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PubMed1988

Delayed primary reconstruction of subtotal nail bed loss using a split-thickness nail bed graft on decorticated bone.

Split-thickness nail bed grafting is the accepted method of treatment for injuries involving loss of nail bed tissue. The nail bed of the great toe may be used without donor-site morbidity, and nail bed grafting may be combined with other procedures for fingertip reconstruction. A case of fingertip avulsion injury with loss of the nail plate, nail bed, and periosteum over the exposed distal phalanx of the thumb was reconstructed by a split-thickness nail bed graft placed directly on granulating decorticated bone. The length, appearance, and function of the injured dominant thumb were preserved.

Accidents, Occupational↗

PubMed2004

Formable acrylic treatment for ingrowing nail with gutter splint and sculptured nail.

BACKGROUND: The treatment of choice for an ingrowing nail has been surgical rather than nonsurgical. Yet, surgical treatments are far from successful, cause pain and patient apprehension, and leave disfigurement. Further, there is misunderstanding about the disease pathophysiology. OBJECTIVE: To demonstrate the benefits of a noninvasive method of treatment for an ingrowing nail using gutter splint and formable acrylics and to present a current understanding of the disease pathophysiology. METHODS: From a total of 541 cases of ingrowing nails treated, full follow-up data were obtained between January 1979 and March 2002. Formable acrylic treatments were carried out in 106 cases treated with acrylic-affixed gutter splint, 17 cases with sculptured nails, and 28 cases in which the two treatments were combined. These were then compared with 233 cases treated with adhesive tape-attached gutter splint and the remainder with other conservative modalities. RESULTS: Acrylic treatment with gutter splint and sculptured nail was found to be vastly superior to the other methods described, especially in the ability to firmly affix the gutter splint and sculptured nail for the extended period required for treatment. The treatment leads to a complete remission with almost instant alleviation of pain, with no disfigurement, while allowing for the resumption of daily activities. CONCLUSION: Conservative methods utilizing formable acrylics are highly beneficial in the treatment of an ingrowing nail and should be viewed as the first treatment option.

Acrylic Resins↗

PubMed1982

The white nails of old age (neapolitan nails).

Nail changes similar to those reported by Terry and Lindsay were defined in an elderly inpatient population. Two hundred fifty-eight patients were studied, and an overall incidence of 19 per cent was found. There was no significant difference between men and women. The only significant correlations in this study were with osteoporosis and thin skin. Eight men with nail changes were compared with seven men without such changes by calculating the metacarpal index of cortical bone mass. The index was much lower in patients with nail changes (t = 2.64; P less than 0.01). All patients with nail changes had thin skin. No correlations were found with serum albumin, liver function, or kidney function. These nail changes are less frequent in the "less frail" elderly living in the community. Changes of the Terry type are common in children but disappear by early adult life. It is suggested that the nail changes are age-related phenomena and that they may reflect an underlying disturbance of collagen being manifested as changes in the nail bed, skin, and bone.

Aged↗

PubMed1986

Subtrochanteric fractures: Zickel nail or nail-plate?

Of 135 consecutive patients admitted with subtrochanteric fractures of the femur, 104 were studied; half had internal fixation with a Zickel nail and half had a nail-plate device. Fractures treated with a Zickel nail had significantly less blood loss during operation and took less time to walk with full weight-bearing, but the incidence of technical error at operation was higher. Errors included malalignment of the cross-pin, penetration of the femoral cortex and comminution of the greater trochanter. There was mechanical failure within one year of surgery in 17% of the nail-plate series but no implant failures in the Zickel nail group within the same period. The total time spent in hospital was similar in both groups. The Zickel nail provides better fixation for subtrochanteric fractures than a simple nail-plate but, because of technical difficulty, its use should be reserved for surgeons of reasonable experience.

Adolescent↗

PubMed2003

Intramedullary nailing of humeral shaft fractures with a locking flexible nail.

