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PubMedDate not supplied

An in vitro biomechanical comparison of an interlocking nail system and dynamic compression plate fixation of ostectomized equine third metacarpal bones.

OBJECTIVE: To compare the mechanical properties of two stabilization methods for ostectomized equine third metacarpi (MC3): (1) an interlocking nail system and (2) two dynamic compression plates. Animal or Sample Population-Ten pairs of adult equine forelimbs intact from the midradius distally. METHODS: Ten pairs of equine MC3 were divided into two test groups (five pairs each): caudocranial four-point bending and torsion. Interlocking nails (6 hole, 13-mm diameter, 230-mm length) were placed in one randomly selected bone from each pair. Two dynamic compression plates one dorsally (12 hole, 4.5-mm broad) and one laterally (10 hole, 4.5-mm broad) were attached to the contralateral bone from each pair. All bones had 1 cm mid-diaphyseal ostectomies. Five construct pairs were tested in caudocranial four-point bending to determine stiffness and failure properties. The remaining five construct pairs were tested in torsion to determine torsional stiffness and yield load. Mean values for each fixation method were compared using a paired t-test within each group. Significance was set at P<.05. RESULTS: Mean (+/-SEM) values for the MC3-interlocking nail composite and the MC3-double plate composite, respectively, in four-point bending were: composite rigidity, 3,454+/-407.6 Nm/rad and 3,831+/-436.5 Nm/rad; yield bending moment, 276.4+/-40.17 Nm and 433.75+/-83.99 Nm; failure bending moment, 526.3+/-105.9 Nm and 636.2+/-27.77 Nm. There was no significant difference in the biomechanical values for bending between the two fixation methods. In torsion, mean (+/-SEM) values for the MC3-interlocking nail composite and the MC3-double plate composite were: composite rigidity, 124.1+/-16.61 Nm/rad and 262.4+/-30.51 Nm/rad; gap stiffness, 222.3+/-47.32 Nm/rad and 1,557+/-320.9 Nm/rad; yield load, 94.77+/-7.822 Nm and 130.66+/-20.27 Nm, respectively. Composite rigidity, gap stiffness, and yield load for double plate fixation were significantly higher compared with interlocking nail fixation in torsion. CONCLUSIONS: No significant differences in biomechanical properties were identified between an interlocking nail and double plating techniques for stabilization of ostectomized equine MC3 in caudocranial four-point bending. Double plating fixation was superior to interlocking nail fixation in torsion.

Animals↗
PubMed1985

Physicochemical characterization of the human nail: solvent effects on the permeation of homologous alcohols.

To assess how vehicles might influence permeation through human nail, the diffusion of homologous alcohols (methanol to decanol) administered as neat liquids through finger nail plate has been studied using in-vitro diffusion cell methods and compared with permeation data for the same compounds in aqueous media. Permeation rates of the homologous alcohols through lipid depleted nail plate have also been assessed and the influences of dimethylsulphoxide (DMSO) and isopropyl alcohol on permeation rates of methanol and hexanol have been examined. With the exception of methanol, permeability coefficients are uniformly about five-fold smaller when the alcohols are undiluted than when they are applied in water. Overall parallelism in the permeability profiles under these separate circumstances of application is an indication that the external concentrations of the alcohols themselves are a determinant of their permeation velocities through the nail plate matrix. The even separation of the profiles suggests a facilitating role of water within the nail matrix. Chloroform/methanol delipidization of the nail led to increased penetration rates of water, methanol, ethanol and butanol. On the other hand, it caused a six-fold decrease in the permeation rate of decanol. Application of methanol and hexanol in DMSO somewhat retards their rates of permeation. Isopropyl alcohol also slows the permeation rate of hexanol but has little influence on that of methanol. Thus it appears that solvents which tend to promote diffusion through the skin horny layer have little promise as accelerants of nail plate permeability.

Alcohols↗
PubMed1992

Topical and systemic absorption of sodium pyrithione following topical application to the nails of the rhesus monkey.

