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At least 757 records · Page 42Linked to original sources
PubMed1988

Unstable femoral shaft fractures: a comparison of interlocking nailing versus traction and casting methods.

Among 60 femur fractures not amenable to fixation by simple intramedullary nailing, 30 were treated with balanced skeletal traction followed by cast bracing or spica casting, and 30 were treated with closed interlocking nailing. The criteria for using an interlocking nail were fractures with less than 50% cortical contact or fractures with rotationally insecure purchase of the nail in either the proximal or distal fragment. In terms of fracture severity, patient age, injury severity, and clinical follow-up, the patient groups were similar. There were three open fractures in each group. The average hospital stay was 61 days for the traction group, and 19 days for the interlocking nail group (p less than 0.001). Time to clinical and radiographic union averaged 34 weeks with traction and casting and 18 weeks with interlocking nail fixation (p less than 0.001). Failure by the criteria of Johnson et al (2) occurred in 67% of the traction group and in 3% of the interlocking nail group (p less than 0.001). Minor complications were more common in the traction group. On the basis of this study and the experience of others, interlocking nail fixation appears to be the method of choice for managing unstable femoral shaft fractures.

Adolescent↗
PubMed1993

[Change in the procedure from external fixator to intramedullary nailing osteosynthesis of the femur and tibia].

Shaft fractures of femur and tibia can be treated successfully by intramedullary nailing. In recent years the use of interlocking nails widened the indication for nailing fractures of the proximal and distal bone and more difficult fractures. There are still limits in polytrauma patients, chain fractures with or without participation of joints and in fractures with severe soft tissue injury (open or closed). In these cases primary treatment with external fixation has proved worthwhile. The main problems and risks of primary nailing osteosynthesis occur in the early phase of treatment, whereas complications in external fixation are more likely to occur in later phases of treatment. In changing from external fixation to intramedullary nailing one can see the advantages of both methods. In the literature only small studies have been made mostly with patient groups below 50 in number. The change of method was rarely standardised and the time period between procedures was either late (more than 3 weeks) or arbitrary. The advantages and disadvantages as well as the risk in changing methods are controversial. In a 2-year prospective study from August 1989 to July 1991, patients with II and III degree open and closed femur and tibia fractures as well as trauma patients with fractures were initially treated by external fixation. A change of method from external fixation to intramedullary nailing was performed at the earliest possible time under exact criteria. 61 femur and 106 tibia fractures were accordingly treated and followed. In comparison to early studies there were no differences in bone healing or in functional results. The infection rate in tibia fractures was 1.9% (2 of 106); no infection was seen in femur fractures. The contamination rate at the time of method change was substantially higher at 14%. The difference between contamination and infection rate can be explained by experience in the technique of nailing, considering biological aspects (no or little reaming), the standardized change of method and the prophylactic use of antibiotics. In a follow-up of additional 37 femur and 58 tibia fractures that were treated accordingly, a total infection rate of 1.9% was achieved (2% in femur fractures [n = 98], 1.8% in tibia fractures [n = 164], 1.9% total [n = 262]). In femur and tibia fractures with open or closed soft tissue damage and in multiple trauma patients the treatment with initial stabilisation by external fixation and secondary change to intramedullary nailing can be recommended under certain conditions.

Adolescent↗
PubMed1995

The new unreamed AO nails for the tibia and the femur.

The advantages of the unreamed nailing technique compared to the reamed procedure are less damage to bone vascularity, lower intramedullary pressure during the operation and a fast operation time. These new solid nails with high mechanical stiffness and no central dead space have extended the nail indications for tibial as well as for femoral fractures, particularly in tibial shaft fractures with severe soft tissue damage and in polytraumatized patients with a femoral shaft fracture. Besides these advantages the new AO unreamed femur nail has a modular proximal interlocking system, which increases significantly the range of indications for nailing. Not only very high subtrochanteric femur fractures can be stabilized with greater stability, but also combined ipsilateral fractures of the shaft and the proximal femur can be treated with this new nail. The first clinical results of the AO unreamed nails for the tibia as well as for the femur are very encouraging. The unreamed nails prove to be excellent implants in the treatment of long bone fractures of the lower extremity.

