Development and mechanical testing of a short intramedullary nail for fixation of femoral rotational osteotomy in cerebral palsy patients

Background: Rotational osteotomy is frequently indicated to correct excessive femoral anteversion in cerebral palsy patients. Angled blade plate is the standard fixation device used when performed in the proximal femur, but extensile exposure is required for plate accommodation. The authors developed a short locked intramedullary nail to be applied percutaneously in the fixation of femoral rotational osteotomies in children with cerebral palsy and evaluated its mechanical properties. Methods: The study was divided into three stages. In the first part, a prototype was designed and made based on radiographic measurements of the femoral medullary canal of ten-year-old patients. In the second, synthetic femoral models based on rapid-prototyping of 3D reconstructed images of patients with cerebral palsy were obtained and were employed to adjust the nail prototype to the morphological changes observed in this disease. In the third, rotational osteotomies were simulated using synthetic femoral models stabilized by the nail and by the AO-ASIF fixed-angle blade plate. Mechanical testing was done comparing both devices in bending-compression and torsion. Results: The authors observed proper adaptation of the nail to normal and morphologically altered femoral models, and during the simulated osteotomies. Stiffness in bending-compression was significantly higher in the group fixed by the plate (388.97 +/- 57.25 N/mm) than in that fixed by the nail (268.26 +/- 38.51 N/mm) as torsional relative stiffness was significantly higher in the group fixed by the plate (1.07 +/- 0.36 Nm/degrees) than by the nail (0.35 +/- 0.13 Nm/degrees). Conclusions: Although the device presented adequate design and dimension to fit into the pediatric femur, mechanical tests indicated that the nail was less stable than the blade plate in bending-compression and torsion. This may be a beneficial property, and it can be attributed to the more flexible fixation found in intramedullary devices.

Melanonychia: the importance of dermatoscopic examination and of nail matrix/bed observation

Melanonychia, from the Greek melaina, means black and is the result of an increased deposition of melanin on the nail plate, originating in the nail matrix. It may have different causes, including subungueal melanoma, making early etiologic diagnosis very important.

The Effect of Different Fluoride Concentrations and pH of Dentifrices on Plaque and Nail Fluoride Levels in Young Children

To evaluate the influence of dentifrice pH and fluoride (F) concentration on F uptake by plaque and nails, two sets of 5-to 6-year-old children were randomly allocated into four groups, according to the type of dentifrice they had been using for 1 year: (1) experimental liquid dentifrice (ELD), 1,100 ppm F, pH 7.0; (2) ELD, 1,100 ppm F, pH 4.5; (3) ELD, 550 ppm F, pH 4.5, and (4) commercial toothpaste, 1,100 ppm F, pH 7.0. In one set of children, nails were clipped. In the second, plaque samples were collected 1 h after the last use of dentifrice. F concentration in plaque and nails was analyzed. Plaque F concentration was significantly lower in group 4 than in groups 1-3. Nail F concentration was significantly higher in group 4, and significantly lower in group 3, than in group 1 or 2. Plaque F uptake was influenced significantly by dentifrice consistency and nonsignificantly by pH and F concentration. Reduction of dentifrice pH did not affect nail F concentration. Copyright (C) 2009 S. Karger AG, Basel

Environmental and Individual Factors Associated with Nail Fluoride Concentration

Nails have been suggested as suitable biomarkers of exposure to F, with the advantage of being easily obtained. The effect of water F concentration, age, gender, nail growth rate and geographical area on the F concentration in the fingernail and toenail clippings were evaluated. Volunteers (n = 300) aged 3-7, 14-20, 30-40 and 50-60 years from five Brazilian communities (A-E) participated. Drinking water and nail samples were collected and F concentration was analyzed with the electrode. A reference mark was made on each nail and growth rates were calculated. Data were analyzed by ANOVA and linear regression (alpha = 0.05). Mean water F concentrations (8 SE, mg/l) were 0.09 +/- 0.01, 0.15 +/- 0.01, 0.66 +/- 0.01, 0.72 +/- 0.02, and 1.68 +/- 0.08 for A-E, respectively. Mean F concentrations (+/- SE, mg/kg) ranged between 1.38 +/- 0.14 (A, 50-60 years) and 10.20 +/- 2.35 (D, 50-60 years) for fingernails, and between 0.92 +/- 0.08 (A, 14-20 years) and 7.35 +/- 0.80 (E, 50-60 years) for toenails. Among the tested factors, geographical area and water F concentration exerted the most influence on finger- and toenail F concentrations. Subjects of older age groups (30-40 and 50-60 years) from D and E showed higher nail F concentrations than the others. Females presented higher nail F concentration than males. Water F concentration, age, gender and geographical area influenced the F concentration of finger- and toenails, and hence should be taken into account when using this biomarker of exposure to predict risk for dental fluorosis. Copyright (C) 2009 S. Karger AG, Basel

Nail manifestations in pemphigus vulgaris

Nail involvement in pemphigus vulgaris is rare. We describe 5 patients with pemphigus vulgaris presenting nail involvement. In this disease, nail manifestations present, by order of frequency, as chronic paronychia, onychomadesis, onycholysis, Beau's lines and trachyonychia. All our 5 cases presented with paronychia, and 1 of them also had Beau's lines. Treatment with prednisone and/or cyclophosphamide controlled mucocutaneous and nail manifestations in all cases.