A study was performed to investigate the local penetration into the nail, the systemic absorption into the rest of the body, and the routes of excretion of sodium pyrithione following topical application to the nail. Approximately 20 microliters of a film-forming 3% sodium 14C-pyrithione solution was applied once daily to 5 fingernails and 5 toenails of 4 rhesus monkeys for 6 or 7 days. Following dose removal on study day 7, 2 animals were sacrificed, and the treated nails were analyzed for radioactivity. The other 2 monkeys received the topical dose for 1 more day and were monitored during the postdosing period. Sodium 14C-pyrithione was absorbed slowly into and across the nail following topical application, with the nails serving as reservoirs for the drug. Further evidence of the slow movement of sodium pyrithione across the nail was provided by peak plasma 14C equivalents obtained on day 9, 1 day after the last dose had been removed from the nails. Only slight drug concentrations were measurable in plasma, with no radioactivity observed beyond day 12. The urinary excretion data exhibited a delay in peak urinary excretion (days 8 and 9), and an elimination half-life of 2 days, so that approximately 90% of the absorbed drug was eliminated within 1 week following treatment. Including a minor excretion pathway through the feces, total excretion as a percent of dosage was 8.5%, indicating that less than 10% of the applied topical dose of sodium pyrithione was absorbed systemically.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Topical↗
PubMed1990

Massive lymphomatous nail involvement in Sézary syndrome.

The case of a 65-year-old man affected by chronic erythroderma due to Sézary syndrome and massive lymphomatous infiltration of the nails is reported. The clinical features of the nail lesions, consisting in thickening and discoloration of the nail plates, were not diagnostic. The nail biopsy showed a typical epidermotropic T cell lymphomatous involvement of all the nail constituents. Immunohistochemical characterization of the nails and skin lymphomatous infiltration showed identical results, confirming the neoplastic etiology of both the chronic erythroderma and the nail dystrophy.

Aged↗
PubMed2006

Tibiotalocalcaneal arthrodesis using a dynamically locked retrograde intramedullary nail.

BACKGROUND: Tibiotalocalcaneal arthrodesis is an important salvage method for patients with complex hindfoot problems, including Charcot arthropathy, osteonecrosis of the talus, combined arthritis of the ankle and subtalar joint, and failed total ankle arthroplasty. This study evaluated the results of a dynamic retrograde intramedullary nail for fixation with posterior to anterior distal interlocking screws placed through the calcaneus for tibiotalocalcaneal fusion. METHODS: Thirty-three consecutive tibiotalocalcaneal fusions were done by a single surgeon (DBT) and were stabilized with a dynamic retrograde intramedullary nail. Time to fusion, impaction of the nail relative to the intramedullary canal, nail-tibial angle, and complications were noted. Average followup was 14 months. RESULTS: Twenty-nine of 33 feet (88%) fused at an average of 3.7 months after surgery. Average impaction of the nail was 2.3 (0.5 to 5.0) mm. Cortical hypertrophy at the tip of the rod or at the proximal interlocking screw was noted in 13 of 27 patients. A trend toward a higher nonunion rate was noted in patients with an increased nail-tibial angle. CONCLUSION: Dynamic retrograde intramedullary nailing for fixation of the tibiotalocalcaneal fusions is a good method of stabilizing this complex fusion construct.

Adult↗
PubMed2002

Application of locked intramedullary nails in the treatment of complications after distraction osteogenesis.

Distraction osteogenesis (callotasis) has been widely used in patients with limb-length inequality or massive bone defects. This procedure, however, may be associated with a high incidence of physical and psychosocial complications. Callotasis telescoping on a locked intramedullary nail has been used to shorten the period of external fixation. Little attention has been given to the use of locked intramedullary nails in the treatment of complications after callotasis. Between 1990 and 1999, we used locked intramedullary nailing in 27 patients for the treatment of complications after distraction osteogenesis. There were 17 men and ten women with a mean age of 33.2 years (16 to 66). The nail was inserted at a mean of 3.4 weeks (0 to 15) after removal of the external fixator. Simultaneous autogenous bone grafting and soft-tissue reconstruction were also undertaken in seven and two patients, respectively. There was consolidation of the callus or docking site in all patients at a mean of 6.4 months (2 to 14) after surgery. The mean shortening of the callus was 0.7 cm (0 to 2.5). Two patients had infection at the site of a distal screw which resolved after removal of the nail. In 17 patients the nail was removed at a mean of 26 months after its insertion. Locked intramedullary nails are useful in treating complications after distraction osteogenesis in skeletally mature patients. The risk of infection should be borne in mind.

Adolescent↗
PubMed2006

Comparison of plain potassium hydroxide mounts, fungal cultures and nail plate biopsies in the diagnosis of onychomycosis.

