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PubMed2000

[Risks and results after simultaneous intramedullary nailing in bilateral femoral fractures: a retrospective study of 40 cases].

PURPOSE OF THE STUDY: A retrospective series of 40 patients who underwent simultaneous intramedullary nailings for bilateral femoral shaft fractures was analyzed. The aim of our study was to verify that simultaneous nailing without reaming does not increased risk of fat embolism and to assess clinical and radiological outcome. MATERIAL AND METHOD: This series included 27 men and 13 women, mean age 27.8 years, who underwent first intention intramedullary nailing between 1986 and February 1999. Thirty-two patients had multiple fractures. Mean ISS was 23 (range 9 to 59). Among the 80 femoral shaft fractures, 15 were open fractures, 3 were associated with sciatic paralysis, and 4 were complicated by an interruption of the femoral vessels. The AO classification was: type A=44; type B=25; type C=11. Mean delay to simultaneous centromedullary nailing was 3. 8 days: surgery was performed on the day of arrival for 25 patients. General anesthesia was used in all cases with respiratory assistance (FIO(2) =50 to 100 p. 100). Mean nail diameter was 11.6 (range 10-14). Gurd criteria and PaO(2) were followed to assess pulmonary function. Clinical and radiological outcome was assessed using the modified Thorensen criteria. RESULTS: Preoperatively, PaO(2) was< 87 mmHg in 8 patients. Four of these patients showed a discrete drop off and three improved well above the normal level. Only one patient experienced an important decrease but did not develop respiratory distress. Among the 32 patients with a normal level preoperatively, PaO(2) remained in the normal range in 18, fell to a limit level but below 87 mmHg in 4, and showed a substantial drop off of 46 to 172 mmHg in 10. Two of these 10 patients developed respiratory distress due to fat embolism which was fatal in one case. One other patient died in the immediate postoperative period of an undetermined cause. All of the other patients recovered normal gas levels within a few hours or days. There were four cases of phlebitis, including one with pulmonary embolism, one case of respiratory distress by pulmonary superinfection, and one case of septicemia. Both femoral fracture sites became infected in one patient. Malunion occurred in two cases. Two vascular repairs of the femoropopliteal axis were unsuccessful, leading to above knee amputations. Thirty-four patients have been examined after a minimal 12 months follow-up (mean 30 months). Outcome was excellent for 48 femurs, good for 10 and fair for 10. DISCUSSION: This continuous series of simultaneous bilateral femoral shaft intramedullary nailings appears to be the only such report to date. The clinical and radiological outcomes were comparable with those achieved in one-side femoral fractures. The risk of fat embolism is inevitable after long bone fractures. Many factors favoring the risk are recognized, the most important being delay to fixation. Reaming creates excessive pressure in the medullary canal and could thus contribute to the risk. The presence of an associated chest trauma is not a formal contraindication if effective hematosis is preserved as evidenced by the blood gases. CONCLUSION: Simultaneous nailing of bilateral femoral shaft fractures can be performed if blood gases remain acceptable and minimal reaming is used.

Adolescent↗
PubMed2000

[Nail tumors].

The presenting sign associated with the tumours of the nail unit may involve: the colouration of the nail plate and/or the subungual tissue; the contour of the nail and the volume of the distal phalanx; the integrity of the nail (partial destruction or nail disappearance); abnormalities in the periungual tissues. The key for the early diagnosis of a nail tumour is a high index of suspicion of any non healing or recurrent condition in the area. Non-invasive studies such as X-ray or MRI may be followed by the need of exploratory nail plate removal and adequate biopsy.

Biopsy↗
PubMed2001

[Progressive limb lengthening with a centromedullary nail versus an external fixator: experimental study in sheep].

