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At least 19 recordsLinked to original sources
PubMed2000

Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures.

BACKGROUND: Cephalocondylic intramedullary nails which are inserted proximally to distally (cephalocondylic) have been used for the surgical treatment of extracapsular hip fractures. OBJECTIVES: To update and expand our review comparing the Gamma nail with the sliding hip screw (SHS) by comparing all cephalocondylic intramedullary nails with extramedullary implants for the surgical treatment of extracapsular hip fractures in adults. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group trials register, Medline, select orthopaedic journals and conference proceedings, and reference lists of relevant articles. We contacted trialists, colleagues and implant manufacturers. Date of the most recent search: June 1998. SELECTION CRITERIA: All randomised and quasi-randomised trials comparing cephalocondylic nails with extramedullary implants for extracapsular hip fractures. DATA COLLECTION AND ANALYSIS: Both reviewers independently assessed trial quality and extracted data. Additional information was sought from all trialists. Wherever appropriate and possible, results were pooled. MAIN RESULTS: The one trial of 230 patients comparing the Kuntscher-Y nail with the SHS, reported no major difference the outcome aside from a significantly increased number of patients with leg shortening, and a tendency for poorer recovery of mobility in the Kuntscher-Y nail group. Fourteen trials comparing the Gamma nail with the SHS were included, with data available for 1977 patients. The Gamma nail was associated with an increased risk of operative and later fracture of the femur and an increased re-operation rate. There were no major differences in the incidence of wound infection, mortality or medical complications between implants. Data were inadequate to determine if there were differences for other outcomes. Two trials involving 231 patients compared the intramedullary hip screw (IMHS) with the SHS. Fracture fixation complications were more common in the IMHS group: all cases of operative and later fracture of the femur and haematoma occurred in this group. Results for post-operative complications, mortality and functional outcomes were similar in the two groups. REVIEWER'S CONCLUSIONS: Further evidence is required before any conclusions can be drawn on the relative merits of the Kuntscher-Y nail and the SHS. Given the lower complication rate of the SHS in comparison with the Gamma nail, it appears that for trochanteric fractures the SHS is superior. Further evidence is still required to confirm this, as well as to determine if the Gamma nail, or modifications of the Gamma nail, have advantages for selected fracture types (for example, subtrochanteric fractures). From the limited evidence available, IMHS appears to have the same problems as the Gamma nail, but other theoretical advantages of the IHMS can not be ruled out.

Bone Nails↗
PubMed1984

[Histological investigation of nail growth in human embryos and regrowth of nail after its removal in adult monkeys--with reference to clinical observation in injuries to the nail and its surrounding tissues].

As the basis to develop adequate treatments which can preserve the nail plate or assure its regrowth in frequently encountered injuries to the nail-surrounding tissues, a histological investigation was made of nail growth in human embryos and regrowth of nail after its removal in adult monkeys. The author's investigation in these two series indicated the following. Firstly the nail plate composed of parakeratotic layer is produced solely of "nail matrix", thus, supporting Zaias' and opposing Lewis' theory as to the nail production. Secondly though the normal, completely formed nail matrix and nail bed have no granulosa cell nor horny layer, the nail bed is temporarily covered with "false nail" which contains these two layers during the process of embryonal nail growth as well as during that of regrowth after its removal. This "false nail" well incorporates with the volar surface of growing or regrowing nail plate, and is gradually pushed distally as the nail grows and stretches distally . These findings raise a question why healthy nail does not grow over ordinary skin graft placed on the nail bed damaged by trauma. Is there any essential difference between "false nail" and ordinary skin graft, though both having these two layers in common? The author thinks there must be and presumes that it lies in the difference of turn-over time as exemplified with autoradiographical study by Zaias, i.e. turn-over time of germinative layers of healthy nail bed is much slower than in ordinary skin, therefore not so thick horny layer as in ordinary skin is formed by the time the growing or regrowing nail plate spread over it, which allows "incorporation" between palmar surface of the growing nail and germinative layer of the nail bed. On the contrary, too thick horny layer provided or formed in the grafted ordinary skin does not allow the "incorporation" between these tissues. Clinical observations coincide with the above result and presumption.

Animals↗
PubMed2001

The microvasculature of the nail bed, nail matrix, and nail fold of a normal human fingertip.