BACKGROUND: Studies on intramedullary nailing of humeral shaft fractures in the orthopaedic literature have shown mixed results. The purpose of this investigation was to document the clinical outcome and complications associated with the use of a new flexible, locking intramedullary nail that can be implanted in the humerus in either a retrograde or an antegrade manner without violating the rotator cuff mechanism or damaging the articular surface of the humeral head. METHODS: Fifty consecutive patients with fifty-one humeral shaft fractures were entered into our prospective clinical outcome study. The fracture was classified on the basis of the anatomic location and pattern. Implant positioning and fracture alignment were assessed postoperatively. Complications were recorded, and the time to union was measured. Shoulder function was evaluated with use of a combination of the Constant shoulder score, Short Form-36 (SF-36) clinical outcome data, range-of-motion measurements, and a subjective pain-rating scale. RESULTS: Forty-one patients with forty-two fractures had an adequate duration of clinical follow-up (a mean of twenty-two months) for analysis. Thirty-nine fractures healed, with a mean time to clinical union of twelve weeks (range, four to fifty weeks). Thirty-eight of the forty-two shoulders had minimal or no pain. Thirty-six shoulders had a full range of motion. The mean Constant shoulder score was 90 points. Four patients had five complications, which included two nonunions, two hardware failures, and one wound infection. All four patients had been managed with a 7.5-mm nail. A multivariate analysis demonstrated that an age of more than fifty years was associated with a lower Constant score and that the occurrence of a complication was associated with a lower physical component score on the SF-36. CONCLUSIONS: The flexible humeral nail allows both retrograde and antegrade implantation and static locking. Nail insertion can be accomplished without violating the rotator cuff or damaging the articular surface of the humeral head. Although the nail functioned well in most of our patients, the use of a small-diameter (7.5-mm) nail was associated with a higher complication rate. This implant should be used with caution in any patient with a medullary canal diameter of <or=8 mm.

Adolescent↗

PubMed1991

[Ingrown nail of the great toe treated with partial resection of the nail-forming matrix].

During the period 1.3.1976 to 31.5.1989, 158 patients were treated for in-growing toe-nail of the great toe by partial resection of the nail-forming matrix. The average age was 26 years and the period of observation was 83 months. A questionnaire was sent to all of the patients and 119 patients with 154 nails submitted to operation replied (75.3%). Ninety-five patients (79.8%) had no discomfort and seven (5.9%) stated that the condition had improved. Ten patients (8.4%) were submitted to reoperation. Seventy-six patients (63.9%) were completely satisfied with the cosmetic result of the treatment. Significantly better results as regards discomfort were obtained in patients who had been treated preoperatively by avulsion of the nail so that infection and inflammation had resolved (p less than 0.05). The authors conclude that partial resection of the nail-forming matrix is a certain and effective method of treating in-growing toe-nail of the great toe and they recommend that the nail is avulsed prior to operation.

Adolescent↗

PubMed1997

Nails and nail disorders in children and adults.

Abnormalities of the nails can provide both subtle and obvious clues to common medical problems or severe systemic diseases. Heredity, minor injuries and a variety of infections account for many changes in the appearance of nails. Several dermatologic disorders, such as psoriasis and alopecia areata, and other multisystem disorders may present with nail changes; abnormalities of the nails may be the single most prominent feature. Common habits and the use of various cosmetics also may result in nail changes. Awareness of normal nail variants and well-defined abnormalities and their disease associations will be beneficial to most clinicians. Specific management and therapy for most nail problems are usually simple and appropriate for primary care physicians.

Adolescent↗

PubMed1996

[A comparison of the modified gamma nail and the ender nail for treatment of intertrochanteric fractures].

We made a comparison between the modified Gamma nailing and the Ender nailing in the treatment of 102 patients with intertrochanteric fracture. Sixty patients were treated with the modified Gamma nailing and forty-two patients with the Ender method. The preoperative conditions of the patients in the two groups were similar as showed by statistical analysis. More intraoperative bleeding was recorded in the modified Gamma nail group. However, there were a earlier full weight -bearing, a better hip function and a lower rate of operative complication in the patients treated with the modified Gamma nailing. We conclude that with the modified technique and the modified femoral component the Gamma nail is advanced in the treatment of intertrochanteric fracture. However, it is danger to apply in elderly patients accompanied with certain vital problems. For these patients the Ender nail may be considered.

Aged↗

PubMed1998

[The impacted intramedullary nail. Re-discovery of an old problem with a new nail].

Impaction of an intramedullary nail during extraction is an unpredictable and delicate situation. Its problematic nature is unfolded on a report of two cases, one with a Küntscher nail and one with a modern solid titanium nail. This event is caused by ingrowth of new bone formation into the slot or the dorsal flute respectively. The new bone formation is a mechanical barrier which effectively forces the distal part of the nail to jam against the cortex. Both, the slot of the unlocked reamed clover leaf nail and the wider dorsal flute of the solid titanium nail, realize certain therapeutic concepts. Their factual benefit within the concept of interlocking nailing is doubtful.

Adult↗

PubMed1980

The double-nail illusion: experiments on binocular vision with nails, needles, and pins.