PURPOSE OF THE STUDY: Progressive limb lengthening with an external fixator often leads to pin-related complications. A new technique allowing progressive lengthening with a centromedullary nail without external fixation has been developed. This original double-locked device consists of matching male and female components fitted with a continuous thread. Lengthening is achieved via a one-way ratchet system. Twelve back-and-forth movements produce 1.25 mm lengthening. MATERIAL AND METHODS: We tested this new device on 20 sheep and compared results with external fixation lengthening in 20 other sheep. The animals were divided into groups for sacrifice on days 5, 10, 20, 45 and 90. Serial x-ray were obtained for all animals. In the 45-day and 90-day groups, histomorphometric (trichrome goldner coloration and polarized light microscopy) and densitometric studies were also performed. Bone mineral density (BMD) was determined and bone trabecular density (BTD) and trabecular bone volume (TBV) were expressed in percent of bone trabecular surface area. RESULTS: Mean lengthening in the 45-day and 90-day groups was 39 mm for the nail and 20 mm for external fixation (1 mm/day). At 90 days, 3 sheep out of 4 had consolidated radiologically with external fixation and 2 out of 4 with the nail. BMD was slightly better for external fixation (0.811 vs 0.695/cm(2)). This difference could probably be attributed to the greater lengthening obtained with the nail. At 45 days, BMD was the same (0.6 g/cm(2)) for both devices. BTD was nearly two-fold higher for the nail compared with external fixation (59.65% vs 32.61% at 90 days), most probably due to primary bone formation. The histomorphometric study allowed an analysis of the osteoid border. Bone quality obtained in the bone regenerate with the nail was superior to that obtained with external fixation. Primary bone formation resulted from membrane ossification with direct transformation of fibroblasts into osteoblasts. CONCLUSION: This work demonstrated that progressive lengthening can be achieved with a specifically designed centromedullary nail without iterative opening of the operative site. Tolerance to this type of device and quality of the bone regenerate are altogether satisfactory.

Absorptiometry, Photon↗
PubMed2001

[Reconstruction of nail folds by double pulp flap in congenital complete syndactyly release].

OBJECTIVE: To introduce a surgical approach for reconstruction of nail folds in congenital complete syndactyly release. METHODS: A narrow flap and a broad flap were raised on the common distal phalanx to cover the denuded nail-edge in 30 fingers of 15 cases whose webs were separated. RESULTS: All of the flaps were successfully transferred and survived. The reconstructed nail folds had satisfied figure in 21 out of 30 fingers. The nail folds in the other 9 fingers, covered by a broad flap in 2 fingers and by a narrow flap in 7 fingers, were a little smaller than normal. All of the 30 fingers had normal fullness of pulp and no twisty nails. CONCLUSION: The reconstruction of nail folds by double pulp flap can be performed with a one-stage technique, and the outcome is satisfactory, which make it as a good surgical approach to reconstruct nail folds in congenital complete syndactyly release.

Child↗
PubMedDate not supplied

Neuropsychological symptoms associated with low-level exposure to solvents and (meth)acrylates among nail technicians.

OBJECTIVE: To evaluate reports of neuropsychological symptoms among women occupationally exposed to products commonly used in nail studios. BACKGROUND: Typical preparations found in nail studios contain a variety of organic solvents (e.g., toluene, acetone, formaldehyde) and (meth)acrylates with known neurotoxic properties. Little research has focused on the neuropsychological sequelae of exposure to these substances occurring in the cosmetics industry. METHOD: Participants included nail salon technicians (n = 150) and controls (n = 148). Nail technicians were compared with demographically similar controls using the Neuropsychological Impairment Scale, a self-reported measure of neuropsychological and psychological symptoms. Aspects of the workplace environment (e.g., square footage of the salon, adequacy of ventilation, hours worked) also were assessed. RESULTS: A MANOVA revealed small but significant differences in the overall level of symptoms as well as in individual scales measuring neurologic complaints, cognitive efficiency, memory, verbal learning, and academic skills (p < 0.001). Moreover, nail technicians were significantly more likely to score above the clinical cutoffs than were controls on four of the seven clinical scales and two of the three summary indices. Multiple regression analysis indicated that the severity of symptoms was associated with level of occupational exposure (p < 0.01). The cumulative impact of workplace size and ventilation were most strongly associated with symptom severity. CONCLUSIONS: Exposure to low-level neurotoxins common to nail studios results in the self-reported experience of cognitive and neurologic symptoms similar to other types of solvent and (meth)acrylate exposure. The profile of reported symptoms is consistent with deficits typically observed in this type of neurotoxic exposure: neurologic complaints as well as perceived problems with cognitive efficiency, memory, and learning. Additionally, the nail technicians reported a higher overall level of complaints and greater severity of symptoms than did the controls.