The organization of the microvasculature of the dorsal human fingertip based on a vascular corrosion cast was examined using a stereoscopic microscope. The variations of the superficial capillary network of the 3 specialized areas of skin of the dorsal fingertip (the nail bed, the nail matrix, and the nail fold) are described. In the nail bed numerous capillary loops were observed arising from a deeper regular arrangement of sagittally aligned, parallel rows of vessels. The size and direction of inclination of the capillary loops varied, getting longer and more inclined to the nail bed distally, with the longest capillary loops seen at the hyponychium. There were no capillary loops at the nail matrix region, but there was a single, layered, rectangular plexus of capillaries in the plane of the nail matrix. This extended distally to sagittally stretched coils of vessels that straightened out as the nail matrix enters the nail bed region. At the edge of the proximal nail fold the capillary loops looked like fine bristles and were approximately 3 times shorter than those found on the nail bed and hyponychium. This study provides a baseline for future work in understanding the changes in the microvasculature of the dorsal fingertip due to injury or pathology.

Adult↗
PubMed1991

Itraconazole penetrates the nail via the nail matrix and the nail bed--an investigation in onychomycosis.

Nail-matrix kinetics were studied in 21 patients (19 with onychomycosis, two with tinea corporis) as soon as taking itraconazole (Sporanox) 100 mg daily for up to 7 months. Itraconazole was detected in the distal nail as soon as 1 month after the start of therapy (42 ng/g in fingernails and 16 ng/g in toenails). During the course of treatment, this concentration rose and reached a mean of 160 ng/g in fingernail clippings and 197 ng/g in toenail clippings. Moreover, in fingernails of 12 out of 21 patients and in toenails of six out of 20 patients, itraconazole was detected in the distal nail clippings before full outgrowth of the fastest-growing nail. In most patients, itraconazole was detected in the distal nail clippings earlier than would be expected if the drug were incorporated only via the nail matrix, indicating that in addition to the nail matrix, a second route of penetration into the nail exists, i.e. the nail bed.

Adult↗
PubMed1996

Nail growth measurement employing nail indentation--an experimental follow-up study of nail growth in situ.

Nail growth was studied over 20 weeks in five healthy volunteers by indenting eight nails in each subject with a dental burr. The indentations were drilled in the middle part of the lunula with the proximal edge of the indentation 1 mm from the cuticle. Their volume was measured by filling them with an elastic two-component material immediately after indentation and 4, 8, 12, 16 and 20 weeks thereafter. Nail growth as reflected by the volume changes of the indentations could be followed for 8-12 weeks in the thumb, the middle finger and the second toe and for 20 weeks in the big toe. The most rapid outgrowth, 8-12 weeks, occurred in the second toe and middle finger. The decrease in the volume of the indentations by approximately 30-35%, as they travelled from the lunula towards the distal end of the nail plate, also reflects nail growth from the nail bed. This study has shown that indentation of the nails and the measurement of their volume changes provides a reliable and simple method for the study of nail growth.

Adult↗
PubMed1998

Ingrown nails: a comparison of the nail matrix phenolization method with the elevation of the nail bed-periosteal flap procedure.

Seventy-five procedures were performed on 62 patients with ingrown nails from 1992 to 1996. Those consisted of 51 nail matrix phenolization methods (NMP) and 24 elevation of the nail bed-periosteal flap procedures (ENF). Ingrown nails were classified into type A (normal nail plate) and type B (incurved nail plate). The duration and intensity of postoperative pain were assessed, and the recurrence rate was monitered. The recurrence rate was 3.9% in the NMP group and 4.1% in the ENF group. Concerning the recurrence rate, there was no statistical significance between ENF and NMP in both types. Postoperative pain intensity was less in the NMP group than in the ENF group in both types (P < 0.01). The same tendency was seen in postoperative pain duration. However, the NMP group had longer duration of wound healing compared with the ENF group in type A (P < 0.01). We conclude that NMP is a recommendable treatment for most ingrown nails.

Administration, Topical↗
PubMed2003

Intramedullary nailing of the femur with an inflatable self-locking nail: comparison with locked nailing.