A sixth-order finite volume method for the 1D biharmonic operator: application to intramedullary nail simulation

A new very high-order finite volume method to solve problems with harmonic and biharmonic operators for one- dimensional geometries is proposed. The main ingredient is polynomial reconstruction based on local interpolations of mean values providing accurate approximations of the solution up to the sixth-order accuracy. First developed with the harmonic operator, an extension for the biharmonic operator is obtained, which allows designing a very high-order finite volume scheme where the solution is obtained by solving a matrix-free problem. An application in elasticity coupling the two operators is presented. We consider a beam subject to a combination of tensile and bending loads, where the main goal is the stress critical point determination for an intramedullary nail.

Images in clinical urology. Nail of glans penis.

A 56-year-old man presented with a "nail" growing at the base of his glans penis. The tumor was locally excised, and microscopic examination revealed papillomatosis and hyperkeratosis of the malpighian epithelium, with a strong inflammatory reaction of the chorion and signs of local microinvasion, as well as the presence of well-differentiated squamous epithelial cells. The surgical margins were negative. The differential diagnosis was made between a benign papillomatous proliferation and verrucous carcinoma.

Long gamma nail in the treatment of subtrochanteric fractures.

INTRODUCTION: The purpose of our study was to retrospectively evaluate the clinical and radiological results of subtrochanteric fractures treated with a long gamma nail (LGN). The LGN has been the implant of choice at our level-1 trauma center since 1992. MATERIALS AND METHODS: Over a period of 7 years, we have treated 90 consecutive patients with subtrochanteric fractures. In order to evaluate the clinical and radiological outcomes, we reviewed the clinical and radiographic charts of these patients followed for a mean time of 2 years (range 13-36 months). RESULTS: We found no intra- or perioperative complications nor early or late infection. Clinical and radiological union was achieved at a mean of 4.3 months in all of the patients (range 3-9 months); in 24 cases (30%) the distal locking bolts were retrieved in order to enhance callus formation and remodeling as a planned secondary surgery. Three patients (3.3%) needed unplanned secondary surgery for problems related to the nailing technique. Two mechanical failures with breakage of the nail were encountered due to proximal varus malalignment, of which one was treated with exchange nailing and grafting and the other one by removal of the broken hardware, blade-plating, and bone grafting. One fracture below a short LGN was treated by exchange nailing. CONCLUSIONS: The minimally invasive technique and simple application of the LGN lead to a low percentage of complications in these difficult fractures after a relatively short learning curve. The biomechanical properties of this implant allow early mobilization and partial weight-bearing even in patients with advanced osteoporosis.

Tibio-talar arthrodesis with long anterograde nail after complex open fracture-dislocation of the ankle : P17

Introduction: Posttraumatic painful osteoarthritis of the ankle joint after fracture-dislocation often has to be treated with arthrodesis. In the presence of major soft tissue lesions and important bone loss the technique to achieve arthrodesis has to be well chosen in order to prevent hardware failure, infection of bulky implants or non-union. Methods: We present the case of a 53 year-old biker suffering of a fracture-dislocation of the ankle associated with a mayor degloving injury of the heel. After initial immobilization of the lesion by external fixation in Spain the patient was transferred to our hospital for further treatment. The degloving injury of the heel with MRSA infection was initially treated by repeated débridement, changing of the configuration of the Ex Fix and antibiotic therapy with favourable outcome. Because of the bony lesions reconstruction of the ankle-joint was juged not to be an option and arthrodesis was planned. Due to bad soft-tissue situation standard open fixtion with plate and/or screws was not wanted but an option for intramedullary nailing was taken. However the use of a standard retrograde arthrodesis nail comes with two problems: 1) Risk of infection of the heel-part of the calaneus/nail in an unstable soft tissue situation with protruding nail. And 2) talo-calcaneal arthrodesis of an initially healthy subtalar joint. Given the situation of an unstable plantar/heel flap it was decided to perform anklearthrodesis by means of an anterograde nail with static fixation in the talus and in the proximal tibia. Results:This operation was performed with minimal opening at the ankle-site in order to remove the remaining cartilage and improve direct bone to bone contact. Arthrodesis was achieved by means of an anterograde T2 Stryker tibial nail.One year after the anterograde nailing the patient walks without pain for up to 4 hours with a heel of good quality and arthrodesis is achieved. Conclusion: Tibiotalar arthrodesis in the presence of mayor soft tissue lesions and bone loss can be successfully achieved with antegrade nailing.