Adolescent↗
PubMed2002

Neurocognitive sequelae of exposure to organic solvents and (meth)acrylates among nail-studio technicians.

OBJECTIVE: To evaluate neuropsychologic performance among women occupationally exposed to products commonly used in nail studios. BACKGROUND: Organic solvents and (meth)acrylates commonly used in nail studios have known neurotoxic properties. Few studies have examined the potential for cognitive and neurosensory effects of occupational exposure to these substances, and none has addressed exposure occurring in the cosmetics industry. METHODS: Participants in this study included nail-salon technicians (n = 33) and demographically similar controls who had no known history of exposure to toxic chemicals (n = 35). The groups were administered psychologic, neuropsychologic, and neurosensory tests. Aspects of the workplace environment (e.g., square footage of the salon, adequacy of ventilation, and hours worked) also were assessed. RESULTS: Multivariate analysis of variance (MANOVA) revealed that the nail technicians performed more poorly than did controls on tests of attention and processing speed (p = 0.015; eta(2) = 0.20). Olfaction among the nail technicians was below expected performance based on normative data (p < 0.001). A trend toward poorer performance by the nail technicians was observed on the MANOVA investigating executive functioning; individual tests within that domain may be worthy of future investigation (ps = 0.03-0.10). No significant group differences were observed in the domains of learning and memory, visuospatial ability, or fine motor coordination, or on measures of depression and anxiety. Multiple regression indicated that level of occupational exposure as measured by time worked in the industry, adequacy of ventilation, and workplace size predicted 29% of the variance of performance on attentional tasks (p = 0.04). CONCLUSION: Exposure to low-level neurotoxicants common to nail studios may result in mild cognitive and neurosensory changes similar to those observed among solvent-exposed workers in other settings.

Acrylates↗
PubMedDate not supplied

Effect of piriformis versus trochanteric starting point on fixation stability of short intramedullary reconstruction nails.

Recently, a new, shorter IM nail using two 6 mm reconstruction screws for proximal fixation was introduced in two versions for femoral insertion: piriformis fossa (FAN) and greater trochanter (TAN). These nails were compared experimentally for their fixation stability, proximal load transmission, and failure strength in an unstable intertrochanteric fracture model in cadaveric femurs. Vertical and axial loads were first applied to the intact femurs. Fractures were created, subsequent fixation applied, and the femurs underwent a series of both vertical and axial loading tests. There was no significant difference in strain readings between the nails for either axial loading or cyclical loading. There was no statistically significant difference between the loads to failure for the trochanteric nails and the standard antegrade nails. The average ultimate loadfor the FAN and TAN nails were 3010 N and 2830 N respectively. These two nails performed very similarly throughout our testing.

Biomechanical Phenomena↗
PubMed2002

[Long gamma nail for the treatment of subtrochanteric fracture of the femur].