We report a comparative study between an inflatable expandable nail and a traditional locked intramedullary implant in closed fractures of the femoral shaft. We matched each of 43 patients who had undergone intramedullary fixation with an inflatable expandable nail with a patient of the same sex, age (within 2 years), and fracture who had undergone statically locked intramedullary fixation with traditional nails. The mean duration of surgery was significantly shorter in the patients who were treated with the inflatable expandable nail. There were no differences in average blood loss, transfusion requirements, or hospitalization. Five of the patients who underwent traditional nailing required dynamization to achieve union. The inflatable expandable nail allows effective management of diaphyseal fractures of the femur. Interlocking is not necessary, operative times are reduced, and exposure to ionizing radiation is minimized. At present, however, the inflatable expandable nail used in the this investigation is markedly more expensive than traditional devices.

Adolescent↗
PubMedDate not supplied

[Experimental studies of the biomechanical properties of hollow nails and solid nails for interlocking intramedullary nailing in the dog].

Since locked intramedullary nailing of the tibia in dogs was followed by material failure of the conventional slotted hollow nails within days, special solid nails were developed and tested with respect to their mechanical properties. There was a clear advantage of the solid nails over the hollow nails in terms of bending resistance and yield force. In animal experiments--even in long-term experiments over nine months--no case of material failure occurred with the solid nails. The high torsional and bending resistance of the solid nails suggests the use of a mechanical device which, as our experience shows, permits reliable interlocking without the need for an image intensifier, that is to say, without radiation exposure.

Animals↗
PubMed1998

[Solution to the problem of extra-articular, femoral hip fracture by the "sliding screw-nail principle". Results of 2 different systems (classical nail and gamma nail)].

Between January 1993 and December 1995 we treated 109 patients (median age: 75 years) with 112 extraarticular hip fractures including combined trochanteric and shaft fractures using two different "sliding-screw-nail implants" (intramedullary hip screw = classic nail: n = 61; gamma nail: n = 51). Comparing the two systems in detail certain advantages and disadvantages were seen, with both being equivalent. We encountered the following complications: secondary varus malalignment of the collum femoris with "cut out" of the sliding-screw (1.8%) and without "cut out" (1.8%), fissure of the femoral shaft occurring intraoperatively and being treated conservatively (1.8%), femoral perforation by the nail (0.9%), infection (2.7%). Thus, 5 reoperations (4.5%) were necessary. None of these complications were attributable to the principle itself or to the different implants used. Each patient was followed-up for a minimum of 12 months postoperatively. In 59% of all patients the pre-trauma range of mobility could be fully restored. Intramedullary hip screw and gamma nail are excellent and equivalent systems, which fully satisfy the biomechanical needs of above mentioned fractures.

Adolescent↗
PubMed2000

[Biomechanics of interlocked nailing in humeral shaft fractures. Comparison of 2 nail systems and the effect of interfragmentary compression with the unreamed humeral nail].

In this biomechanical study the implanted Unreamed Humeral Nail (UHN) has been tested concerning bending and torsional stiffnesses. In literature other intramedullary implants have been criticized for insufficient rotatory stability especially in transverse and short oblique fractures of the humeral shaft. This study examined, whether the implanted UHN, as well as the UHN implanted with interfragmentary compression through a specific compression device, is able to augment torsional stiffness significantly. To evaluate bending and torsional stiffnesses, the UHN has been compared biomechanically to the Russell-Taylor humeral nail (RT) in paired mid-shaft osteotomized cadaveric humeri. Identic paired comparison has been performed with the UHN without and UHN with interfragmentary compression. In anterior-posterior, as well as medio-lateral direction stiffness under four-point-bending is significantly higher in stabilizing with the RT. Under torsional loading with moments of 4 Nm, 6 Nm and 8 Nm the UHN reached more than the double torsional stiffness. The RT, which is only dynamically interlocked, owns a high initial "play" between bolts and nail itself. Through additional interfragmentary compression stiffness of the UHN under four-point-bending in anterior-posterior, as well as medio-lateral direction augments significantly. Also under torsional loading with moments of 4 Nm, 6 Nm und 8 Nm torsional stiffness increases with interfragmentary compression significantly. In comparison to other biomechanical studies of different authorship it is clear, that this statically interlocked intramedullary nailing of the humeral shaft is superior to non-statically interlocked types of nailing concerning their stabilizing potency in torsion and serves especially for fracture types, which are critically under rotation, as transverse or short oblique humeral shaft fractures.

