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PubMed1993

Nail changes of punctate keratoderma: a clinical and pathological study of two patients.

The pathological study of the nail changes of 2 patients affected by punctate keratoderma is described. Both patients presented nail abnormalities that were clinically suggestive of a nail psoriasis. Subungual hyperkeratosis was a prominent feature but onycholysis, splinter haemorrhages and pitting were also present. The pathology of the nail bed revealed sharply limited columns of hyperkeratosis associated with hypergranulosis and depression of the underlying nail bed epidermis. Etretinate therapy produced a significant improvement in the palmoplantar keratoderma, but it was of no apparent value in treating nail keratoderma.

Adult↗
PubMedDate not supplied

Hyperthermic treatment of canine tibia through RF inductive heating of an intramedullary nail: a new experimental approach to hyperthermia for metastatic bone tumours.

Although the incidence of metastatic bone tumours is recently increasing, the local control rate of conventional treatment modalities is not satisfactory. If an intramedullary nail for the fixation of a weakened bone with metastatic lesions can be used as a heat-generating material for hyperthermia, the treatment result is expected to improve. This new approach to hyperthermic treatment of bone tumours has been investigated in a canine tibia. An intramedullary nail made of stainless steel was put into a medullary canal of a canine tibia. The leg was exposed to an alternating magnetic field of 100 kHz in the frequency and 100 Oe in the maximum intensity. The nail was inductively heated for 60 min. The temperature of the nail > 50 degrees C and the cancellous bone 5 mm from the nail was heated to a therapeutic temperature, 42.5 degrees C. After a bone labelling with tetracycline and calcein, the dogs were killed 2, 4 and 12 weeks after the heating. The area of osteonecrosis was evaluated by fluorescence microscopy analysis. The heated cancellous bone around the nail showed osteonecrosis in 2 weeks after the treatment, but it recovered completely in 12 weeks. This experiment has demonstrated the heating capability of the new hyperthermic technique and minimal toxicity to the bone, and suggests the clinical application to metastatic bone tumours.

Animals↗
PubMed1997

A technique of acrylic nail fixation in multilayered silicone finger prostheses.

A technique for the secure fixation of acrylic nails in multilayered silicone finger prostheses is described. The secure fixation of the nail to the prosthesis is achieved by a method of "sandwiching" portions of the nail between the silicone layers of the prosthesis akin to the overlapping of the nail by the anatomical nail fold and nail wall. In addition the use of a cynoacrylate adhesive ensures strong surface to surface bonding.

Acrylic Resins↗
PubMed1983

Fracture healing after rigid intramedullary nailing in rats.

Rigid intramedullary nailing of the right tibia after osteotomy with resection of the fibula was performed on 48 male Wistar rats weighting 300-400 g. Nailing was performed with 1.4-mm nails after reaming. Nail stiffness was similar to that of intact tibias. The left leg remained unoperated as control. The animals were sacrificed after 4, 8, 12 or 16 weeks, and both tibiae were tested in a 3-point bending test. Of the 35 animals with the nail in situ, nine animals showed non-union at the time of testing. At 8 weeks stiffness had reached normal values, while strength and deflection showed about half of normal values. Poor strength and small deflectability combined with near normal stiffness may be taken as evidence that Wolf's law is valid also in newly formed tissues of fracture healing; the protection given by a rigid nail makes normal strength and pliability unnecessary.

Animals↗
PubMed1990

Twenty-nail dystrophy treated with topical PUVA.

A case of twenty-nail dystrophy treated with topical PUVA is described. The patient, a 19-year-old woman, had a 4-year history of a nail dystrophy involving all finger- and toe-nails. The finger-nail changes were treated with topical PUVA, dose 0.7-1.4 J/cm2 x 3/week. After 7 months excellent improvement was seen, while the untreated toe-nails were unaffected. A maintenance dose of 0.7 J/cm2 x 3/week was necessary to prevent recurrence. We suggest that topical PUVA is worth trying for the treatment of twenty-nail dystrophy.

Adult↗
PubMed2001

Pincer nails: a new surgical treatment.

BACKGROUND: Pincer nails are a kind of nail deformity characterized by a transverse overcurvature of the nail that increases along the longitudinal axis. Alteration of the shape of the underlying distal phalanx due to osteophyte formation at the apex may be a cause of pincer nails. This causes widening of the proximal matrix and as a result secondary torque in the distal nail plate leading to the typical appearance. Apart from conservative treatment, several surgical techniques have been proposed in the past. METHODS: This article presents a new surgical approach in the treatment of recalcitrant pincer nails which has several distinct advantages over other methods. RESULTS: Long-term results in six patients are presented.