OBJECTIVE: To compare the relative sensitivity of direct microscopy, fungal culture and nail plate biopsy in the diagnosis of onychomycosis. DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: The Skin Department, Military Hospital, Rawalpindi from February 1998 to February 1999. PATIENTS AND METHODS: A total of 50 patients who were suffering from different clinical variants of onychomycosis, irrespective of their age, gender, with or without simultaneous presence of systemic diseases, were subjected to laboratory investigations including direct microscopy with 20% potassium hydroxide (KOH) for fungal hyphae, fungal cultures and nail plate biopsies. These patients were later categorized into two groups based upon the results of nail plate biopsies. RESULTS: Of 50 patients, 15 (30%) were positive for fungal elements in direct microscopy, 8 (16%) were positive for fungal culture and 16 (32%) revealed positive results in nail plate biopsies. Amongst nail plate biopsy positive cases, 10 (63%) were positive for direct microscopy and 6 (37.5%) were positive for fungal cultures. In biopsy negative cases, positive results for direct microscopy were seen in 5 (14.7%) patients and positive fungal culture was found in 2 (5.88%) patients. CONCLUSION: The clinical impression of onychomycosis is not true in all the cases. Nail scraping for direct microscopy with 20% KOH should be the first line screening test for all patients which should then be supplemented with fungal culture and/ or nail plate biopsy.

Biopsy↗
PubMed1997

Locking intramedullary nailing with and without reaming for open fractures of the tibial shaft. A prospective, randomized study.

Ninety-one patients who had ninety-four open fractures of the tibial shaft were randomized into two treatment groups. Fifty fractures (nine type-I, eighteen type-II, sixteen type-IIIA, and seven type-IIIB fractures, according to the classification of Gustilo et al.) were treated with nailing after reaming, and forty-four fractures (five type-I, sixteen type-II, nineteen type-IIIA, and four type-IIIB fractures) were treated with nailing without reaming. The average diameter of the nail was 11.5 millimeters (range, nine to fourteen millimeters) in the group treated with reaming and 9.2 millimeters (range, eight to ten millimeters) in the group treated without reaming. Follow-up information was adequate for forty-five patients (forty-seven fractures) who had been managed with reaming and forty patients (forty-one fractures) who had been managed without reaming. No clinically important differences were found between the two groups with regard to the technical aspects of the procedure or the rate of early postoperative complications. The average time to union was thirty weeks (range, thirteen to seventy-two weeks) in the group treated with reaming and twenty-nine weeks (range, thirteen to fifty weeks) in the group treated without reaming. Four (9 per cent) of the fractures treated with reaming and five (12 per cent) of the fractures treated without reaming did not unite (p = 0.73). There were two infections in the group treated with reaming and one in the group treated without reaming. Significantly more screws broke in the group treated without reaming (twelve; 29 per cent) than in the group treated with reaming (four; 9 per cent) (p = 0.014). There was no difference between the two groups with regard to the frequency of broken nails (two nails that had been inserted after reaming broke, compared with one that had been inserted without reaming). The functional outcome, in terms of pain in the knee, range of motion, return to work, and recreational activity, did not differ significantly between the groups. We concluded that the clinical and radiographic results of nailing after reaming are similar to those of nailing without reaming for fixation of open fractures of the tibial shaft, although more screws broke when reaming had not been done.

Adolescent↗
PubMed1998

Forces required to initiate sliding in second-generation intramedullary nails.

Second-generation intramedullary nails, which allow the fixation screw that is placed in the femoral head to slide distally and thus allow compression of the fracture of the femoral neck, have become a popular option for the treatment of ipsilateral fractures of the femoral neck and shaft. However, the sliding characteristics of the screw within the barrel of the nail or the side-plate have not been assessed biomechanically, to our knowledge. The goal of the current study was to investigate the forces required to initiate sliding of the proximal screw in intramedullary devices and to compare these forces with those required to initiate sliding of hip screws. The loading configuration simulated the typical angle of 135 degrees between the intramedullary nail and the proximal screw. The forces required to initiate sliding of the proximal screw, with the screw extended fifty-one, seventy-six, eighty-six, and 102 millimeters beyond the proximal end of the barrel, were measured for three different types of second-generation intramedullary nails (Recon, ZMS, and Gamma), a sliding compression hip screw, and an intramedullary hip screw, and these forces were then compared. With each amount of extension of the screw, the hip screws required lower forces to initiate sliding than did the second-generation intramedullary devices. Of the second-generation devices, the Gamma nail required the highest forces to initiate sliding; the Recon and ZMS nails required 20 to 40 percent lower forces compared with the Gamma nail. None of the devices jammed in any of the loading configurations that were tested. When the extension of the screw was increased, higher forces were required to initiate sliding.

Biomechanical Phenomena↗
PubMed2002

Femoral lengthening over a humeral intramedullary nail in preadolescent children.

