or Ender nails when tested to failure by axial loading.

Adult↗
PubMed1986

Intramedullary forearm nailing.

Nailing of the forearm, beginning with Schöne, antedated nailing of the femur and tibia. Its slower development appears due to anatomic problems with the radius, the interdependence of the two bones, and the strong torque loads from the pronators and supinators. Kirschner wires, threaded Steinman pins, Küntscher U nails, and Rush pins were investigated extensively on fracture services before 1954 when a square-shaped nail to improve stability and fracture healing was designed. A broaching point, allowing some bite of the corners into the circumference of a reamed canal, provided better control of torque loads. Closed nailing has many advantages, including early union, low incidence of infection, small scars, less blood loss, and, frequently, relatively short operating time with minimal surgical trauma. Complications and pitfalls during surgery relate mainly to improper nail size and reaming technique. Open fractures led to the highest number of infections, and in highly comminuted fractures nonunion was occasionally seen. In a series of 137 nailed fractures, the nonunion rate was 7%. While the compression plates may give a slightly lower nonunion rate than nailing, the incidence was more than offset by the greater incidence of refractures and disfiguring scars.

Adolescent↗
PubMed1984

[Biomechanical studies on fracture fixation mechanism of the clover leaf medullary nail].

The intramedullary nailing method described by Küntscher is used widely now as an excellent treatment of the fracture of the long bone. However, it is well known from clinical experience that fracture fixation of the clover leaf nail is not so strong and especially rotational fixation is very poor. For the purpose of re-evaluating fracture fixation mechanism with Küntscher's nail, the following studies were performed. Osteotomized human cadaveric femur was fixed with the clover leaf nail in an ordinary manner. This osteosynthesis model was imbedded in plastic resin (RIGOLAC) in situ. Afterwards this model was cut into specimens 1.5 cm in thickness. The contact area between the bone and the nail was investigated macroscopically and roentgenographically on each specimen. Stress distribution in cross section of some commercially available clover leaf nails was investigated by the technique of photoelastography. Total expansive force of the clover leaf nail was obtained by the calculation based on the measured values. From these investigations the author concludes that the clover leaf nail does not fix the fracture by the expansive spring mechanism only, as was originally claimed by Küntscher.

Biomechanical Phenomena↗
PubMed1995

Exchange reamed intramedullary nailing for delayed union and nonunion of the tibia.

Twenty-eight tibial fractures, initially treated with nonreamed interlocking nails, were exchanged to reamed intramedullary nails to promote union. Initially, there were 8 closed fractures with compartment syndromes; 5 Type 2 open fractures; 6 Type 3 A injuries; and 6 Type 3B injuries. Exchange nailing was performed if followup radiographs did not show callus formation between 3 and 5 months after injury. Originally, 16 of the 28 nailings were statistically locked. Twenty-five of 27 fractures united after exchange nailing. In 2 patients with bone loss, additional bone grafting was required. Infection developed in 3 patients after exchange nailing (11%). Exchange nailing is a useful method to promote union of tibial fractures when slow consolidation occurs after initial treatment with a nonreamed nail. This method should be combined with autogenous bone grafting in patients with bone loss. The procedure is safe and effective in closed and minor open fractures; however, caution should be exercised in patients with prior Grade 3B open fractures because of the risk of infection.

Bone Nails↗
PubMed1994

Treatment of grade-IIIb open tibial fractures. A prospective randomised comparison of external fixation and non-reamed locked nailing.

Severe open fractures of the tibia have a high incidence of complications and a poor outcome. The most usual method of stabilisation is by external fixation, but the advent of small diameter locking intramedullary nails has introduced a new option. We report the early results of a randomised, prospective study comparing external fixation with non-reamed locked nails in grade-IIIb open tibial fractures. Of 29 patients, 15 were treated by nails and 14 by external fixation. Both groups had the same initial management, soft-tissue procedures, and early bone grafting. All 29 fractures healed within nine months, but the nailed group had slightly better motion and less final angulation. Complications included one deep infection and two pin-track infections in the external fixator group and one deep infection and one vascular problem in the nailed group. Although the differences in healing and range of motion were not statistically significant, we found that the nailed fractures were consistently easier to manage, especially in terms of soft-tissue procedures and bone grafting. It is the treatment preferred by patients and does not require the same high level of patient compliance as external fixation. The only factors against nailing are the longer operating time and the greater need for fluoroscopy. We consider that locked non-reamed nailing is the treatment of choice for grade-IIIb open tibial fractures.

Adult↗
PubMed1998

Complications in the use of the Bailey-Dubow extensible nail.

The results of 40 extensible intramedullary nailing procedures in 15 children who had osteogenesis imperfecta were reviewed to identify risk factors leading to complications of this method of treatment. There were 40 complications, 17 major and 23 minor. The 17 major complications led to 15 additional procedures, 10 of which were to remove or replace the implant. The prevalence of major complications was highest in patients who were younger than 5 years when the nail was inserted. Nails placed in the tibia tended to produce a higher incidence of major complications than did those placed in the femur, but this difference was not statistically significant. By survivorship analysis, patients had a greater risk of requiring a revision procedure when a technical error occurred at the time the nail was inserted. Patients who had nails placed in the femur tended to have a lower risk of needing revision surgery than did those who had nails placed in the tibia, but this difference was not statistically significant. The results suggested that the extensible nail is most advantageous in the femur and in patients older than 5 years. Avoiding technical errors when inserting the nail may improve the longevity of the device.

Age Factors↗
PubMed1998

Effects of hyperbaric oxygen therapy on perfusion parameters and transcutaneous oxygen measurements in patients with intramedullary nailed tibial shaft fractures.

