Dyskeratosis congenita (DC) is a rare, inherited, bone marrow failure syndrome caused by premature telomere shortening. The classic mucocutaneous triad of clinical features comprises reticulated skin pigmentation, nail dysplasia, and oral leukoplakia. Multiple somatic features, including bone marrow failure, pulmonary fibrosis, and liver disease, are also common. Read More
Department of Anesthesiology, Yamanashi Medical University, Shimokato 1110, Tamaho-cho, Nakakoma-gun, 409-38, Yamanashi, Japan.
Intraoperative hypothermia is difficult to avoid and may present a significant clinical risk during the early postoperative phase. We evaluated a forced-air system [Bair Hugger, OR-type (BH)] for warming intraoperative patients with open abdominal surgery. Twenty patients received BH warming [BH(+) group] and another 20 patients, who served as controls, did not [BH(-) group]. Read More
RWTH Aachen University Hospital, Department of Orthopaedic Trauma, Aachen, Germany.
Purpose: Despite intense research and innovations in peri-operative management, a high mortality rate and frequent systemic complications in trochanteric femoral fractures persist. The aim of the present study was to identify predictive factors for mortality and cardio-respiratory complications after different treatment methods in a ten year period at a level I trauma centre.
Methods: Retrospectively, all patients above 60 years of age with trochanteric femoral fracture between January 2000 and May 2011 were analyzed at a level I trauma centre. Read More
Drug Des Devel Ther 2017 30;11:2527-2535. Epub 2017 Aug 30.
Department of Dermatology, University of Rome "Tor Vergata", Rome, Italy.
Psoriasis is a chronic inflammatory disease affecting up to 3% of the general population. The prevalence of nail involvement in psoriasis patients varies between 15% and 79%. While the nails represent a small portion of the body surface area, psoriasis in these areas can have a disproportionate influence on a patient's physical and psychosocial activities. Read More
Introduction: Complications after internal fixation of proximal humerus fracture are common and may require surgical revision. Reverse total shoulder arthroplasty (RTSA) is frequently performed in such cases. The aim of the present study was to evaluate the functional results and complications after RTSA for the treatment of type I fracture sequelae after internal fixation of proximal humerus fractures. Read More
Background: In order to treat onychomycosis, topical and systemic medications are available. The choice of a systemic or topic treatment depends on numerous factors, such as patient's age, the presence of comorbidity, responsible fungal species, the clinical form of onychomycosis, its location (fingernails or toenails), the number of nails affected and the percentage of the nail plate infected. As for topical medications, given that nail plate has an insufficiently permeable structure, it is necessary to use appropriate formulae that create in the surface of the nail plate a film able, in turn, to function both as an active ingredient's deposit and moisturising agent in nail's superficial layers in order to facilitate the spread of the active ingredient. Read More
c Orthopaedic Surgery , Weill Medical College of Cornell University , New York , NY , USA.
Introduction: The Precice magnetic internal lengthening intramedullary nail is being used with great success in femur lengthening and deformity correction with a retrograde approach. Areas Covered: Our personal history of limb lengthening and the Precice nail will be reviewed. Several technical aspects are discussed including design updates, pre operative planning, selection of nail length, the use of blocking screws and intra operative temporary external fixation, osteotomy practice, post operative management, and cost analysis. Read More
Purpose: Anteromedial cortical support reduction is favourable for secondary stability after limited sliding in unstable pertrochanteric fractures. The aim of this study was to compare the accuracy and agreement between intra-operative fluoroscopy and post-operative 3D reconstruction.
Materials And Methods: A retrospective analysis of 28 patients (mean 81. Read More
J Plast Reconstr Aesthet Surg 2017 Aug 16. Epub 2017 Aug 16.
Division of Cancer Surgery, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia; Department of Surgery, The University of Melbourne, Grattan Street, Melbourne, Victoria, 3010, Australia. Electronic address:
Subungual melanoma is a rare subtype of cutaneous melanoma that arises from the structures of the nail apparatus. It presents most commonly in older patients and at an advanced stage. A retrospective review of all patients with subungual melanoma in a single institution over a 15-year period was performed. Read More
*Department of Neurosurgery, University of Bern, Inselspital, Bern, Switzerland †Department of Neurosurgery and F.M. Kirby Neurobiology Center, Boston Children's Hospital, Harvard Medical School, Boston, MA ‡Department of Otorhinolaryngology, Head and Neck Surgery §Institute for Diagnostic and Interventional Neuroradiology, University of Bern, Inselspital, Bern ||Department of Diagnostic Imaging, University Children's Hospital Zürich, Zürich, Switzerland.