Adult↗
PubMed1997

[A penetrating cranio-facial injury due to a nail-gun accident].

We report a case of a penetrating cranio-facial injury due to a nail-gun accident. An 18-year-old worker was admitted to our hospital as an emergency patient. He was working using a nail-gun when a nail ricocheted off a wall and pierced the right side of his face. Skull X-rays and a CT scan showed that a 9 cm nail had pierced his right frontal lobe through the right maxillary bone via the orbital space. The patient was alert without any neurologically abnormal findings. A small stab wound was recognized on his face. The nail was removed six hours after the injury through a sublabial approach and a fronto-temporal craniotomy. The nail was very tightly fixed in the maxillary bone and skull base bones, and a screw driver normally used in orthopedic surgery proved to be very useful for removing the nail. The patient returned home 14 days later without any neurological deficits. The technical problems associated with such a nail-gun injury in the face and skull are also discussed.

Adolescent↗
PubMed2005

[Aging of hair and nails].

Human hair and nails, like all other organs, undergo chronological aging. Age-associated changes in growth, color, and structure of the hair and nails are common. In contrast to the aging process of the skin, the gerontobiological course of hair and nails has not been investigated comprehensively. Investigations on signaling pathways important for melanogenesis of the hair follicle improve our understanding of processes involved in hair greying. Differences in the structure and quality of the nails at an advanced age are determined mainly by age-dependent variations in lipid content of the nail plates. However, it is important to recognize age-dependent processes in hair shafts and nails and to distinguish between chronological aging and pathological changes. The possibilities to improve these aging processes have, primarily, to be seen in the field of external cosmetic procedures. Since the effect of preexisting hormonal substitution treatment has not yet been adequately investigated, it can be regarded as critical to evaluate the confirmed benefits and possible risks of such treatment either for hair or for nail quality improvement.

Aging↗
PubMed1982

Familial severe twenty-nail dystrophy.

Severe nail dystrophy is a recently described acquired nail disorder. The nails are variably involved and may show thinning, thickening, pitting, ridging, koilonychia, opalescence, and loss of luster. Not uncommonly, some nails are completely spared. Although most of the cases reported were among children, and nail changes showed gradual resolution, in a few cases the disorder is seen in adulthood. We recently investigated a pedigree extending through five generations in which twenty-one of the thirty-seven members were variably afflicted with the dystrophic nail changes. To our knowledge, the familial pattern, inherited as an autosomal dominant trait, has never been previously reported. We propose the term "familial severe twenty-nail dystrophy" for the disorder in this family.

Adult↗
PubMedDate not supplied

Congenital hypertrophy of the lateral nail folds of the hallux: clinical features and follow-up of seven cases.

Congenital hypertrophy of the nail folds of the hallux describes an abnormality of the periungual soft tissues of the big toe characterized by hypertrophy of the nail fold which partially covers the nail plate and is frequently associated with inflammation and pain due to an ingrowing nail. We describe the clinical picture and follow-up of seven patients with this abnormality. In three patients the affected toe showed an asymptomatic, dome-shaped, hypertrophic lip that partially covered the nail plate. Four patients had acute inflammatory changes due to toenail ingrowth, with considerable swelling and reddening of the hypertrophic lip that was painful on pressure. Topical treatment with steroids was useful to reduce inflammation and produced persistent remission in two patients. Follow-up showed a spontaneous disappearance of the hypertrophic nail fold in one of the seven patients. In two patients the hypertrophic lip partially regressed, but remained clearly visible, while in two patients it remained unchanged. In two patients surgical correction of the soft tissue abnormality was necessary due to painful nail ingrowth unresponsive to topical treatment.

Acute Disease↗
PubMed2001

Nail art: a review of current infection control issues.

Nail art or nail technology is a form of nail decoration which frequently entails applying extensions to the natural nail and then adding decorative effects. There have been a number of outbreaks of infection which have implicated nail art. These infections are likely to be as a result of difficulties in cleaning and maintaining the nail extensions. Nail art appears to be incompatible with clinical care.