PURPOSE OF THE STUDY: The standard gamma nail is commonly used for the treatment of trochanteric fractures but cannot be used if the fracture lies at the level of the distal locking. Theoretically, the long gamma nail would overcome this inconvenience and could be used for all cases of subtrochanteric and trochanteric-shaft fractures. MATERIAL AND METHODS: Clinical and radiological charts were established in 1990 for a multicentric study. The radiology work-up included an AP view of the pelvis and an oblique lateral view of the hip. Two classifications were used: Seinsheimer and Muller as modified by Nazarian. Three stages of fracture reduction were recorded: 1=anatomic reduction, 2=acceptable reduction, 3=poor reduction. From January 1995 to December 1999, 46 patients were treated with the long gamma nail. Twenty-four cases were excluded for various reasons (from which 3 early death). 22 remaining patients were followed for more than six months. Mean age was 68 years (range 42-96); there were six women and 16 men. Ten patients were traffic or work accident victims and 12 had had a home accident. RESULTS: Mean duration of surgery was 70 minutes. Three patients required revision surgery within a week of the initial osteosynthesis. Mean hemoglobin level before surgery was 12.9 g/dl; 8.9 g/dl during the first postoperative week. Mean hospital stay was 14 days. Weight-bearing with support was possible early after surgery in 16 patients who walked with crutches or a walker. Mean delay to weight-bearing was 11 days. At three months, all patients were using an aid for walking; at six months, four patients used a walker. Bone healing was achieved on the average at the twelfth week. Radiological reduction was anatomic in four, acceptable in three and poor in 15. DISCUSSION: We advocate the AO classification as it allows a structured analysis of all fractures within a unique system. We compared our results with nine series reported in the literature using other therapeutic methods (screw-plate, nail-plate, Ender nail). The operative time for the long gamma nail (70 min) was comparable with that for other surgical techniques. Treatment with the long gamma nail favors bone healing and limits the risk of infection. Radiological results in our series were poor, but there were no cases with nonunion and the morbidity was low.

Adult↗
PubMed2003

[Treatment of solitary bone cysts by intra-medullary nailing or steroid injection in children].

PURPOSE OF THE STUDY: Several methods are used to treat essential bone cysts in children: curettage with bone graft, simple drainage, steroid injection, intramedullary nailing. No one method is preferred by all. We compared two retrospective series of children with solitary bone cysts treated by steroid injection or intramedullary nailing. MATERIAL AND METHODS: Seventy-two cysts were treated by the same team: 54 by injection of methylprednisolone, and 18 by intramedullary nailing. Fifty cysts were disclosed by bone fracture. The others were revealed by pain or discovered fortuitously. Seventy-five percent of the patients were boys. The humerus was involved in two-thirds of the cases. Patient age ranged from 5 to 10 years. Intramedullary nailing was used for the femur in 10 cases and the humerus for 8. Steroid injections were given after cyst opacification using 160 mg per injection, total mean dose 800 mg (range 80-2400 mg). RESULTS: Cure was obtained at 4 years on the average, with no difference between the two series. Complications observed were transient or definitive and more severe in patients treated by steroid injections. Most of the complications were transient effects of steroid overdosage or limb length discrepancy: 7 shortenings (1-8 cm) for injected cysts (all in patients given > 100 mg methylprednisolone), compared with 2 shortenings<2 cm after intramedullary nailing. DISCUSSION: Steroid injections have been used for many years with variable results depending on the reported series. Cyst opacification before injection is recommended to identify anomalies which could compromise outcome. Strict compliance with the rules of steroid treatment is required to avoid complications, as observed in our patients, which are dose dependent. The percutaneous method is attractive but can be used with other products such as bone marrow or bone substitutes to optimize results. Intramedullary nailing has the advantage of providing immediate support of the damaged bone while allowing cyst drainage and evacuation of the lytic segments. This method should probably be preferred for weight-bearing segments whether the cyst is associated with fracture or not. For non-weight-bearing segments, the choice between percutaneous treatment, and the substance to use, and intramedullary nailing depends largely on bone quality.

Adolescent↗
PubMed2003

Design of a retractable intramedullary nail for the humerus.

