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At least 127 records · Page 7Linked to original sources
PubMed2002

Pertrochanteric fractures: is there an advantage to an intramedullary nail?: a randomized, prospective study of 206 patients comparing the dynamic hip screw and proximal femoral nail.

OBJECTIVES: To compare the results between a sliding compression hip screw and an intramedullary nail in the treatment of pertrochanteric fractures. DESIGN: Prospective computer-generated randomization of 206 patients into two study groups: those treated by sliding compression hip screw (Group 1; n = 106) and those treated by intramedullary nailing (Group 2; n = 100). SETTING: University Level I trauma center. PATIENTS: All patients over the age of fifty-five years presenting with fractures of the trochanteric region caused by a low-energy injury, classified as AO/OTA Type 31-A1 and A2. INTERVENTION: Treatment with a sliding compression hip screw (Dynamic Hip Screw; Synthes-Stratec, Oberdorf, Switzerland) or an intramedullary nail (Proximal Femoral Nail; Synthes-Stratec, Oberdorf, Switzerland). MAIN OUTCOME MEASUREMENTS: Intraoperative: operative and fluoroscopy times, the difficulty of the operation, intraoperative complications, and blood loss. Radiologic: fracture healing and failure of fixation. Clinical: pain, social functioning score, and mobility score. RESULTS: The minimum follow-up was one year. We did not find any statistically significant difference, intraoperatively, radiologically, or clinically, between the two groups of patients. CONCLUSIONS: There is no advantage to an intramedullary nail versus a sliding compression hip screw for low-energy pertrochanteric fractures AO/OTA 31-A1 and A2, specifically with its increased cost and lack of evidence to show decreased complications or improved patient outcome.

Aged↗
PubMed2004

Intramedullary nailing of femoral fractures in children through the lateral aspect of the greater trochanter using a modified rigid humeral intramedullary nail: preliminary results of a new technique in 15 children.

OBJECTIVES: To evaluate the clinical results of intramedullary nailing of femoral shaft fractures using a rigid intramedullary nail placed through the lateral aspect of the greater trochanter in older children and adolescents. DESIGN: A retrospective study was carried out evaluating all skeletally immature patients with femoral shaft fractures treated using a modified rigid humeral intramedullary nail. PATIENTS/PARTICIPANTS: Fifteen children and adolescents with displaced femoral diaphyseal fractures and open physes. INTERVENTION: Femoral shaft fractures in children and adolescents were stabilized using a modified humeral intramedullary nail placed through the lateral aspect of the greater trochanter. MAIN OUTCOME MEASUREMENTS: Patients were evaluated to determine time to union, final fracture alignment, hospital stay, complications, clinical outcome, and proximal femoral changes including avascular necrosis or proximal femoral valgus with femoral neck narrowing. RESULTS: Fifteen patients were followed for a minimum of 1 year (range 70-157 weeks). The average age of the patients was 12 years and 5 months (range 8 years and 2 months-17 years and 1 month). All fractures healed at a mean of 7 weeks (range 5-14 weeks) after fracture. The average hospital stay for patients with isolated femur fractures (8/15) was 2.8 days (range 1-5 days). At an average follow-up of 141 weeks (range 70-326 weeks), no patient had developed avascular necrosis, femoral neck valgus, femoral neck narrowing, or other complications. CONCLUSIONS: The technique of intramedullary nailing in children through the lateral aspect of the greater trochanter seems to be safe, effective, and well tolerated by patients.

Adolescent↗
PubMed1992

Pulmonary damage after intramedullary femoral nailing in traumatized sheep--is there an effect from different nailing methods?

Stabilization of femoral shaft fractures is a controversial issue in the management of patients with multiple trauma. Intramedullary nailing usually is preferred primarily; in recent years, however, pulmonary complications (e.g., ARDS) have been reported that were attributed to the reaming procedure. To study the effects of different nailing methods in a model of severe trauma, hemorrhagic shock and lung contusion were created at day 1 in sheep prepared by the method described by Staub. After recuperation (day 3) the animals in the study group (group 1) underwent intramedullary nailing of a closed femur without prior reaming; group 2 was treated with reaming and nailing according to AO standards. The reaming procedure led to an acute increase of pulmonary arterial pressure only in group 2 (19.8 +/- 2.1 to 31.0 +/- 4.6 mm Hg). Pulmonary triglyceride levels increased at parallel time points from 18.27 +/- 2.3 to 33.04 +/- 7.37 mg/dL only in group 2. Stimulatory capacity of polymorphonuclear leukocytes (PMNL) increased in the study group and decreased in controls (group 1: 2.652 +/- 0.23 x 10(6) cpm to 3.387 +/- 1.34 x 10(6) cpm; group 2: 2.699 +/- 0.34 x 10(6) cpm to 2.460 +/- 0.187 x 10(6) cpm). Intramedullary nailing caused an increase of lung capillary permeability in both groups; in the study group less damage was seen (group 1: 0.390 +/- 0.0006 to 0.354 +/- 0.011; group 2: 0.391 +/- 0.0004 to 0.336 +/- 0.015; p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Acetylglucosaminidase↗
PubMed1996