Adult↗
PubMed2001

Knee fusion--a new technique using an old Belgian surgical approach and a new intramedullary nail.

Knee arthrodesis is a useful procedure in difficult cases such as failed total knee arthroplasty, severe articular trauma, bone tumors, and infected knee joints. The most common techniques for knee fusion include external fixation and intramedullary nailing. Küntscher's nail is driven antegrade from the intertrochanteric region into the knee. We describe a new technique for knee arthrodesis using a new intramedullary nail and an old Belgian surgical approach to the knee joint published by Lambotte in 1913. This approach provides excellent exposure for the implantation of the nail by osteotomizing the patella vertically. The nail is implanted using HeyGroves method, whereby the nail is inserted retrograde into the femur and pulled distally anterograde into the tibia. We now use this technique as our standard procedure for knee fusion.

Arthrodesis↗
PubMed2001

Retrograde femoral nailing: a focus on the knee.

A consecutive series of 23 patients with reamed retrograde femoral nails was reviewed. Nails were placed through the intercondylar notch with a minimal incision. Nineteen patients with retrograde femoral nails were available at an average follow-up of 19.3 months. The union rate was 100% with no infections or malunions. No second surgeries were required for union. Knee range of motion averaged 109 degrees and was greater in those patients with shaft fractures (117 degrees) than in those with supracondylar-intercondylar fractures (91.3 degrees) (P=.02). Pain (0-3 scale) averaged 0.36. Hospital for Special Surgery knee scores averaged 80.4 (90% good or excellent results). Minor knee pain (55%) and secondary surgeries (35%) were common. The only fair or poor results were in patients with preexisting osteoarthritis. A literature review of 14 papers and abstracts was conducted. Exposure, often extensive initially, is more recently percutaneous. The infection rate is acceptable (0-14%), with knee sepsis uncommon. Lower union rates were observed for supracondylar femur fractures (80%-84%) than for femoral shaft fractures (85%-100%) after a single surgery. Second surgeries are common (14%-60%). Varus/valgus malunion, common (12%-29%) with the initial extrarticular entry site, occurs less with the intercondylar entry site. The antegrade femoral nail allows for better control of proximal shaft fractures, while the retrograde femoral nail is more reliable in controlling distal shaft fractures. Rotational malunion still remains a problem. Mild knee pain is common (13%-60%). The treatment of supracondylar femur nonunions with retrograde femoral nailing is disappointing.

Adolescent↗
PubMed2002

Artificial nails... very real risks.

The current social trend towards personal esthetics has come into conflict with safe perioperative care practices. While artificial nails have become very popular they pose a significant risk to patients. Surgical personnel who scrub while wearing artificial nails are putting their patients at higher risk for post-surgical wound infection. Artificial nails harbour microbes and cannot be cleaned as effectively as short, natural nails. We cannot rely on surgical gloves to always contain these hand organisms. There are reported cases where artificial nails have been the cause of post-surgical infections and even death. OR personnel who scrub should not wear artificial nails.

Cosmetics↗
PubMed2002

[Open reduction and intramedullary fixation through minimal incision with Ender nails in femoral fractures of children aged from 6 to 16 years].

OBJECTIVES: We evaluated functional and radiologic results of the treatment in patients aged 6 to 16 years, who underwent indirect reduction with Ender nails through minimal incisions for troublesome femoral fractures. METHODS: We treated femoral fractures of 20 children (3 girls, 17 boys; mean age 10 years; range 7 to 15 years) by indirect reduction and relative stabilization with Ender nails through mini-incisions. Indications for intramedullary nailing were the presence of multiple fractures, accompanying head injuries, neurological or pathologic disorders. According to the Müller classification, there were two 32A1, three 32A2, nine 32A3, three 32B1, and three 32B2 fractures. Secondary callus formation was monitored with follow-up serial x-ray examinations. Range of motion of the hips and knees, leg length discrepancy, and the femoral anteversion were examined clinically. The mean follow-up was 30.5 months (range 24 to 46 months). RESULTS: Surgery was performed after a mean of 4.5 days of admission. The mean hospital stay was 12 days. Full weight-bearing was achieved after a mean of 69 days (range 45 to 98 days). Union was obtained in all patients without any complications. Ender nails were removed surgically after a mean of 10.3 months (range 6 to 16 months). The femoral anteverison was more than 10 degrees in three patients. The mean leg length shortening was 0.35 cm (range 0 to 1 cm). CONCLUSION: Intramedullary nailing of femoral fractures with Ender nails through minimal incisions provides a safe and adequate stabilization in cases in which conservative treatment is likely to fail, and in multiple fractures, open fractures, coexistent head injuries, in mentally-retarded children, and in children aged from 6 to 16 years.