We evaluated the effect of hyperbaric oxygen (HBO2) therapy on tibialis posterior (TPA), dorsalis pedis (DPA), and sum (TPA + DPA) arterial peak signals, as well as transcutaneous oxygen (PtcO2) tension and leg skin temperature (T) after intramedullary nailing of tibial shaft fractures. Twenty consecutive patients with closed and simple tibial shaft fractures treated with reamed intramedullary nailing were assigned randomly to HBO2 or control groups. HBO2 therapy was given postoperatively at 2.5 atm abs pressure for 90 min daily for a total of five treatments. The first HBO2 therapy was given 1 h after the operation. In both groups, measurements were performed preoperatively, 30 min and 6 h postoperatively, and on the following 5 days. There was a statistically significant improvement in TPA values in the nailed legs in the HBO2 treatment group after the first postoperative day, and these values remained at a significantly higher level until the end of the study when compared to the nailed legs in the control group. Further, there was a statistically significant improvement in PtcO2 values in the nailed legs in the HBO2 group after the third HBO2 treatment. However, there were no statistically significant differences in DPA and TPA + DPA values within or between the nailed legs in HBO2 and control groups. HBO2 therapy seemed to decrease the skin temperature of the nailed legs, but this alteration was not statistically significant. In addition to the clearly documented advantages in the management of crush injuries and compartment syndromes, HBO2 therapy has a positive effect on the perfusion parameter (TPA) and PtcO2 in patients with low energy, intramedullary nailed simple tibial shaft fractures. The improvement in TPA and PtcO2 values may result from the vasoconstrictive and edema reductive effect on HBO2 with concomitant inhibition of inflammatory reactions with slight cooling.

Adolescent↗
PubMed2004

Drug-induced nail abnormalities.

A large number of drugs may be responsible for the development of nail changes, including cancer chemotherapeutic agents and retinoids, however, only a few classes of drugs are consistently associated with nail symptoms. Drug-induced nail abnormalities result from toxicity to the matrix, the nail bed, the periungual tissues or the digit blood vessels. The most common symptoms include Beau's lines, onychomadesis, melanonychia, onycholysis and periungual pyogenic granulomas. Drug-induced nail changes usually involve several or all of the nails. In most cases, nail abnormalities are asymptomatic, but can sometimes cause pain and impair manual activities.

Drug-Related Side Effects and Adverse Reactions↗
PubMed2002

[Intramedullary femoral osteosynthesis with the "rendezvous procedure". A new philosophy of retrograde intramedullary nailing].

OBJECTIVE: The disadvantages of retrograde intramedullary nailing are the necessity of explanting the nail through the knee and the occasional difficulties with proximal interlocking. The new retrograde intramedullary nail includes the following innovations: The nail is inserted into the medullary canal beyond the great trochanter, so that a proximal aiming device can be used. The nail is removed through the proximal opening. The distal opening can be closed with the osteochondral cylinder that has been taken out before. MATERIAL AND METHODS: In all, 27 patients have been included in this prospective study. The intraoperative data of the implantation has been recorded. A clinical/radiologic examination took place on the day of discharge and 6-12-26 weeks after the operation in order to record the postoperative complications. RESULTS: The mean time of follow-up examinations at the moment is 8.9 months (2-14). No infections have occurred. The healing of the fractures was without any problems. No patient complained of any major problems concerning the knee and the hip. CONCLUSIONS: The new Sinart-Nail seems to be a nail that can be implanted easily and without complications. It combines the advantages of the retrograde intramedullary nailing with the advantages of the anterograde explantation. The two aiming devices facilitate a distal and proximate fixation without fluoroscopy. The replanting of the osteochondral cylinder reduces internal damage to the knee.

Adolescent↗
PubMed2002

[The BEHAC nail--a new intramedullary implant for managing 2-stage fractures of the humerus].

The BEHAC-nail is a new implant for the treatment of complex humeral fractures, particularly for segmental fractures. It is an elastic intramedullary implant that is inserted retrograde into the distal humerus. The special feature of this nail is its proximal "loop design" which reduces the implant penetration at the proximal fixation site in the subchondral area of the humeral head in comparison to implants with tips such as Rush pins or Hackethal's nails. Thus, the risk of nail migration and perforation of the humeral head is less with the BEHAC-nail than with other nails. Another advantage of the "loop design" is that the humeral head fragment can be fixed adequately. Even short proximal fragments can be stabilized with this design. In contrast a short humeral head fragment cannot be held with implants like the UHN, HVN or Seidel's nail. The BEHAC-nail is a useful implant for segmental fractures of the humerus.

Equipment Design↗
PubMed1998

[Intramedullary boring in infected intramedullary nail osteosyntheses of the tibia and femur].

UNLABELLED: The infection after intramedullary nailing is a severe complication, which is hard to eradicate. The results of reaming the intramedullary canal after removal of the infected nail were evaluated in our investigation. From 1984 to 1991 fifty-five patients with infected intramedullary nails of the lower extremity were included in this trial. Twenty-one patients had an infection of the femur. Thirty-four patients had a primary infection of the nail, twenty-one patients had multiple operations with periods of infection prior to nailing. All patients had signs of a chronic osteitis and sinus formation. At the time of the follow-up the success of the procedure was evaluated regarding recurrence of infection, range of motion of the extremity and patient comfort. The mean time of observation was 10.1 +/- 4.9 years. All patients with initially infected intramedullary nails had no recurrence of the infection, compared to 62% of those with multiple operations prior to nailing. At the time of the follow up all fractures had healed. 85% of the patients performed full weight bearing. 32 patients (91%) had good or excellent ROM of the adjacent joints. CONCLUSION: Intramedullary reaming after infected nails is a successful procedure and results in infect healing in the majority of patients.

Adult↗