Biomechanical Phenomena↗
PubMed2003

[Shiny nail, spotted nail. Beau-Reil lines. When dermatoses entrench in the nails].

Numerous skin diseases, for example psoriasis, eczema, lichen planus, Reiter's syndrome or alopecia areata, may also involve parts of the nail. Depending on the structure involved and the nature and duration of the lesion, a certain disturbance pattern presents. Matrix disorders, which are often observed, may manifest as such characteristic lesions as spots, tracheonychia or Beau's lines. Treatment is determined by the respective underlying disease.

Diagnosis, Differential↗
PubMed2001

Calculation of nail plate and nail matrix parameters by 20 MHz ultrasound in healthy volunteers and patients with skin disease.

BACKGROUND/AIMS: The objective, but noninvasive, assessment of the nail plate and nail matrix is of interest in dermatology, and cosmetics as well. These cutaneous structures were investigated with 20 MHz ultrasound. This study was performed to obtain data on normal nails in adults of different age groups, with a left-right comparison, and to investigate nail changes in selected dermatologic diseases. METHODS: Healthy controls (n = 34) and patients with dermatologic complaints and nail disease (n = 37) were included after informed consent. In the control group, 18 woman and 16 men with a mean age of 37.2 years (range 15 to 82 years) were investigated for age- and gender-related differences. Patients with one of the following disorders were investigated: systemic lupus erythematosus (SLE; n = 11), systemic sclerosis (PSS; n = 8), psoriasis (n = 9), chronic hand eczema (n = 5), and others (n = 4). Measurements of length and width of the nail plate and the lunulae were performed with a micrometer device. Sonography was performed with a 20 MHz probe in B-scan mode. RESULTS: The mean nail thickness of healthy controls varied between 0.481 mm (right thumb) and 0.397 mm (left fifth finger). The nail volume and the matrix volume disclosed a positive, but mostly nonsignificant, correlation for all controls. Age-specific differences were investigated for both genders. In men and women, the matrix volume increased significantly with age. The nail and matrix volume was higher in men than in women, independent of age. The left-right comparison disclosed a trend to higher nail and matrix volumes on the right hand. In patients with SLE there was an increase in nail thickness and in matrix volume. Patients with PSS showed a significant decrease in nail thickness and matrix volume. In other diseases the measurements disclosed no confident differences to healthy controls. CONCLUSION: The 20 MHz ultrasound offers a noninvasive method to calculate nail thickness, nail volume and matrix volume in healthy volunteers and in nail disease. Skin diseases show characteristic quantitative changes in these parameters.

Adolescent↗
PubMed1984

Comminuted femoral-shaft fractures: treatment by roller traction, cerclage wires and an intramedullary nail, or an interlocking intramedullary nail.

In a retrospective study, we attempted to assess progress in the treatment of comminuted fractures of the femoral shaft at Parkland Memorial Hospital from 1978 to 1983. Seventy-nine comminuted femoral-shaft fractures were available for follow-up: thirty-two treated by roller traction, twenty-three treated by cerclage wires and an intramedullary nail, and twenty-four treated by an interlocking intramedullary nail. Using the classification of Winquist and Hansen, Grade-III and IV comminuted fractures accounted for 69 per cent of those treated by roller traction, 68 per cent of those treated by nailing and cerclage wires, and 96 per cent of those treated by an interlocking nail. The frequency of multiple injuries was 38 per cent in the patients treated by roller traction, 39 per cent in those treated by nailing and cerclage wires, and 58 per cent in those treated by an interlocking nail. The average hospitalization times were thirty-one days for roller traction, sixteen days for cerclage wires and an intramedullary nail, and 19.5 days for an interlocking nail. The average length of follow-up was 132 weeks after roller traction, 115 weeks after cerclage wiring and an intramedullary nail, and sixty weeks after insertion of an interlocking nail. All fractures were followed until after union; the average times to union were 18.4 weeks after roller traction, thirty-four weeks after open reduction and intramedullary nailing with cerclage wires, and 13.8 weeks after insertion of an interlocking nail. For the purposes of this study, treatment was assumed to have failed if a change in treatment was necessary, an unplanned reoperation was performed, femoral shortening exceeded 2.5 centimeters, angulation was more than 15 degrees, non-union or a deep infection developed, motion of the knee was less than 70 degrees of flexion, or a refracture occurred. By these criteria, the frequency of failure after roller traction was 66 per cent (secondary to malalignment and shortening); after insertion of an intramedullary nail with cerclage wires, 39 per cent (secondary to unplanned surgery, non-union, shortening, and infection); and after use of an interlocking nail, 4 per cent (secondary to shortening). Currently, at our institution, an interlocking intramedullary nail is the treatment of choice for comminuted femoral-shaft fractures because it encourages early union with maintenance of length and alignment and the results are predictable.