This paper describes the design of a retractable intramedullary nail for the humerus that does not require inter-locking screws. The developed nail has a series of fins which open out from the casing to grip the medullary canal of the bone, thus securing it in position. Prototypes of the nail have been mechanically tested using static compression, dynamic compression and static torsion tests. During the compression tests no nails were found to fail. Statically a mean force of 809 N was withstood. During dynamic testing all the nails survived 1 million cycles, with a maximum applied load of 400 N. In torsion the two nails failed at 1.0 and 2.2 N m. Based on the mechanical testing, the retractable intramedullary nail would appear strong enough to withstand the expected loading conditions in the human body.

Adult↗
PubMed1975

[Should one choose the nail or the plate in treating a leg fracture?].

The authors have analysed the results of 126 tibial fractures treated by blind nailing with reaming and 112 tibial fractures treated by plating. They noted 5 septic complications after nailing, after plating, one non-union after nailing and 12 after plating, 3 malunions after nailing and 2 after plating. The cases treated by nailing united earlier. The Authors conclude that nailing is a more fiable technique than plating, and that the only fractures which should be plated are those which are not fit for nailing.

Bone Nails↗
PubMed2004

[A comparison between locked intramedullary nailing and plate-screw fixation in the treatment of tibial diaphysis fractures].

OBJECTIVES: The results of treatment with plate-screw or locked intramedullary nailing were evaluated for tibial diaphysis fractures, with a comparison of time to union and complications. METHODS: The study included 44 patients (31 males, 13 females; mean age 38 years; range 14 to 64 years) with tibial diaphysis fractures. The fractures were on the left side in 23 patients and on the right side in 20 patients. One patient had bilateral involvement. Twenty-six fractures were treated by intramedullary nailing and 19 fractures by plate-screw fixation after a mean time of nine days and 10 days from injury, respectively. The patients were evaluated with regard to operation time, range of motion, time to union, and complications after a mean follow-up of 23 months (range 18 to 46 months). RESULTS: The mean operation time and the mean range of motion of the ankle and knee were found similar in both groups. The mean time to union was five months with intramedullary nailing, and 3.5 months with plate-screw fixation. Length discrepancy occurred in only two patients (2 and 2.5 cm) in whom intramedullary nailing was performed. One patient treated by intramedullary nailing for a type III open fracture developed osteomyelitis. Plain radiographs showed angulation in four patients and in three patients following intramedullary nailing and plate-screw fixation, respectively, all of whom had distal-third tibial fractures. CONCLUSION: Plate-screw osteosynthesis yields satisfactory results in uncomminuted fractures of the tibial diaphysis, whereas locked intramedullary nailing is more appropriate in comminuted fractures because of better preservation of periosteal circulation, and thus lower complication rates.

Adolescent↗
PubMed2004

[A comparative study on two different absorbable intramedullary nails in treating metacarpal and phalanx fractures].

OBJECTIVE: To study the effect of two different absorbable intramedullary nails in treatment of metacarpal and phalanx fractures. METHODS: From January 2002 to December 2002, open reduction and internal fixation were done with two different absorbable intramedullary nails in 60 cases of metacarpal and phalanx fractures (52 cases of open fractures and 8 cases of closed fractures). The fracture locations were metacarpal in 24 cases, proximal phalanx in 22 cases and media phalanx in 14 cases. The emergency operation was performed in 47 cases, selective operation in 13 cases. Out of 60 patients, 24 were treated with intramedullary nails of poly-DL-lactic acid (PDLLA) (PDLLA group), 36 with intramedullary wire of PDLLA composed of chitosan(PDLLA+chitosan group). RESULTS: In the PDLLA group(n = 24), the rejection occurred in 8 cases 3-4 weeks after operation. PDLLA nails were taken out in 6 of the 8 cases after 5-10 days of operation and bone healing was achieved 2 months after re-fixation by Kirschner wire; the rejection subsided in the other 2 cases after 25 days of conservative treatment, and bone fracture healed after 14 weeks. No rejection was observed with primary healing in the other 16 cases of the PDLLA group. In PDLLA + chitosan group(n = 36), the rejection occurred in 1 case 19 days after operation, but the rejection subsided after 3 days of conservative treatment. No rejection was observed in the other 35 cases with primary healing. All patients were followed up 4-11 months with an average of 6 months. No rejection was observed and bone healing was achieved during the follow-up. The time of bone healing was 6-16 weeks (8 weeks on average). There was statistically significant difference in the curative result between two groups(P < 0. 05). Conclusion Intramedullary nail of PDLLA was very suitable to fix fractures of metacarpal and phalanx. During the degradation of PDLLA, the acidic products can cause rejection. When PDLLA mixed with chitosan, PDLLA can not only strengthen the intensity but also neutralize the acidity. So the rejection can be decreased. PDLLA intramedullary nails composed of chitosan were better than PDLLA intramedullary nails in clinical treatment of metacarpal and phalanx fractures.

