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At least 145 records · Page 8Linked to original sources
PubMed2001

Mechanical failure of unsupported Huckstep intramedullary nail in malignant bone tumor reconstruction.

Seventeen segmental resections of diaphyseal tumors and five knee resection arthrodeses were reconstructed using the Huckstep nail with intercalary bone grafts (fibula), cementation, and ceramic and titanium spacers. Although the bone defects were 0 to 25.5 cm in length (mean, 13.1 cm), all patients had relief of pain and were able to move alone with a wheelchair or a cane. Nail breakage occurred in four patients who had reconstruction surgery using a ceramic spacer (four patients without intercalary fibula graft and one patient with intercalary fibula graft). The nail survival rate was significantly better in the patients with reinforcement by vascularized fibular graft (100% at 5 years and 75% at 10 years; n = 8) than in the patients without reinforcement by vascularized fibular graft (87.5% at 3 years and 0% at 5 years; n = 14). Huckstep nailing is a useful option for reconstruction of large bone defects in diaphyseal tumors and knee resection arthrodesis. It should be used in combination with a vascularized fibula graft to prevent mechanical failure and to achieve durability of limbs with defects from primary bone tumors. Huckstep nailing with nonbiologic augmentation is good for palliative surgery for bone metastases in patients with a shorter expected survival rate.

Adolescent↗
PubMed1993

A histomorphometric study of rabbit tibiofibular bones after rigid intramedullary nailing.

The effects of rigid intramedullary nailing on cortical bone structure were studied in osteotomized and non-osteotomized rabbit tibiofibular bone at time intervals ranging from three to 24 weeks postoperatively. Histological specimens were analysed morphometrically observing changes in cortical bone and the medullary cavity in transverse sections distal to the tibiofibular junction. Throughout the series, when compared to intact control bones, computerized planimetry revealed significant differences only in the osteotomized bones. At 24 weeks, the area of whole cortical bone was less and the area of the medullary cavity greater in the osteotomized bones than in respective control bones. The reason for these changes seemed to be a profound resorption of subendosteal bone. The amount of cortical osteoporosis was slight, but a steady increase could be seen towards the end of the experiment. The results suggest that the morphological changes in cortical bone detected in the present study mostly depend on the operative trauma and not so much on the protection from stress provided by the rigid intramedullary nail.

Analysis of Variance↗
PubMed1997

[Skeletal anomalies in nail-patella syndrome. Case report and overview].

The nail-patella syndrome (NPS), also known as hereditary onychoosteodysplasia (HOOD), is a hereditary disorder with an autosomal dominant mode of inheritance involving nails, bones and other tissues. It is characterized by onchodysplasia of the finger nails (most prominent on the thumb and index finger) and V-shaped lunulae. Extraosseous manifestations include ocular (glaucoma, microcornea) and renal involvement (proteinuria, nephrotic syndrome). A variety of skeletal anomalies can be observed. We report a 59 year old male with NPS. In addition to dysplastic patellae and elbow joints and the pathognomonic posterior iliacal horns, he had involvement of humerus, radius, ulna. and finger bones, leading to early and painful degenerative changes. Furthermore, microproteinuria was noted. Early diagnosis of NPS is important to prevent early secondary arthrosis and severe renal damage.

Bone Diseases, Developmental↗
PubMed2002

[Elastic stable intramedullary nailing of hand bones. ECMES even with the hand].

AIM: Apply the principles of elastic intra-medullary nailing developed by Metaizeau for children, to bone fixation of bones of the hand. METHOD: Retrospective review of 43 patients treated between 1995 and 1999 for fracture of one or more bones of the hand. Thirty five concerned the right hand, 11 the left; 54 involved metacarpal fractures and 2 fractures of the phalanx. Only those patients whose lesions were considered mended were taken into account in this study. RESULTS: In 32 cases, bone fixation was completed with the use of a single pre-stressed pin, in 24 cases 2 prestressed pins forming a double arc were used. The delay in removal of material varied from between 35 days to 4 1/2 months. In three cases it required a dynamic splint treatment. Functional re-education was prescribed for two patients. Eight patients were lost for follow up. Fourty eight were followed with complete recovery of joint range of motion. We deplored one necrosis of the skin due to the contusion at the time of the initial trauma, one delayed healing after an animal bite required keeping the material in place for 4 months, one case of infection; in another case insufficient stabilization by the ECMES resulted in a 10 degrees mal-union of the metacarpal diaphysis. Three times the site of a fracture had to be opened in order to perform bone fixation. CONCLUSION: The ECMES appears perfectly suitable for bone fixation of the diaphysis of bones of the hand and certain metaphyseal and epiphyseal fractures. Small incisions help to avoid unbecoming scars and adhesions and foster a rapid recovery of function.