Adolescent↗
PubMed1999

Comparison of nail bed repair versus nail trephination for subungual hematomas in children.

Fifty-three fingers in 52 children were divided into 2 groups, operative and nonoperative, after fingernail crush injury. Criteria for inclusion into the study were an intact nail and nail margin with subungual hematoma and no previous nail abnormality. The length of the follow-up period averaged longer than 2 years for each group. Twenty-six fingers in 26 children were treated by nail removal, exploration, and repair of nail bed lacerations (operative group). Twenty-seven fingers in 26 children were treated by evacuation of hematoma by nail trephination without nail removal in 11 fingers and by observation in the other 16 fingers (nonoperative group). In the operative group, transient abnormalities (nail depression or hypertrophy), which resolved by 4 months, occurred in 3 patients. In the group treated by simple decompression, there were no complications except for 1 transient nail depression at 3 months. The average cost to the operative group was $1,263 compared with $283 to the trephination group. Although formal nail bed reconstruction has been advocated for hematomas larger than 25%, we found no notable difference in outcome between the 2 groups regardless of hematoma size, presence of fracture, injury mechanism, or age. Charges, however, were 4 times greater for the operative group. Based on the results of this study, we do not feel that nail removal and nail bed exploration is indicated or justified for children with subungual hematoma and an intact nail and nail margin.

Adolescent↗
PubMed2004

In vitro permeation of several drugs through the human nail plate: relationship between physicochemical properties and nail permeability of drugs.

The objectives of the present study are to clarify the relationship between the physicochemical properties and the nail permeability of drugs through human nail plates. Homologous p-hydroxybenzoic acid esters were used to investigate the relationship between the octanol/water partition coefficient and the permeability coefficient of several drugs. The nail permeability was found to be independent of the lipophilicity of a penetrating drug. However, the nail permeability of several model drugs was found to markedly decrease as their molecular weights increased. The nail permeability of an ionic drug was found to be significantly lower than that of a non-ionic drug, and the nail permeability of these drugs markedly decreased as their molecular weights increased. The permeation of a model drug, 5-fluorouracil (5-FU), through healthy nail plates was also determined and compared with that through nail plates with fungal infections. The drug permeation through a nail plate decreased with an increase in nail plate thickness. Nail plates with fungal infections exhibited approximately the same 5-FU permeation as healthy nail plates. We suggest that the permeability of a drug is mainly influenced by its molecular weight and permeability through nails with fungal infection can be estimated from data on healthy nail permeability.

Adult↗
PubMed1996

Occupational allergic contact dermatitis caused by photobonded sculptured nails and a review of (meth) acrylates in nail cosmetics.