BACKGROUND: Femoral lengthening over an intramedullary nail has been described in adults. A technique of femoral lengthening over a humeral intramedullary nail in children is described, and the results and complications are presented. METHODS: Nine preadolescent patients (average age, nine years and ten months) with femoral length discrepancy were treated with femoral lengthening over a humeral intramedullary nail. After nail insertion, a monolateral external fixator was placed with half-pins either anterior or posterior to the intramedullary nail, and lengthening was performed through a proximal osteotomy. RESULTS: The femora were lengthened a mean of 6.1 cm (range, 5.0 to 8.0 cm), 19.5% (range, 15.9% to 26.2%) of the preoperative femoral length. Patients had a mean lengthening index of 12.2 days/cm of length (range, 9.5 to 16.9 days/cm of length). Five complications including osteomyelitis, failure of the distal interlocking site, and femoral fracture at the distal end of the nail occurred in four patients; four of the complications led to surgical intervention. No case of proximal femoral valgus secondary to nailing through the greater trochanter had developed by the time of final follow-up. All patients were followed for a minimum of two years postoperatively, with a mean of 128 weeks (range, 111 to 161 weeks). CONCLUSIONS: The technique is effective but has a high rate of complications, including osteomyelitis, which developed in two of the nine patients. No avascular necrosis or proximal femoral valgus was noted.

Bone Lengthening↗
PubMed2001

Repair of diaphyseal femoral fractures in cats using interlocking intramedullary nails: 12 cases (1996-2000).

OBJECTIVE: To determine the outcome of femoral fractures repaired with 4.0- and 4.7-mm interlocking intramedullary nails in cats. DESIGN: Retrospective study. ANIMALS: 12 cats with diaphyseal femoral fractures. PROCEDURE: Records of all cats in which the 4.0- and 4.7-mm interlocking nail system was used for repair of diaphyseal femoral fractures at the Animal Medical Center and Florida Veterinary Specialists between 1996 and 2000 were reviewed. Information included signalment, type of fracture, size of the implant, details of the surgery, intra- and postoperative complications, fracture healing, and clinical outcome. RESULTS: Femoral fractures in 12 cats were repaired. Eleven of the fractures were comminuted, with 2 of these being open. Clinical outcome was excellent in 7 cats, good in 3, and fair in 1. One resulted in a nonunion. Complications included screw breakage (1 cat) and fracture distal to the nail (1). Fracture distal to the nail occurred from a second trauma. CONCLUSION AND CLINICAL RELEVANCE: Use of the interlocking nail has been limited in cats because of the small diameter of the medullary canal. Use of the 4.0-mm nail will allow for greater application of this implant in small patients. Results of this study indicate that the 4.0- and 4.7-mm interlocking nails can be used to repair simple or comminuted diaphyseal femoral fractures in cats.

Animals↗
PubMedDate not supplied

Psychophysiological reactivity to stress in nail biters.

Heart rate and skin conductance were measured for 83 college students (20 male nail biters, 19 male non-nail biters, 22 female nail biters, and 22 female non-nail biters) during baseline, task, and 3 stressors. Psychodiagnostic measures included the Beck Depression Inventory and the State-Trait Anxiety Inventory. A significant nail-biting status x sex interaction was found in skin conductance reactivity (task minus baseline) for all tasks. Male nail biters were significantly more reactive than the other 3 groups. There was no significant difference in heart rate reactivity in any of the tasks. None of the psychodiagnostic measures differentiated among any of the subgroups. Nail biting, for males, is associated with psychophysiological changes during stress, although the implication of this relationship remains to be clarified.

Anxiety↗
PubMed1999

Identification of LMX1B gene point mutations in italian patients affected with Nail-Patella syndrome.

Nail-Patella syndrome, or osteo-onychodysplasia, is an autosomal dominant disorder characterized by nail dysplasia, absent or hypoplastic patellae, iliac horns and nephropathy. Previous studies have demonstrated linkage of the Nail-Patella locus with polymorphic markers on human chromosome 9q34. Recently, point mutations in the LMX1B gene have been identified in Nail-Patella patients and in families with recurrence of Nail-Patella syndrome and open-angle glaucoma. We describe here the identification of additional point mutations in the LMX1B gene in a set of Italian patients affected with Nail-Patella syndrome: two deletions of 1 and 2 bp causing a frameshift in two sporadic patients and nonsense mutations in two familial and one sporadic cases have been identified. All the mutations affect the homeodomain of the LMX1B protein and could cause the Nail-Patella syndrome through a loss of function as well as a dominant negative effect. Haplotype analysis in the two familial cases carrying the same stop codon mutation suggests the presence of a founder effect. Finally, analysis of cDNA clones obtained from human fetal kidney has revealed the existence of two different transcripts of LMX1B gene likely due to an alternative splicing.