When two nails or similar slender objects are held straight ahead at reading distance, one a few centimetres behind the other and aligned at the same eye level, they are seen side by side rather than one behind the other. A quantitative study of this 'double-nail' illusion shows that the objects are judged to be at the positions of the so-called apparent or ghost images known from fusional theories of stereopsis. Most recent fusional theories assume that apparent images are suppressed by neuronal interactions, and the usual absence of percepts corresponding with apparent images is often quoted as an argument against 'projection' theories of stereopsis. The double-nail illusion shows, however, that percepts which correspond with apparent images do occur. The results are interpreted in terms of a neuronal-network type of fusional theory, in which the interpretation that corresponds with the minimum overall disparity is assumed to dominate. The following parameters were varied in the experiments: length, width, colour, and contrast for each of the nails; and fixation point position; and the orientation of the nail carrier. The results show that identity of the stimuli is not a necessary condition for the illusion. A stable vergence can be enforced by the double-nail illusion, and with additional nails multistable states of vergence can be obtained.

Color↗

PubMed1982

Fractures of the femoral shaft: a prospective study of closed intramedullary nailing, modified open intramedullary nailing, and cast-bracing.

One hundred twelve consecutive fractures of the femoral diaphysis were treated in a prospective study at Grady Memorial Hospital, a designated trauma center, during the three-year period 1978 through 1980. Fifty of these were treated by closed intramedullary nailing; all united. Of the rest, 20 were treated by modified open intramedullary nailing, and 42 by cast-bracing. Closed intramedullary nailing offered a significant reduction in hospitalization and healing times compared to the other two methods; however, the high cost of equipment, along with the added cost of reoperation to remove the nail, rendered cast-bracing economically superior. Fractures treated by modified open intramedullary nailing developed no infections, but these patients lost significantly more blood during operation than those treated by closed nailing. Because of the decreased hospitalization and healing times, we prefer the closed intramedullary nailing technic for use in selected femoral fractures treated during the acute phase by an experienced surgical team.

Adult↗

PubMed2002

A comparative study of trochanteric fractures treated with the Gamma nail or the proximal femoral nail.

The aim of the present paper is to compare the results obtained using two osteosynthesis systems developed for the surgical treatment of fractures of the trochanteric region of the femur, based on the principles of closed intramedullary nailing: the Gamma nail and the proximal femoral nail (PFN). A prospective study is presented of 125 trochanteric fractures of the femur treated with PFN and 125 treated with the Gamma nail in our service between the years 1997 and 2000, with the prerequisite of a minimum follow-up of 1 year. Fractures were classified according to the AO system, the most commonly recorded subtype encountered being the A2. Clinical and radiographic controls were performed upon admission and in the post-operative follow-up at 1, 3, 6, and 12 months, the corresponding assessment protocol being completed on each occasion. Of the 250 patients, 179 were women and the rest men. The average age was 78.9 years. Both systems enabled early mobilisation and walking in most of our patients. There were no significant differences in the use of either nail in terms of the recovery of previous functional capacity, nor in terms of the time required for fracture healing (12 weeks on average). With regard to the more significant technical complications recorded, shaft fractures and the cutting-out phenomenon were more common with the use of the Gamma nail, while secondary varus occurred at a greater rate when using the PFN.

Aged↗

PubMed2001

The nail-insertion point in unreamed tibial nailing and its influence on the axial malalignment in proximal tibial fractures.

The consequence of choosing a point of insertion for the nail (i.e. medial or lateral of the lig. patellae) in unreamed tibial nailing (AO unreamed tibial nail, UTN) was studied in 22 formaldhyde-fixed tibiae. A lateral osteotomy at the transition from the first to the second fifth of the tibia was used as a model for the fracture. A nail insertion point medial of the lig. patellae caused a valgus deformity, combined with a shift of the distal fragment to the medial side. A lateral point of entry resulted in a varus deformity, together with a lateral shift of the distal fragment. Our results show that the insertion point of the nail is important for the alignment of the axis. Choosing a different point for the insertion of the nail can be useful in operative correction of malalignment of the tibia.

Biomechanical Phenomena↗

PubMed2002

Intramedullary femoral nailing: removing the nail improves subjective outcome.