A locked hip screw-intramedullary nail (cephalomedullary nail) for the treatment of fractures of the proximal part of the femur combined with fractures of the femoral shaft.

Twenty-seven patients with complex femoral fractures (combined shaft and proximal femoral fractures) were treated with a modified Grosse-Kempf slotted locking nail (cephalomedullary nail), wherein two screws were inserted in the hip. Four types of complex, multifocal femoral fractures were represented in the series. Eleven of the femoral shaft fractures were secondary to a previous, internally fixed, not yet united hip fracture (type I). Ten comminuted peritrochanteric fractures occurred in normal bone (type II). Three similar fractures were pathologic because of metastasis. Two patients had an ipsilateral fracture of the femoral shaft and the trochanteric area (type III), and one of the shaft and the femoral neck (type IV). Locking was made static in 24 cases. Additional cerclage wiring was used in three type II fractures. Five complications were as follows: one cutting out of a screw in the femoral head, two fractures of the nail, one deep venous thrombosis, and one wound hematoma. Reoperations were two salvage operations using a new nail and one evacuation of hematoma. One patient with multiple injuries and four elderly patients died within 2 months. Eighteen patients with fractures in normal bone were followed for a median of 20 (6 to 37) months. All fractures united. Two nails were removed. The end result was excellent in ten patients, good in seven, and fair in one (2-cm shortening and 20-degree external rotation). We conclude that a locked intramedullary construct with locking screws in femoral neck and distal femur controls a complex fracture situation well.

Adult↗
PubMed1991

Ciclopirox nail lacquer 8%: in vivo penetration into and through nails and in vitro effect on pig skin.

This report presents original methods to assess the bioavailability of an antifungal drug from a varnish preparation in finger nails. For the studies with human volunteers a ciclopirox 8% nail lacquer was used to determine its efficacy in the treatment of onychomycoses. In vivo studies were performed on the fingernails of healthy volunteers by determining the total amount of ciclopirox penetrated per milligram of nail and the partition of the drug in the plate of the nails (technically divided into four layers). Ciclopirox concentrations were evaluated by measuring the inhibition of Candida pseudotropicalis growth in vitro. The ciclopirox concentration after 30 days treatment was determined as 3.35 +/- 0.82 micrograms/mg nail material. This is a sufficient amount to kill the fungal pathogens. In addition, in vitro penetration experiments were carried out with excised pig skin. Lacquer formulations from 0.5 to 8% were used to inhibit the growth of Trichophyton mentagrophytes. Formulations from 2 to 8% led to a strong to total inhibition of the dermatophyte after 30 min treatment time.

Administration, Topical↗
PubMed1981

Comparison of nail-plate fixation and Ender's nailing for intertrochanteric fractures.

Two comparable groups of patients with fractures of the trochanteric region of the femur were studied. One hundred and sixty-five fractures had been fixed with conventional nail-plates and 132 with Ender's nails. Ender's nails gave superior results in the treatment of trochanteric fractures. The operation was quicker and less traumatic than that using conventional nail-plates and both the mortality rate and the time in hospital were reduced. More patients in the group with Ender's nails who were initially independent returned to an independent existence.

Adult↗
PubMed1991

Initial experience with a second generation locking femoral nail: the Russell-Taylor reconstruction nail.