Attitude of Health Personnel↗
PubMed1995

Pigmented longitudinal bands of the nail. A clinicopathologic study.

Eighteen patients with pigmented longitudinal bands of the nail were evaluated. The following clinical data were obtained: age, gender, and race, duration of the pigmented bands, description and location of the lesion, history of any clinical changes; other nail changes; and family and past history. Nail matrix and/or nail bed biopsy were performed in all cases. The histopathologic findings of 18 patients with longitudinal melanonychia showed hyperpigmentation of the epidermis with no apparent increase in the number of melanocytes in 10 cases. One case showed melanoma in situ; another showed keratinocytic proliferation with focal atypia. Three cases showed subungual hemorrhage. The cause of solitary pigmented bands is often not readily apparent, making the clinical diagnosis challenging. Melanotic macule of the nail matrix, consisting of increased pigmentation of the epidermis with no apparent increased in the number of melanocytes, seems to be the most common cause. When the cause of longitudinal melanonychia is not clinically apparent, biopsy of the nail matrix and the nail bed should help to establish it.

Adult↗
PubMed1997

A case of congenital ectopic nails on bilateral little fingers.

Congenital ectopic nails are a rare anomaly, but we observed a case of a 43-year-old woman with ectopic nails at the tips of her bilateral little fingers. On X-ray, the distal phalanx of the each little finger appeared depressed. We surgically removed the ectopic nails. One year and 6 months later, no relapse had occurred. The histopathological examination revealed undifferentiated nail tissue including nail, nail matrix, and nail epithelium.

Adult↗
PubMed1992

Onychomatrixoma. Filamentous tufted tumour in the matrix of a funnel-shaped nail: a new entity (report of three cases).

Identical lesions of the nails were observed in three patients. The main signs were a yellow colouration along the entire length of the nail plate with splinter haemorrhages in its proximal portion, a tendency towards transverse overcurvature of the affected nails, and exposure of a matrix tumour after the nail had been avulsed and the proximal nail fold turned back. The nails signs were striking enough to lead to the clinical suspicion of a filamentous tufted tumour in the matrix of a funnel-shaped nail, an entity not previously described.

Aged↗
PubMed2006

En bloc excision of proximal nail fold for treatment of chronic paronychia.

BACKGROUND: Chronic paronychia is a very recalcitrant dermatosis, which is particularly prevalent in housewives. Medical treatment for this condition is unsatisfactory in a significant number of cases. Surgical approach forms an important part of management, however, this area has received little attention. Various surgical approaches have been tried in the past but a comparative analysis has not been attempted. OBJECTIVES: The present study aims at assessing the efficacy of en bloc excision of proximal nail fold (PNF). Moreover, a comparative analysis has been undertaken to assess whether or not simultaneous nail plate avulsion improves the treatment outcome. METHODS: Thirty patients of chronic paronychia with nail plate irregularities were randomly divided into two treatment groups (15 patients each). After a detailed evaluation, en bloc excision of PNF with or without nail plate removal was performed. Postoperative measures were advised and the patients were kept under regular follow-up thereafter. Assessment of postoperative complications was also performed. RESULTS: Twelve patients in group I and 13 patients in group II completed the treatment protocol. Of these, 70% of patients were cured in group II (en bloc excision with nail avulsion) whereas only 41% were cured in group I (en bloc excision without nail avulsion). CONCLUSION: En bloc excision of the PNF is a useful method in recalcitrant chronic paronychia. Simultaneous avulsion of the nail plate improves the surgical outcome. Strict avoidance of irritant exposure is necessary to ensure complete treatment and prevent recurrence.

Adolescent↗
PubMed1990

Nail biting and picking as a possible cause of longitudinal melanonychia. A study of 6 cases.

Examination of individuals affected by onychotillomania led us to describe a new cause of longitudinal melanonychia (LM) of the finger-nails. Damage of the finger-nails was caused both manually and by chewing. The nail cuticles were usually pushed back, and biting caused pressure damage of the base of the nail. It is likely that finger-nails respond similarly to toe-nails and the matrix melanocytes can be stimulated by trauma. Such stimulation can apparently persist long after cessation of the trauma. Histological examination of the nail plates demonstrated that the pigment was melanin. In the matrix an increase in melanin content of melanocytes was found without melanocytic proliferation. LM due to onychotillomania should not be overlooked.