Bone Nails↗
PubMed2001

Effect of unreamed, limited reamed, and standard reamed intramedullary nailing on cortical bone porosity and new bone formation.

OBJECTIVE: To compare the effects of unreamed nail insertion and reamed nail insertion with limited and standard canal reaming on cortical bone porosity and new bone formation. DESIGN: A canine segmental tibial fracture was created in fifteen adult dogs. The tibiae were stabilized with a statically locked 6.5-millimeter intramedullary nail without prior canal reaming (n = 5), after limited reaming to 7.0 millimeters (n = 5), or after standard canal reaming to 9.0 millimeters (n = 5). Porosity, new bone formation, and the mineral apposition rate of cortical bone were directly compared between the three nailing techniques. RESULTS: A significant increase in cortical bone porosity and new bone formation was seen in all three groups of experimental animals compared with the control tibiae. The overall lowest porosity levels were measured in the limited reamed group, with similar porosity levels measured in the unreamed and standard reamed groups. Porosity was lower in the limited reamed group in the entire cortex of the segmental and distal cross sections, as well as the endosteal, anterior, and posterior cortices along the length of the tibia. Overall, there was no difference in the amount of new bone formation or the mineral apposition rate between the three groups of animals at eleven weeks after surgery. DISCUSSION: The results of this study suggest that limited intramedullary reaming is a biologically sound alternative for the treatment of tibial diaphyseal fractures in which the circulation is already compromised.

Analysis of Variance↗
PubMed1985

Loss of bone strength after intramedullary nailing. Torsion tests of tibial osteotomies in rabbits.

Rigid intramedullary nailing was used in 75 rabbits to stabilize a transverse osteotomy of the midshaft of the tibia. In 36 additional rabbits intramedullary nailing was performed without osteotomy. No additional external immobilization was used postoperatively. After removal of the nail the mechanical strength of the tibiofibular bones was tested torsiometrically in 30 osteotomized and 18 non-osteotomized animals from 3 to 24 weeks after the operation. At 3 weeks the torsional load fractured all osteotomized bones through the osteotomy line. At later stages a spiral fracture occurred either crossing or close to the osteotomy area, usually distal to the tibiofibular junction. The increase in mechanical strength of the osteotomized bones reached a maximum at 6 weeks and then decreased. The strength of the non-osteotomized nailed bones also decreased slightly. The results suggest that rigid intramedullary nailing, although providing good conditions for early consolidation of experimental osteotomy, leads secondarily to deterioration of the mechanical properties of tubular bone.

Animals↗
PubMed1998

Minocycline-induced pigmentation. Incidence, prevention and management.

Pigmentation is a well recognised adverse effect of minocycline therapy. Various body sites, most notably the skin, nails, bones, thyroid, mouth and eyes are affected and the pigmentation may appear at multiple sites. In general, pigmentation results from long term administration of minocycline at cumulative doses greater than 100 g, although cutaneous or oral mucosal pigmentation may appear, regardless of dose or duration of therapy. When the skin is involved, the blue-black pigmentation develops most frequently on the shins, ankles and arms. Other patterns of skin involvement include pigmentation that is either generalised and symmetrical, or that develops at sites of inflammation. The bones of the oral cavity are probably the most frequently affected sites of pigmentation affecting greater than 20% of patients taking minocycline for more than 4 years. In contrast, the oral mucous membranes and teeth are infrequently pigmented from minocycline. Ocular, thyroid and visceral pigmentation is also relatively uncommon and usually develops only with high doses and long term minocycline use. Whereas pigmentation of the skin and oral mucosa is generally reversible when the drug is discontinued, the pigmentation is often permanent when other sites are involved. Although minocycline-induced pigmentation is not harmful, the drug should be discontinued when the adverse effect is recognised. All patients receiving minocycline, especially those treated for longer than 1 year, require screening for the development of pigmentation.