Self-inflicted penetrating head injuries in patients with paranoid schizophrenia are an infrequent phenomenon. The authors report on a psychiatric patient who presented with epistaxis. Computed tomography showed a nail passing from the nasal cavity into the frontal lobe. Read More
Background: Scalp involvement is not directly evaluated in patients with dermatomyositis (DM). Therefore, the exact frequency of scalp dermatomyositis (SDM) and its clinical and trichoscopic characteristics have been poorly described.
Objective: The aim of this study was to determine the frequency and clinical and dermoscopic features of SDM in patients diagnosed with DM. Read More
J Surg Case Rep 2017 Aug 30;2017(8):rjx170. Epub 2017 Aug 30.
Cardiothoracic Surgery, Cork University Hospital, Ireland.
We present the case of a 64-year-old man who was referred to our service after sustaining a self-inflicted nail-gun injury to his chest. He received three nails penetrated into his chest. Computer tomography revealed no massive haemorrhage or damage to major vessels. Read More
J Clin Orthop Trauma 2017 Aug 19;8(Suppl 1):S67-S71. Epub 2017 Mar 19.
Elmhurst Hospital Center, Department of Orthopaedic Surgery, 79-01 Broadway, Queens, NY 11373, United States.
Atypical femur fractures as a result of long term bisphosphonate use are characterized by several unique radiographic features. We describe an atypical femur fracture treated by cephalomedullary nail with a previously undescribed segmental fracture pattern. Other than 1. Read More
Duke University Medical Center, Department of Orthopaedic Surgery, Durham, NC, USA.
The utilization of intramedullary devices in the surgical fixation of hip fractures is increasing. Although intramedullary devices offer many advantages in the treatment of these injuries, they are also associated with a unique set of potential complications, particularly during preparation of the femoral canal. Cardiac dysrhythmia resulting from reaming the femoral canal is rare and has not been previously described in detail in the literature. Read More
Hand (N Y) 2017 Sep 1:1558944717725376. Epub 2017 Sep 1.
1 Rothman Institute, Philadelphia, PA, USA.
Background: Distal ulna fractures at the ulnar neck can be seen in association with distal radius fractures, and multiple techniques have been described to address the ulnar neck component of these injuries. We have found that treatment of ulnar neck fractures can be challenging in terms of anatomy and fracture fixation. We present a new percutaneous fixation technique for ulnar neck fractures commonly seen with distal radius fractures. Read More
CARECI-University of Messina, Via C. del Mare, 41-98121 Messina, Italy. Electronic address:
In this paper, an innovative design of nail for fractures occurring on long bones has been investigated. Its functioning is based essentially on sliding of conical surfaces, located in a spindle and in holding pins. Spindle and holding pins are connected together by a sleeve. Read More
IEQ Clinica, Floor 3rd Office 3-4, 110 Street, Los Mangos Neighborhood, Valencia 2001, Venezuela; Valle de San Diego Medical Center, Floor 1st, Office: 18, Don Julio Centeno Avenue, El Morro 2 Neighborhood, San Diego District, Carabobo State, Venezuela. Electronic address:
Objective: Evaluate the results of treatment of subtrochanteric fracture with interlocked intramedullary nail and describe a technical for accurate and secure verification of distal locking position when we do surgery without arc-C.
Methods: A case series where was reviewed the results in 49 patients with subtrochanteric fracture and treated locking intramedullary nailing. The AO and Russell-Taylor Classification were used. Read More
Retrograde femoral nail malpositioning can obviously destroy knee trochlear cartilage. A solution is osteochondral allograft transplantation surgery. Although case reports are rarely published in Arthroscopy, we make an exception and publish a report of 2 cases of this complication (and how to treat it) because exposure of complications that have not been previously well-reported could allow future surgeons, and their patients, to solve-and, preferably, proactively avoid-similar problems. Read More
Department of Orthopaedics and Traumatology, Okmeydanı Research and Training Hospital, İstanbul, Turkey.