Adult↗
PubMed2003

Drug-induced nail abnormalities.

This article reviews the different nail symptoms produced by drugs. Drug-induced nail abnormalities may result from toxicity to the matrix, the nail bed or the periungual tissues. The most common symptoms include Beau's lines/onychomadesis, melanonychia, onycholysis, and periungual pyogenic granulomas. Nail changes usually affect several nails and in most cases are asymptomatic. Drugs that most frequently produce nail abnormalities include retinoids, indinavir, and cancer chemotherapeutic agents. In this article, we also include nail adverse effects as a result of radiotherapy since they are commonly observed in clinical practice.

Humans↗
PubMed2001

Pincer nails: definition and surgical treatment.

BACKGROUND: There are four main types of ingrown nail. These are distal nail embedding, juvenile (subcutaneous) ingrown nail, hypertrophy of the lateral nail fold (lip), and pincer nail. OBJECTIVE: The etiology of pincer nail may be hereditary or acquired. The mechanism of the most common form, an enlarged base of the distal bony phalanx, is discussed. METHODS: Use of roentgenogram and magnetic resonance imaging highlights exophytes of the base and dorsal hyperostosis of the distal phalanx. RESULTS: Global assessment may lead in mild cases to medical therapy. Usually, however, the lateral matrix horn must be surgically removed or cauterized by phenol. Dermal grafting under the nail matrix provides excellent long-term results.

Humans↗
PubMed1990

Nail grafts for reconstruction.

Monkey digits were used experimentally to demonstrate the pathologic anatomy of nail deformities and the results of treatment using full and partial thickness nail matrix grafts. Seventy-five human nail deformities were evaluated and treated. In both the experimental and clinical groups, microscopic hypertrophy of the superficial epithelial elements underlying the deformed nail existed. A follow-up of treatment of nail deformities indicated that nail matrix grafts, both full and partial thickness, are beneficial when the defect involves the sterile matrix and the proximal nail fold.

Animals↗
PubMed1982

[The ultrastructure of psoriatic nail changes].

The various and subsequent psoriatic nail changes can only be understood on the basis of parakeratotic changes. If parakeratosis is localized in the nail matrix specific changes in the nail will result depending on localization and spreading in the matrix. Punctate indentations (pits) may develop; if there is a ribbon-like, square-dimensioned localization we see streaks and ridges (psoriasis unguis striata). If parakeratotic cells invade the whole of the matrix the so-called psoriasis unguis crateriformis will develop. Well-known to the dermatologist is the irregular salmon-colored patch--a type of psoriasis involving the nail-bed. This salmon-colored patch may finally cause onycholysis semilunaris as the nail plate is not fixed to the nail-bed any longer. There may be onycholysis, too, if the cuticle is involved in the course of the psoriatic change. A long-standing psoriasis of the nails is characterized by para- or hyperkeratotic masses ("Krümelnagel").

Humans↗
PubMed2004

Ciclopirox delivery into the human nail plate.

The human nail penetration of the antifungal ciclopirox was determined for marketed gel containing 0.77% of ciclopirox, an experimental gel containing 2% of ciclopirox, and a marketed lacquer containing 8% of ciclopirox. After 14 days dosing, unabsorbed drug remaining on the surface, drug within the infection-prone area, and the amount that had penetrated through the nail were determined. Ciclopirox delivery into and through the nail was significantly greater from the marketed gel, than from either the experimental gel or the nail lacquer (p < 0.05). In addition, the surface nail contained more unabsorbed drug from the lacquer. Further, the drug penetrating into and through the nail was also greater from the marketed gel, leading to a higher Calculated Efficacy Coefficient for the marketed gel, than from the marketed lacquer or the experimental gel. The formulation plays an important role in the enhancement of ciclopirox permeation into and through the human nail plate, and the concentration of ciclopirox in the formulation was not a factor in determining penetration.

Adjuvants, Pharmaceutic↗