Adolescent↗
PubMed2002

[Short-term results of treatment of humeral and tibial fractures with new inflatable intramedullary nails].

OBJECTIVES: We evaluated the effectiveness of a new inflatable intramedullary nail system in the treatment of tibial and humeral fractures. METHODS: The study included seven patients (4 men, 3 women; mean age 37.5 years; range 27 to 48 years) whose humeral or tibial fractures were treated by new inflatable intramedullary nails. Five fractures were in the tibial diaphysis; three were humerus fractures. One patient had bilateral involvement. All tibial fractures and one humeral fracture were fresh, whereas two patients presented with delayed union. Treatment consisted of closed reduction and antegrade intramedullary nailing, with the addition of bone grafting in delayed unions. The patients were evaluated with regard to operation duration, healing periods, complications, and final clinical and radiologic findings. The mean follow-up period was 15.3 months (range 12 to 20 months). RESULTS: Operation time for both tibial and humeral fractures was less than that with other internal fixation techniques. The need for fluoroscopic monitoring decreased appreciably, as well. Healing times were similar to those of other intramedullary nailing systems. No complications occurred related to the use of the inflatable intramedullary nail system. CONCLUSION: The use of inflatable intramedullary nails may have significant implications in selected fractures, allowing easier stabilization of long bone fractures and saving valuable operation time.

Adult↗
PubMedDate not supplied

Intramedullary nailing of femoral shaft fractures. Ten years' experience.

In 236 intramedullary nailings of femoral shaft fractures there was a 2 per cent deep infection rate, and a 7 per cent nonunion rate; 87 per cent had good primary healing; 42 per cent had further surgery after the initial nailing (two-thirds for removal of the nail). Statistical analysis of the data does not support the view that delayed internal fixation results in less nonunions. The 55 femurs nailed in the first 3 days had a nonunion rate of 11 per cent, as opposed to a 7 per cent postinjury rate for the entire series, a statistically significant increase in nonunions with the Vesely-Street nail. Intramedullary nailing has the following advantages over treatment with traction: shorter hospital stay; better knee motion; less angulation, and less shortening.

Adolescent↗
PubMed2003

[Interlocking intramedullary nailing of humeral shaft fractures in adults].

OBJECTIVES: We evaluated the effectiveness of interlocking intramedullary nailing in the treatment of humeral shaft fractures. METHODS: Forty-three patients (30 men, 13 women; mean age 42 years; range 20 to 83 years) were treated with interlocking intramedullary nailing for humeral shaft fractures. All fractures but one (type II open) were closed. Three patients had radial nerve, one patient had radial and ulnar nerve dysfunction. As all the nerve lesions were assessed as neuropraxia, no immediate surgical exploration was performed. Intramedullary nailing was performed by closed (18 fractures) and open technique (25 fractures), with (n=22) or without (n=21) reaming. Functional evaluation was made according to the Constant-Murley's shoulder scoring system. The mean follow-up was 16.5 months (range 5 to 40 months). RESULTS: Radiologically, union was achieved in all patients in a mean of 15.6 weeks. No surgery-associated nerve injuries or infections were encountered. Preoperative nerve dysfunction resolved in all patients in a mean of 12.5 weeks. No signs of rotator cuff impingement or restriction were detected in two patients in whom the nails were placed high in close proximity to the shoulder girdle. Of these, one patient underwent reoperation for the removal of the nail after the fracture union completed. Functional results were excellent in all patients at the end of postoperative three months. No significant correlation was found between the techniques employed and time to union and functional outcome. CONCLUSION: Interlocking intramedullary nailing provides adequate fixation and early mobilization, and results in satisfactory radiographic and functional results in the treatment of humeral shaft fractures.

Adult↗
PubMedDate not supplied

The Fixion nail in the lower limb. Preliminary results.