BACKGROUND: Mono(meth)acrylates (monoacrylates and monomethacrylates) are moderate to strong sensitizers. They are used in the production of a great variety of polymers, including nail cosmetics. OBJECTIVE: A patient who became occupationally sensitized to photobonded sculptured nails is reported. Detailed patch testing and analyses of the patient's nail cosmetics containing mono(meth)acrylates clarified the cause of her hand and face dermatitis. The current knowledge on mono(meth)acrylates in nail cosmetics is also reviewed. METHODS: Patch testings with conventional methods, including patch testing with the patient's own substances, were performed. The patient's nail cosmetics suspected of containing mono(meth)acrylates were analyzed with gas chromatography/mass spectrometry analysis. RESULTS: In the (meth)acrylate series, 15 of the 31 (meth)acrylate compounds tested gave an allergic reaction: 2 acrylates, 5 methacrylates, 3 dimethacrylates, and 5 diacrylates. Epoxy diacrylates, cyanoacrylate, triacrylates, and methacrylic acid were negative. Three of seven of her own nail cosmetic preparations contained mono(meth)acrylates as revealed by the gas chromatography/mass spectrometry analysis, and these also gave allergic patch test reactions, namely, the nail liquid, nail hardener, and UV-cured nail gel. CONCLUSION: The patient probably had been sensitized to the following (meth)acrylate compounds from her nail cosmetics: tripropylene glycol diacrylate and methyl acrylate from her photobonded nail gel; ethyl methacrylate, triethylene glycol dimethacrylate, and methyl methacrylate from her nail liquid; and butyl methacrylate from her nail hardener. She was probably also sensitized to the rare sensitizer aliphatic urethane diacrylate, but the source was not verified. Because nail cosmetics containing mono(meth)acrylates are strong sensitizers, both the workers and the customers should be aware of their sensitizing capacity; they should use no-touch techniques regarding the skin before the mono(meth)acrylates are polymerized.

Acrylates↗
PubMed2000

Assignment of the gene for a new hereditary nail disorder, isolated congenital nail dysplasia, to chromosome 17p13.

Isolated congenital nail dysplasia is an autosomal dominant disorder recently observed in a large family from southern Germany. The disorder is characterized by longitudinal streaks, thinning, and impaired formation of the nail plates leading to increased vulnerability of the free nail margins. In most cases, all fingernails and toenails are similarly involved with some accentuation of the thumb and great toenails. Histologic changes include hypergranulosis of the nail matrix and epithelial outgrowths from the nail bed. Patients do not show any alterations of hair growth and dentition, no malfunction of sweat glands and sensory organs, and no skeletal abnormalities. Isolated congenital nail dysplasia manifests from the first year of life with variable expressivity. In order to localize chromosomally the gene underlying isolated congenital nail dysplasia, linkage to the known keratin gene cluster regions on chromosomes 12q12 and 17q21 was ruled out first. The analysis of 150 microsatellite markers on various chromosomes mapped the isolated congenital nail dysplasia gene to the 6 cM interval between markers at D17S926 and D17S1528 on chromosome 17p13. Markers at D17S849, D17S 1840, and D17S1529 co-segregated completely with the isolated congenital nail dysplasia locus. The maximum two-point LOD score was found for the marker at D17S 1840 (Zmax = 6.72 at Thetamax = 0.00). The identified region harbors no currently known genes involved in skin or nail abnormalities. Isolated congenital nail dysplasia probably represents a novel isolated defect of nail development. The localization of this gene is, therefore, the first step towards the identification of a new factor in nail formation.

Child↗
PubMed2003

Nail-splinting technique for ingrown nails: the therapeutic effects and the proper removal time of the splint.

BACKGROUND: An ingrown nail is a common disorder that occurs most frequently in the great toe and causes much discomfort in patients. Although many therapeutic methods have been described, most of them can lead to severe damage to the nail or to frequent relapses. The nail-splinting technique is known to be a noninvasive therapeutic method for treating an ingrown nail. OBJECTIVE: Our purpose was to access the recurrence rate of the nail-splinting technique and to determine the proper removal time of the splint from the ingrown nail. METHODS: Fifty-seven patients with ingrown nail were treated with the nail-splinting technique. Subjects were randomized into two groups. For group 1 (28 patients), the splint was removed splint 3 days after treatment, whereas for group 2 (29 patients), the splint was removed splint 2 weeks after treatment. All patients underwent a follow-up examination at 1, 2, and 4 weeks after treatment and were evaluated for tissue status and level of pain. After 1 year, we evaluated the rate of recurrence by means of a telephone interview with each patient. RESULTS: A low recurrence rate (8.7%) for the nail-splinting technique was observed in both groups (7.1% in group 1 vs. 10.3% in group 2). The tissue status and level of pain were found to improve with time, with no statistical significance between the two groups (P> 0.05). CONCLUSION: This study indicates that the nail-splinting technique constitutes a very simple and effective, noninvasive therapeutic method for treating ingrown nail. We suggest that the 3-day nail-splinting technique is the most useful when the nail is intact or has only a slight defect.

Female↗