Superficial Acral Fibromyxoma involving the nail's apparatus. Case report and literature review.

Superficial Acral Fibromyxoma is a rare tumor of soft tissues. It is a relatively new entity described in 2001 by Fetsch et al. It probably represents a fibrohistiocytic tumor with less than 170 described cases. We bring a new case of SAF on the 5th toe of the right foot, in a 43-year-old woman. After surgical excision with safety margins which included the nail apparatus, it has not recurred (22 months of follow up). We carried out a review of the location of all SAF published up to the present day.

Use of trochanteric nail for proximal femoral extracapsular fractures.

Proximal femoral extracapsular fractures have shown a significantly high morbidity and mortality rate at 1 year in cases of nonoperative treatment. The standard gamma nail was originally designed to provide stable fixation and allow early mobilization and weight bearing for elderly patients. The design of the standard gamma nail, however, appears to be associated with intraoperative or postoperative femoral shaft fractures in < or = 17% of patients, compromising the outcome. The trochanteric nail was developed to overcome the problems encountered with the use of the standard gamma nail. Between July 2000 and January 2001, 88 consecutive proximal femoral extracapsular fractures were treated with a trochanteric nail, Seventy-five patients (76 fractures) were observed clinically and radiographically for 2 years.

Antibiotic cement nail for the treatment of posttraumatic intramedullary infections of the tibia: Midterm results in 10 cases.

INTRODUCTION: This is a single, level 1 trauma centre, prospective consecutive patient series with intramedullary infection in the presence of unstable tibial fracture treated using the Kirschner wire-reinforced, antibiotic cement nail. PATIENTS AND METHODS: A total of 10 consecutive patients (eight males and two females) with a mean age of 42 years (range, 20-59) suffering from infection after intramedullary nailing for tibial fracture, admitted during a period of 4 years, were included. An antibiotic cement-coated nail, handmade at the time of surgery, was implanted in all patients. This was followed by a standardised 6-week treatment protocol, extraction of the nail and definitive fixation. RESULTS: At 6 years of follow-up, infection eradication and bony union were possible in all of the patients. No further infection treatment was necessary; however, all of our patients underwent additional procedures (mean: four additional procedures per patient) for cosmetic or other non-infectious reasons (bone grafting, muscle flaps, etc.). CONCLUSIONS: The antibiotic cement-coated nail seems to be an effective treatment for intramedullary infections of the fractured tibia.

Oral Terbinafine and Itraconazole Treatments against Dermatophytes Appear Not to Favor the Establishment of Fusarium spp. in Nail.

Background: Fusarium onychomycoses are weakly responsive or unresponsive to standard onychomycosis treatments with oral terbinafine and itraconazole. Objective: To examine whether the use of terbinafine and itraconazole, which are highly effective in fighting Trichophyton onychomycoses, could be a cause of the high incidence of Fusarium nail infections. Methods: Polymerase chain reaction methods were used to detect both Fusarium spp. and Trichophyton spp. in nails of patients who had either received treatment previously or not. Results: No significant microbiological differences were found between treated and untreated patients. In 24 of 79 cases (30%), Fusarium spp. was detected in samples of patients having had no previous antifungal therapy and when Trichophyton spp. grew in culture. Conclusion: Oral terbinafine and itraconazole treatments do not appear to favor the establishment of Fusarium spp. in onychomycosis. © 2014 S. Karger AG, Basel.

Use of trochanteric nail for proximal femoral extracapsular fractures

Résumé Les fractures extra capsulaires du fémur proximal sont connues pour le risque élevé de morbidité et de mortalité en cas de traitement non chirurgical. Ainsi, le clou Gamma standard a été produit pour garantir une fixation stable de ces fractures permettant par conséquent une mobilisation rapide et en charge des personnes en âge avancé et présentant ce genre de fracture. Mais il a été reproché à ce type de clou un nombre relativement élevé de fracture per ou post opératoire (environ 17%). Cette complication est liée au design de cet implant. Et, de ce fait, le clou Trochantéric a été créé pour remédier à cette complication en changeant la forme du clou et notamment sa courbure. Entre juillet 2000 et janvier 2001, 88 patients ont été traités par clou Trochantéric pour une fracture pertrochantérienne et suivis consécutivement dans notre Service. 75 patients, soit 76 fractures, ont pu être évalués cliniquement et radiologiquement durant une évolution de deux ans.