The Fixion nail is an intramedullary nail made of stainless steel, that may be used to treat fractures of the humerus and in the lower limb. This nail is made up of a cylinder that has 4 longitudinal bars which, once inserted in the bone segment, expands via a pressure hydraulic system using physiological solution. The nail may be introduced without reaming and after its expansion it adheres to the bone walls producing stabilization of the fracture. In order to guarantee good stability, the apex of the nail must exceed the fracture line by 5 cm. Indications were initially limited to type 32 and 42 A1-2-3 fractures of the mid third of the lower limb, to then be expanded to type B1 fractures in the AO system. A total of 20 nails were used in 19 patients, with an average time of 7 days for partial weight-bearing and 40 days for total weight-bearing, achieving consolidation on day 18 after an average of 5 months in the femur and 4 months in the tibia. Reaming of the intramedullary canal was carried out in all of the cases.

Adolescent↗
PubMed2003

[Study and clinical application of auto-compressive and anti-rotate intramedullary nail].

OBJECTIVE: To design an auto-compressive and anti-rotate intramedullary nail (ACACIN) and to evaluate the preliminary clinical efficacy on fixing adult femur fracture. METHODS: From January 1998 to June 2001, 23 patients with femur fracture were stabilized with auto-compressive and anti-rotate intramedullary nail. 2-4 elastic blocks were installed into the proximal and distal different distance of quincunx nail to defend rotate and axis compress. RESULTS: Fracture healing were obtained in all 23 patients treated with auto-compressive and anti-rotate intramedullary nail, the time of fracture healing was 6-13 weeks in 21 cases and 15-22 weeks in 2 cases of old fracture. There was no complication related to infection, nail break, abnormal union and joint ankylosis. The results were excellent in 19 cases, good in 3 cases, and moderate in 1 case according Kolmert's criterion for function; the effective rate was 95.7%. CONCLUSION: Auto-compressive and anti-rotate intramedullary nail has a suitable radian for adult femur, can afford stable fixation, anti-rotate and axis compress.

Adolescent↗
PubMed2003

[Treatment of humeral shaft fractures with Russell-Taylor interlocking intramedullar nail].

OBJECTIVE: To evaluate the clinical effects of Russell-Taylor interlocking intramedullar nail (RT nail) on humeral shaft fractures. METHODS: Twenty six patients with humeral shaft fractures were treated with RT nail, of whom 19 cases were treated with antegrade RT nail and 7 cases with retrograde RT nail. RESULTS: With an average of 16 months (range 6-24 months) of follow-up, all cases acquired bony union with mean union time 4.7 months (range 3-8 months). The recovery of shoulder function was excellent in 18 cases, good in 5 cases, and fair in 3 cases. The recovery of elbow function was excellent in 23 cases and good in 3 cases. One case had shoulder impingement caused by proximal locking screw. All cases had no infection, iatrogenic fracture, and peripheral nerve injury. CONCLUSION: RT nail is an effective method for the treatment of humeral shaft fractures.

Adolescent↗
PubMed1992

[Reconstruction of distal loss of substance in the nail-bed by a de-epithelialized flap from the digital pulp].

Twelve patients, presenting with traumatic avulsion of the distal nail bed, repaired by a de-epithelialized palmar advancement flap, were reviewed with an average follow-up of 23 months. Subjective results were considered excellent in two cases, good in seven, fair in two and poor in one patient. Nail adherence with the de-epithelialized flap was observed over almost 90% of the new nail bed. Nail dystrophy was observed in three patients, but was severe in only one. Two patients had slight curvature of their nail, while one had a severe hook-nail deformity. Mobility in the finger was always complete, and only one patient had a slightly decreased two-point discrimination on the flap.

Adolescent↗
PubMed1992

Treatment for nonunion of the shaft of the humerus: comparison of plates and Seidel interlocking nails.

From July 1986 to November 1989, fractures of the humeral shaft in 35 adults who had nonunion of the fracture were managed by plate fixation (19 patients) or antegrade nailing of the fracture fragments with the Seidel interlocking nail (16 patients) together with cancellous bone grafting. The follow-up period ranged from 12 to 52 months. Of the patients who had plate fixation, 89.5% had fracture union within 4.5 +/- 1.7 months; of the patients whose fracture was managed with the Seidel interlocking nail, 87.5% had fracture union within 4.4 +/- 1.8 months. The range of shoulder motion was improved with both techniques. Patients who had plate fixation had more complications than those whose fracture was managed by interlocking nailing (21% v. 12%). The authors prefer interlocking nailing because it is a relatively simpler technique, resulting in fewer complications. It may replace plating in the treatment of nonunion of humeral shaft fractures. However, rotatory instability with interlocking nailing cannot be disregarded, and if this is evident plate fixation should be done.

Adult↗