Adolescent↗
PubMed2005

A new anatomical repair method for the treatment of ingrown nail: prospective comparison of wedge resection of the matrix and partial matricectomy followed by lateral fold advancement flap.

Currently, there are various surgical treatment modalities for ingrowing nail. None of these procedures are perfect to achieve esthetic results with low cost, recurrence, and complication rates. Eighty-seven toenails of 77 patients were operated in our clinic; 49 wedge matrix resections (WMR) and 38 partial matricectomy followed by lateral fold advancement flap (LFAF) were applied. Average follow-up period of the patients was 13 months. The recurrence rates, spicule formation, immobilization periods, and patient satisfaction for cosmetic result and discomforting symptoms were investigated. Nail, distal phalanx bone, soft tissue measurements were performed in the counterlateral healthy toe of 34 patients that we operated due to the unilateral ingrowing nail and 34 randomized individuals with no ingrowing nail by lateral and anteroposterior toe x-rays. There were no significant differences for age, sex, the side of the ingrowing nail, postoperative mobilization period, and the follow-up period between 2 groups that the techniques were applied to. There was no statistically significant difference in WMR (8.1%, 4 toes) and LFAF (none) for the recurrence rate. But there was significant difference between WMR (36.7%, 18 toes) and LFAF (5.2%, 2 toes) for the spicule formation rates (P < 0.05), and there was significant difference between WMR (20.4%, 10 toes) and LFAF (none) for the reoperation (P < 0.03). It was observed that patient satisfaction in cosmetic view was better in patient group treated with LFAF (P < 0.05). Phalanx heads were wider in patient group with ingrowing nail at the results of the measurements (P < 0.01). The fact that granulation and scarred tissues are removed instead of performing the great soft tissue excisions is more correct for both recurrence and cosmetics. Partial matricectomy and LFAF is a good alternative method for the treatment of ingrown nail, with less recurrence rates and cost and better cosmetic results.

Adult↗
PubMed2004

Fit-and-fill analysis of trochanteric gamma nail for the Thai proximal femur: a virtual simulation study.

The present study present a three-dimensional virtual simulation method to evaluate the fit-and-fill effect of the insertion of a trochanteric gamma nail (TGN) in 98 Thai dadaveric proximal femora. The circular best fit of the 2-dimensional cross-section of the femoral canal and the nail at 4 levels [d100, d120, d140 and d160] which were located at 100, 120, 140 and 160 mm distal to the tip of the greater trochanter were calculated. The evaluation of each level included, 1) the diameters of the medullary canal, 2) the percentage of area filled by the nail in the unreamed medullary canal, 3) the minimal reamer diameter that required enlargement of the canal to accommodate TGN insertion, 4) the minimal inner cortical reaming thickness that needed to be removed, 5) the percentage of cortical bone area that needed to be removed prior to nail insertion and 6) the deviation of the nail center from the center of the medullary canal. The results showed that at 4 studied locations the diameter of unreamed medullary canal averaged 10.3 to 11.8 mm. The nail cross-section that could fill the medullary canal averaged 86.9-95.1%. The minimal reaming diameter for the medullary canal to accommodate the TGN insertion averaged 11.3 to 12.3 mm. The inner cortical thickness that should be removed averaged 0.6 to 0.8 mm. The cortical bone that needed to be removed averaged 13.6 to 19.3% of the total cortical area. The deviation of the nail center from the canal center averaged 0.3 to 0.8 mm. The present study showed some mismatching of the TGN to that of the Thai proximal femur. Appropriate reaming to prepare the medullary canal should be considered prior to TGN insertion to prevent technical problem. Future re-design of the implant may be considered for Thai patients.