Alternative Splicing↗
PubMed2000

The use of elastic nails for intramedullary fixation of humeral fractures and nonunions.

From May 1993 to January 1997, a total of 130 humeral fractures and nonunions were treated using an "elastic" unreamed nail. The elastic nail consists of a cylindrical proximal component tapered for the application of the impactor-extractor, distally containing the proximal ends of four or five secondary nails preloaded to diverge and held together by a retaining system. The surgical approach is through the olecranic fossa apex. Once introduced, the proximal end of the nail locks automatically by diverging the secondary nails in the proximal humeral epiphysis. Distally, the elastic nail is locked with a crossbolt. The elastic nail enables stable fixation of fractures or nonunions and allows early rehabilitation.

Adult↗
PubMedDate not supplied

Intramedullary nailing of the femur: reamed versus nonreamed.

All intramedullary nailing creates some loss of endosteal blood supply and an increase in intramedullary pressure, resulting in marrow embolization. In laboratory studies, both reamed and nonreamed intramedullary nailing have led to alteration in selected pulmonary variables. This effect, although transient, appeared more pronounced with reamed techniques than with nonreamed techniques. Concern about the systemic pulmonary effects of reamed intramedullary nailing has led to an increase in the use of nonreamed nailing. The authors of most clinical studies have reported that reamed intramedullary nailing has not been associated with a concomitant increase in pulmonary complications in multiply injured patients, although this point is still controversial. Femoral shaft fractures treated with nonreamed nailing have been shown to have slightly higher rates of delayed union and nonunion compared with those treated with reamed nails. Reamed interlocking intramedullary fixation remains the treatment of choice for femoral shaft fractures in adults. Further study is required to determine whether an identifiable subgroup of trauma patients is adversely affected by intramedullary reaming, which would suggest the need for alternative fixation techniques.

Adult↗
PubMed1990

Nickel in nails, hair and plasma from nickel-hypersensitive women.

The concentrations of nickel in finger-nails, toe-nails, hair and plasma from 71 nickel-hypersensitive women and 20 non-hypersensitive women were determined. Nickel concentrations in finger-nails were significantly higher than in toe-nails in both the nickel-hypersensitive group and the control group. Nickel-sensitive women had significantly higher levels of nickel in toe-nails, hair and plasma than had control subjects, whereas there was no significant difference in nickel concentration in finger-nails between the two groups. No correlation could be demonstrated between nickel levels in any combination of nails, hair and plasma in the nickel-hypersensitive or in the control group.

Adolescent↗
PubMed1999

Anatomic considerations of locked humeral nailing.

To investigate the risk of axillary nerve injury by the proximal locking screws in antegrade nailing of humeral fractures, the anatomy of the axillary nerve was examined in 20 fresh anatomic specimen humeri, which subsequently were nailed antegrade with specially designed humeral locked nails. The axillary nerve was found to be on average 45.6 mm below the tip of the greater tuberosity; it was jeopardized by insertion of the lower proximal locking screw in one of the 20 specimens. Short humeri, humeri with small heads, or too deeply inserted nails may increase the risk of nerve injury; likewise, a lower location and more horizontal direction of the locking screws and a greater curvature of the nail can heighten the risk. In addition to the examination of the axillary nerve, a geometric study of these anatomic specimen was performed and was aimed at improving retrograde nailing technique and thus treatment results. The humeral geometry indicated that for the best linearity in the sagittal plane, an entry portal incorporating the superior margin of the olecranon fossa would be recommended for the 14 humeri with a distal humeral offset less than 4 mm, whereas a supracondylar entry portal would be recommended for the six humeri with an offset larger than 4 mm. For best linearity in the coronal plane, the entry portal and nailing direction should be more lateral in humeri with a smaller humeral elbow angle.

Aged↗
PubMed2000

Retrograde nailing for subtrochanteric femur fractures.

This study reviews the results of subtrochanteric femur fractures treated with a retrograde nail at a level 1 trauma center. Sixteen patients with 17 fractures were followed up until union. The average Injury Severity Score (ISS) was 19, and average knee range of motion was 127 degrees. Four patients required dynamization of their nail, and three healed over a prolonged period of time. Two patients required exchange nailing: one after failure of union after dynamization and one with a broken nail that was revised to an antegrade nailing. The average varus deformity was 5.06 degrees and only 35% of fractures healed in greater than 5 degrees of varus, with an average time to union of 22.4 weeks (range, 6-54 weeks). Antegrade nailing remains the treatment of choice for the vast majority of subtrochanteric femur fractures. However, retrograde femoral nailing may be an effective treatment option for some subtrochanteric fractures in a selected group of patients.

Adolescent↗