Anti-Bacterial Agents↗
PubMed2004

Nancy nailing of diaphyseal forearm fractures. Single bone fixation for fractures of both bones.

We identified 25 children (10 girls and 15 boys) who had been treated with single bone intramedullary fixation for diaphyseal fractures of both forearm bones. Their mean age was 10.75 years (4.6 to 15.9). All had a good functional outcome. We conclude that in selected children, single bone intramedullary nailing is a suitable method of treatment for diaphyseal fractures of both bones of the forearm.

Adolescent↗
PubMedDate not supplied

Radiographic changes in cortical bone after intramedullary nailing. An experimental investigation on rabbits.

Transverse osteotomies of the midshaft of the tibia in 75 rabbits were stabilized with intramedullary nails which prevented rotational instability. In a further 36 animals intramedullary nailing was performed without preceding osteotomy. The animals were able to move freely immediately after the operation without any supporting case or splint. The structural changes in the bones were analysed radiographically 3 to 24 weeks after the operation. Fracture repair was accompanied by moderate periosteal callus formation and remodelling of the callus was seen from 9 weeks on. A sleeve of new endosteal bone surrounding the nail was found after 12 weeks. Porotic transformation of the diaphyseal cortical bone was seen in both osteotomized and non-osteotomized bones from 12 weeks onwards. It is concluded that intramedullary nailing provides favourable conditions for fracture repair and enables accurate radiographic assessment of the healing. Attention is focused on the causes and features of secondary porotic transformation of the cortical bone after intramedullary nailing.

Animals↗
PubMed2000

[One-stage emergency treatment of open tibial shaft fractures with bone loss. Specifics and indications].

OBJECTIVES: The purpose of this study was to report our experience in the reconstruction of severe tibial shaft fractures in emergency treatment. PATIENTS: Five male patients were admitted to the emergency room with a grade IIIB open tibial shaft fracture with bone loss, one patient with a grade IIIA open tibial fracture with massive articular bone loss and one patient with a grade IIIC open tibial fracture. INTERVENTION: Primary one-stage management was the same for the five patients with a grade IIIB: debridement, stabilization by locked intramedullary nailing, bone grafting from iliac crest. Skin loss was covered in the same operative time using free muscle flaps (four latissimus dorsi, one gracilis). For the patient with massive articular and diaphyseal bone loss, a vascularized fibula transfer with arthrodesis was performed one day after the trauma. For the patient with grade IIIC open tibial fracture, a shortening was performed in emergency treatment. RESULTS: The average follow-up was 21 months (range: eight months to 3.5 years). Partial weight-bearing was started at three months and the time of full weight-bearing was five months after the trauma. No angular complication and no non-union were observed. We noted one superficial infection without osteitis. All fractures healed within five to ten months (mean: 8.5 months). At the last follow-up, ankle and knee motion was normal and no pain was noted, except for the patient who had an arthrodesis and another who had associated lesions. CONCLUSION: We think that "aggressive" emergency management for severe open tibial fractures gives good results. It significantly reduces tissue loss from infection and improves healing and rehabilitation times.

Adolescent↗
PubMed2005

[Principles of OSG arthrodesis in cases of joint infection].