A series of 36 patients with 20 subtrochanteric fractures, 12 ipsilateral neck/shaft fractures, and five intertrochanteric fractures with shaft extension underwent closed intramedullary nailing with the Russell-Taylor reconstruction (RECON) nail. The average Injury Severity Score was 16, and seven of the fractures were open. All fractures were acute injuries, and all but one were treated within 24 hours of admission. Follow-up was obtained at three, six, nine, 12, and 24 months or until the fracture healed. The range of follow-up was one to three years. Complete follow-up was obtained in 33 of 36 patients. Union was achieved in all acute fractures. Shortening occurred in two cases and chondrolysis and avascular necrosis occurred in another patient. Excellent hip and knee range of motion were obtained except in a few cases of ipsilateral limb injuries. While many complex femoral shaft fractures can be treated successfully with first generation locking nails, this study demonstrates that second generation locking nails, such as the RECON nail, offer the added strength and design features necessary for more effective treatment of complex proximal and ipsilateral femoral neck/shaft fractures.

Bone Nails↗
PubMed1991

Subtrochanteric femur fractures: a comparison of the Zickel nail, 95 degrees blade plate, and interlocking nail.

Seventy-nine nonconsecutive patients with subtrochanteric femur fractures were divided into three groups based on the method of fracture fixation. Group I consisted of 21 patients treated with a Zickel nail, Group II comprised 25 patients treated with a 95 degrees blade plate, and Group III included 33 patients treated with an interlocking nail. All patients in Group I and Group II had open reduction and internal fixation of their fractures. Ninety-four percent of the patients in Group III were treated by closed intramedullary nailing. The average operating times for Groups I, II, and III were 212, 272, and 181 min, respectively, while blood loss averaged 900, 1,500, and 600 ml for each group, respectively. Group I had one infection, ten malunions, and one nonunion. Group II had one infection, six malunions, and two nonunions. Group III had no infections, two malunions, and one nonunion. We conclude that closed interlocking nailing is the treatment of choice for acute nonpathologic subtrochanteric femur fractures in adults. There is decreased blood loss, reduced operating time, and fewer complications than with either the Zickel nail or the 95 degrees blade plate regardless of the fracture pattern or the degree of fracture comminution.

Adult↗
PubMed1982

[The Ender nailing : state of the art and new improvements. The sliding nailing (author's transl)].

The authors, as well as many other people, have encountered some misuses and complications of Ender nailing. Some surgical improvements are pointed out : reduction with a slight valgus, meticulous digging of the hole, sagital precurving of the nails, careful selection of loading criteria. A new device is also described from the Ender nail, that they modified : an Ender nail with a distal screwing slide which allows distal screwing and therefore prevents going down and rotation of the nails. A case study of three comparative series showed the substantial progress which was made possible by these technical improvements, and most of all by the distal sliding screwing.

Aged↗
PubMed1997

Prevention of potential fracture between two implants using interlocking bipolar cut short GK nail and Enders nail.

A technique to prevent a potential fracture occurring between the distal end of a cementless hip prosthesis and the proximal end of a dynamic compression screw (DCS) is described. The method involves bridging the two implants using a bipolar shortened femoral nail, which is further improved by filling the gap between the stem and the femoral nail with an Enders nail. The distal connection is secured by placing the distal locking screw of the femoral nail through the distal femoral plate of the dynamic compression plate first before locking the nail to the distal femur. Further stabilisation and promotion of healing at the distal femur were achieved using cement and bone graft.

Aged↗
PubMed1997

Architecture of the femoral medullary canal and working length for intramedullary nailing. Biomechanic indications for dynamic nailing.

We classified human femoral intramedullary architecture into 3 types. The cortex in the first type is thick and the medullary canal narrow with an even and smooth translation towards the metaphysis. In the second type, the cortex is thin and the canal wider, also evenly distributed along the entire length, while in the third type the canal narrows just distal to the subtrochanteric region and similarly a few centimeters distally. Some medullary canals of the second type do not allow dynamic nailing, while canals of the third type presents some difficulties for unreamed nails. Most medullary canals belong to the first and second type and only few belong to type three. We performed comparative experimental loading in 11 pairs of cadaveric fractured femora fixed with static and dynamic nailing. Dynamic nailing was found to behave as safely as static ones in the presence of a sound femoral shaft central and peripheral to the fracture with a length twice the diameter of the femur at the fracture level. This could be checked intraoperatively with gentle rotation under image intensifier. In a clinical series, dynamic nailing was performed in about one quarter of the patients with femoral shaft fractures (18 of 72 patients) with excellent results.

Biomechanical Phenomena↗
PubMedDate not supplied

Closed interlocking nailing of humeral shaft fractures with the Russell-Taylor nail.