Intramedullary nailing has become an established treatment for femoral fractures. We reviewed the subjective and objective outcome of locked intramedullary nailing since its introduction to our unit in 1988. The outcome was assessed subjectively using the Short Form 36 (SF 36) health questionnaire and objectively by clinical, radiological and case note review. From 1988 to 1995, 220 intramedullary femoral nails were inserted at the North Staffordshire Royal Infirmary. Of these we were able to match the SF 36 questionnaire and case review of 91 patients. Fifty-six patients were male and 35 female with an average age of 40. Acute trauma accounted for 86 cases (six with an injury severity score >15 and seven open injuries). There was a 24% incidence of minor complications; there were no deep infections and no major complications. All cases recorded subjective scores within the normal range but 34 symptomatic patients who had their femoral nails removed (mainly for persistent pain or prominent metalwork) recorded noticeably higher scores in all eight assessment areas. Intramedullary nailing for femoral fractures is a technically demanding procedure and results in both a good objective and subjective outcome. It is associated with a low rate of major complications but a relatively high rate of minor complications. We conclude that the removal of intramedullary femoral nails is justified in symptomatic patients. It results in an improved subjective outcome and has a low complication rate.

Adult↗

PubMed1999

A biomechanical comparison of the antegrade inserted universal femoral nail with the retrograde inserted universal tibial nail for use in femoral shaft fractures.

Femoral shaft fractures with and without bony contact were simulated in cadaver specimens fixed with one of two different types of intramedullary locked nail systems; conventional antegrade nail fixation of the femur with the universal AO femoral nail or retrograde insertion in the femur with the universal tibial nail (a smaller diameter slotted nail) were utilized. Mechanical testing simulated one leg stance, and resultant deformation was measured in bending, torsion, and shortening. In stable fractures, fracture stability was similar to both devices, while in unstable fractures, the larger femoral nail was more stable. Furthermore, the simulation of single leg stance led to a coupled deformation of varus bending, axial shortening, and external rotation, which was dependent on bone geometry.

Adult↗

PubMed2000

Femoral nailing for metastatic disease of the femur: a comparison of reamed and unreamed femoral nailing.

A total of 73 consecutive intramedullary femoral nails were inserted for metastatic disease of the femur; 43 were reamed and 30 were solid nails. The two groups were similar with regards to age, type of primary tumour, anatomical site, acute or 'impending' fracture and postoperative survival. The 'solid' nail offers a satisfactory alternative form of stabilisation for metastatic disease of the femur with rates of implant failure which are comparable with the reamed nail. In this series bilateral nailing was not associated with any increase in mortality. Contrary to other reports, imposing a delay in patients with pain and a short life expectancy seems unjustified. The use of the 'solid' femoral nail does not prevent sudden death due to massive fat embolism.

Adolescent↗

PubMed2003

Nail Psoriasis Severity Index: a useful tool for evaluation of nail psoriasis.

The Nail Psoriasis Severity Index (NAPSI) is a numeric, reproducible, objective, simple tool for evaluation of nail psoriasis. This scale is used to evaluate the severity of nail bed psoriasis and nail matrix psoriasis by area of involvement in the nail unit. The NAPSI will be useful during clinical trials for evaluating response to treatment of psoriatic nails. The scale is reproducible, and because there are few data points, statistical analysis is simplified.

Humans↗

PubMedDate not supplied

Ilizarov compression over a nail for aseptic femoral nonunions that have failed exchange nailing: a report of five cases.

OBJECTIVE: To evaluate a new operative treatment of femoral nonunion following failed exchange nailing. DESIGN: Retrospective review, consecutive series. SETTING Office-based orthopaedic practice. PATIENTS: Five consecutive patients (ages 31-67 years) were referred in with a femoral nonunion following exchange nailing an average of 28 months (range 11-55) after the initial traumatic injury. The patients had undergone an average of 5 (range 2-8) previous surgeries on the femur. No patient had signs or history of bone infection or segmental bone loss at presentation. All patients had diaphyseal or diaphyseal-metaphyseal oligotrophic nonunions and had failed an average of 2 (range 1-3) previous exchange nailings. INTERVENTION: Slow compression (0.25 to 0.50 mm per day) of the nonunion site over a new, smaller diameter nail using an Ilizarov external fixator. MAIN OUTCOMES MEASUREMENTS: Clinical and radiographic evidence of bone union, ambulation, pain, residual deformity, or shortening. RESULTS: All nonunions healed without the need for further nonunion surgery. The external fixator was removed at an average of 133 days (range 86-238 days). No deep infections occurred in any patient. All patients experienced some degree of pin site irritation. At the most recent follow-up (average 45 months; range 12-75 months), all patients had improved their functional ambulatory status and had discontinued or decreased the use of assistive devices to walk. All patients were full weight bearing. Average pain, as rated on a 0 to 10 Visual Analogue Scale, decreased from 8 of 10 before treatment to 1 of 10 after treatment. No patient experienced a clinically significant worsening of leg length discrepancy. CONCLUSIONS: Slow compression over an intramedullary nail using external fixation successfully promotes the healing of problematic femoral nonunions that have failed one or more prior exchange nailings.

Adult↗