A chronic empyema of the ankle joint often develops after an open fracture or surgery. In the case of the destruction of the joint due to an infection, an arthrodesis should be performed. Normally we use an external fixator with two bone-nails placed into the calcaneus and two into the tibia. The arthrodesis is distracted and Septopal is permanently implemented. At 4-6 weeks after surgery the Septopal is removed, with distraction being reduced and a cancellous bone-graft taken from the dorsal iliac crest is performed to fill the bony defect. After bone healing, the external fixator is removed and the patient mobilized in a brace. Initially, weight-bearing is limited to 10 kg but is increased gradually to full weight. The brace is used for 6-9 months; later the patient is mobilized in orthopaedic shoes. In difficult cases, also in combination with a malposition which has to be corrected or a lengthening of the lower limb, we use the Ilizarov fixator. From 1993 to 2003 we performed arthrodeses of the ankle joint due to infectious destruction in 107 cases. In 82.2%, the empyema was caused by a fracture of the ankle joint and the following treatment. In 58% of the patients, we saw associated diseases such as obesity, alcohol abuse, diabetes and malposition of the foot. In 55% we found Staphylococcus aureus. In 86%, we used the external AO-fixator, in 14% the Ilizarov fixator. The patient retained the fixator for an average of 128 days. In our study, 92.1% of the 101 patients who had completed therapy showed a good stability an average of 4.5 years after the arthrodesis. In 5% we found partial stability, while three patients had to be amputated. In 57 patients (56.4), an arthrosis of the tarsal bones was found, and 38 patients (54.3%) of the 70 patients who at the time of the arthrodesis were still working could return to work.

Adult↗
PubMed1977

On the possibilities of the application of scanning electron microscopy in the forensic medicine.

The aim of the paper is to provide pertinent, information about scanning electron microscopy (SEM), with a detailed survey on the great possibilities of SEM which is becoming increasingly important in research and practical work of forensic medicine. The electronoptical characteristics of the method are discussed and the basic preparation methods to be selected are described. The areas of forensic medicine where these methods have already been used, as well as the results obtained, are briefly surveyed. The present state of affairs as well as personal experiences with hairs, bones, muscle and skin are described in detail. The experience with the critical point drying method is described. This method according to the reviewers, is very useful for work with hairs, bones, nails and sometimes with skin although the preparation may result in secondary destructions of the tissues of high water content to such an extent that the evaluation will be interfered with or becomes impossible. Further possibilities of these perspectivic methods are under research. The discussion of the physiological data is preceded by a historical description of the SEM and TEM systems and the basic principles of its function, which should facilitate reading of the text.

Bone and Bones↗
PubMed2001

One-stage emergency treatment of open grade IIIB tibial shaft fractures with bone loss.

The purpose of this study was to report the authors' experience with emergency reconstruction of severe tibial shaft fractures. Five male patients were admitted to the emergency room with a grade IIIB open tibial shaft fracture with bone loss (average age, 33 years; age range, 18-65 years). Injuries were the result of motorcycle accidents (N = 2), pedestrian accidents (N = 1), gunshot wound (N = 1), and paragliding fall (N = 1). Primary emergent one-stage management for all patients consisted of administration of antibiotics, debridement, stabilization by locked intramedullary nailing, bone grafting from the iliac crest, and coverage using free muscle flaps (four latissimus dorsi and one gracilis). The average follow-up was 21 months (range, 8 months-3.5 years). Partial weight bearing with no immobilization was started at 3 months, and full weight bearing began 5 months after trauma. No angular complications and no nonunions were observed. There was one case of superficial infection without osteitis. All fractures healed within 6 months in 4 patients and within 10 months in 1 patient. At the last follow-up examination, ankle and knee motion was normal and no pain was noted, except for 1 patient who had associated lesions (ankle motion reduced by 50%). Aggressive emergency management of severe open tibial fractures provides good results. It improves end results markedly, not only by reducing tissue loss from infection, but also reducing healing and rehabilitation times.

Adolescent↗
PubMed1995

Bone regrowth in young mice stimulated by nail organ.

Recent studies of postamputational repair following digit-tip amputation revealed an unexpected correlation between nail regrowth and bone regrowth in mice. To examine putative effects of nail on bone regrowth, phalangeal tips were amputated such that nail was artificially removed from distal levels or retained following proximal level amputations. In the absence of nail, bone did not regrow at distal levels. Conversely, when nail was surgically retained bone regrew from proximal levels. The nail organ profoundly influences bone regrowth.

Amputation, Surgical↗