OBJECTIVE: To assess the role of the Russell-Taylor humeral nail in the treatment of humeral shaft fractures. STUDY DESIGN: Retrospective with a mean radiologic and clinical follow-up at thirty-two months. SETTING: University teaching hospital. PATIENTS: Total of thirty-seven patients treated with the Russell-Taylor humeral nail. INTERVENTION: All patients were treated with the Russell-Taylor humeral nail inserted in an antegrade fashion. OUTCOME MEASURES: Radiologic union and shoulder function in terms of pain, power, range of movement, and activities of daily living. RESULTS: There were four established nonunions and four cases of delayed union (time to union > four months). Age of patient was the only predictor of nonunion. There was one infection and one intraoperative fracture. Two prominent proximal screws required removal, and one nail was removed after union because of impingement. Three patients required manipulation under anesthesia to improve shoulder movement. At review, six patients had residual poor shoulder function as per Constant score, four attributable to shoulder stiffness and two to residual pain. CONCLUSION: The authors' findings indicate a significant rate of delayed or nonunion in the elderly patient. When the high rate of union with conservative treatment is considered, the indications and rationale for intramedullary humeral nailing should be clearly defined.

Adult↗
PubMed1978

[Ascending bipolar nailing using elastic nails in the treatment of fractures of the upper end of the humerus (author's transl)].

In the treatment of non-impacted fractures of the upper end of the humerus, the tendency of many surgeons is to use nailing with the fracture site closed, from the supra-olecranon fossa. This would seem to merit certain criticisms. Following reduction of the fracture, we use Ender elastic nails and two modified nails of a smaller calibre, one inserted via the epicondyle and the other via the epitrochlea. The technique of this ascending bipolar nailing using elastic nails is carried out in a horizontal supine position, which facilitates manoeuvres of reduction and facilitates anaesthesia. Apart from non-impacted fractures of the upper end of the humerus, other indications exist.

Fracture Fixation, Internal↗
PubMed2002

Diseases of the generative nail apparatus. Part I: Nail matrix.

Disorders of the generative structures of the nail produce a characteristic set of outcomes. The matrix is the seat of nail development and diseases or insults of this germinative epithelium will tell a story in the signs that unfold in the ensuing nail growth. This story will be influenced by the intensity, duration and extent of this pathology. A method of categorizing changes associated with the generative matrix of the nail will be presented.

Humans↗
PubMed2005

Congenital brachydactyly and nail hypoplasia: clue to bone-dependent nail formation.

Congenital hyponychia and anonychia are rare malformations which may form part of syndromes such as nail-patella syndrome, ectodermal dysplasias and brachydactylies, or may occur as an isolated finding. Congenital hyponychia and anonychia are frequently accompanied by underlying skeletal abnormalities. A 20-year-old woman showed congenital bilateral hypoplasia or aplasia of the second, third and fourth toenails with corresponding phalanx dysplasia or aplasia of the affected toes. Malformations of the hands or other congenital defects were absent. The findings in this patient do not exactly fit any known entities. Our clinical observation prompted us to review the literature on congenital hyponychia/anonychia and to summarize recent advances in understanding molecular events in nail development. In conclusion, the association of nail anomalies with aplasia and/or hypoplasia of corresponding middle and/or distal phalanges supports the hypothesis of bone-dependent nail formation.

Adult↗
PubMed1990

Pigmented nail streak associated with Bowen's disease of the nail matrix.

We described a 59-year-old male physician with Bowen's disease occurring on the nail matrix of his right 5th finger. The rapid growth of the pigmented nail streak accompanied by nail deformity led us to consider the possibility of subungual melanoma clinically. Histologic features, however, were compatible with those of Bowen's disease accompanied by melanocytes with melanin-rich long dendrites in the nail matrix. We speculate that his occupational exposure to X-rays for 25 years played an important role in the pathomechanism of the present case.

Bowen's Disease↗
PubMed1989

Nail disorders due to trauma and other acquired conditions of the nail.

Physical and chemical trauma to nails may lead to damage, which presents as various conditions. At times the deformity will imitate systemic disorders or cutaneous diseases. Nail cosmetics and footwear are examples of exogenous factors that can cause such deformity if improperly used. Direct and self-inflicted trauma cause injuries as minor as temporary bands or as severe as permanent nail loss. Prompt treatment can prevent long-term cosmetic and functional damage.

Humans↗