Adult↗
PubMed2005

Familial median canaliform nail dystrophy.

Median canaliform nail dystrophy typically appears as a central nail groove, beginning at or distal to the proximal nail fold, from which small lateral fissures may be found. Although the onset of this nail dystrophy has occasionally been associated with either prior local trauma or the initiation of treatment with isotretinoin, the etiology of this condition remains elusive for most affected individuals. We describe a man with median canaliform nail dystrophy whose brother and mother had the same nail dystrophy, review the other reported cases, and discuss the differential diagnosis of this nail disorder.

Aged↗
PubMed1992

[The gamma-nail as a resilient alternative to the dynamic hip screw in unstable proximal femoral fractures in the elderly].

In a prospective randomised trial between September 1989 and June 1990 one hundred patients with per- and subtrochanteric fractures were consecutively treated by gamma-nail or DHS. The average age of both groups was about 80 years. The operation time for gamma-nailing was longer than for DHS implantation and also the postoperative blood loss was higher in the gamma-nail group. We found no difference of intraoperative blood loss, of perioperative lethality and in duration of hospital care. 90% of gamma-nail patients and 80% of DHS patients were successfully able to walk four days after operation with full weight bearing on the operated limb. Three patients in the DHS group with unstable fractures got cranial perforation of the cephalic screw mobilisation. Five patients of the gamma-nail group were reoperated, one case because of missed distal locking, one because of cranial perforation of the cephalic screw after varus dislocation of the proximal fragment. One patient suffered intraoperatively a proximal femur shaft fracture which was corrected during operation. In one case a wound hematoma was evacuated, an other patient needed secondary wound closure. Despite technical imperfection of implant and instruments, we conclude that the gamma-nail allows a very high percentage early and full weight bearing immediately after operation. So we consider that in the treatment of unstable pertrochanteric fractures of geriatric patients, the gamma-nail has proven to be more efficient than the DHS.

Aged↗
PubMed2005

Topical calcipotriol therapy in nail psoriasis: a study of 24 cases.

There are few reports regarding the treatment of nail psoriasis with topical calcipotriol. We undertook a case series study to evaluate the efficacy and safety of calcipotriol ointment (50 microg/g) in the treatment of nail psoriasis in 24 patients. This study involved 19 women and 5 men with nail psoriasis referred to Dermatology clinics of Razi hospital. The duration of trial was from October 2002 to September 2004. Informed consent was obtained from all patients before entering into the study. The patients applied calcipotriol ointment to the affected nails twice daily without occlusion for 3 months. Patients were seen by two academic dermatologists initially, after 2 weeks, and then at monthly intervals. The efficacy and safety were clinically assessed and any side effect was recorded. Patients who showed 50 percent or greater reduction in the baseline subungual thickness in at least one nail were considered to be responders and were offered continuation of therapy for an additional 2 months. After discontinuation of therapy, followup visits were performed at 1 and 2 months. After 3 months of therapy, fourteen patients showed significant clinical improvement, two of them were completely free from nail lesions after 5 months. Calcipotriol was particularly effective in subungual hyperkeratosis, onycholysis, and discoloration. In four patients fingertip tenderness and in one case the pain of involved distal phalanx were significantly reduced. No clinical response was observed in four patients. Only two cases showed adverse reactions. Topical Calcipotriol is an effective treatment for nail psoriasis and can be considered to be a safe topical treatment in chronic cases; its high tolerability allows prolonged usage without severe side effects.

Administration, Topical↗