Purpose: The aim of this study was to assess applicability of arthroscopic technique in intramedullary nail fixation of humerus shaft fractures and to compare with conventional nailing in terms of its effects on perioperative and postoperative intra-articular complication rates as well as on clinical and functional outcomes.
Methods: This prospective randomized controlled clinical trial included 40 patients (12 females and 28 males) indicated for surgery between either undergo arthroscopy-assisted (Arthroscopy-assisted intramedullary nailing [AIMN]; n = 20) or conventional (Intramedullary nailing [IMN]; n = 20) anterograde intramedullary nailing. Two groups were compared in terms of mean number of fluoroscopic shootings until the guide wire was inserted, time for union, length of hospital stay, and complication rates. Read More
Intramedullary (IM) nailing for humeral shaft fracture has provided excellent outcomes in terms of fracture biology and cosmetic appearance because of the relatively small incision involved. However, antegrade nailing causes issues such as iatrogenic rotator cuff injury. Retrograde nail fixation method could avoid cuff injury, but has shortcomings such as the need for the prone or lateral decubitus position during surgery. Read More
Aims: We reviewed all patients who sustained a fracture of the hip and were treated in Northern Ireland over a period of 15 years to identify trends in incidence, the demographics of the patients, the rates of mortality, the configuration of the fracture and the choice of implant.
Patients And Methods: Since 01 January 2001 data about every fracture of the hip sustained in an adult have been collected centrally in Northern Ireland. All adults with such a fracture between 2000 and 2015 were included in the study. Read More
Aims: To compare the outcomes for trochanteric fractures treated with a sliding hip screw (SHS) or a cephalomedullary nail.
Patients And Methods: A total of 400 patients with a trochanteric hip fracture were randomised to receive a SHS or a cephalomedullary nail (Targon PFT). All surviving patients were followed up to one year from injury. Read More
Background: FFA is a cicatricial alopecia that affects the frontotemporal hairline, eyebrows, and body hair. OCT is a non-invasive imaging technique useful in understanding skin architecture and vascularization.
Objective: To describe structural and vascular findings in FFA using OCT. Read More
*Sinop Ataturk State Hospital, Plastic, Reconstructive and Aesthetic Surgery Clinic, Sinop, Turkey; †Aydin State Hospital, Plastic, Reconstructive and Aesthetic Surgery Clinic, Aydin, Turkey; ‡Guru Aesthetic Clinic, Plastic, Reconstructive and Aesthetic Surgery Clinic, Ankara, Turkey; §Ankara Training and Research Hospital, Plastic, Reconstructive, and Aesthetic Surgery Clinic, Ankara, Turkey.
Background: Pincer nail deformity (PND) is characterized by an excessive transverse curvature of the nail plate that increases along the longitudinal axis of the nail. Although many conservative and surgical techniques have been used in clinical practice, an established consensus for the correction of PND has not been present yet.
Objective: Aim of the technique described in this article is to provide to restore the suitable nail-matrix system curvature by a simplified and quick approach, which could be seen as a synthesis of conservative and surgical treatments described in the literature. Read More
Current algorithms for decision making in proximal humerus fractures consider the fracture pattern along with the patient characteristics and surgeon’s experience. Minimally invasive techniques for reduction and internal fixation of many types of these fractures have recently been widely promoted, especially with the use of the newly developed locking plate systems. Intramedullary flexible nailing is one of the oldest techniques using minimally invasive reduction and fixation of proximal humerus fractures. Read More
Objective: To quantify and optimize metal artifact reduction using virtual monochromatic dual-energy CT for different metal implants compared to non-metal reference scans.
Methods: Dual-energy CT scans of a pair of human cadaver limbs were acquired before and after implanting a titanium tibia plate, a stainless-steel tibia plate and a titanium intramedullary nail respectively. Virtual monochromatic images were analyzed from 70 to 190 keV. Read More
Background: Fractures of the proximal humerus in patients under the age of 18 years show a low incidence; existing clinical studies only comprise small patient numbers. Different treatment methods are mentioned in the literature but a comparison of the outcome of these methods is rarely made. Up to now, no evidence-based algorithm for conservative and operative treatment is available. Read More
The diagnosis and treatment of ankle fractures has evolved considerably over the past two decades. Recent topics of interest have included indications for operative treatment of isolated lateral malleolus fractures, need for fixation of the posterior malleolus, utilization of the posterolateral approach, treatment of the syndesmosis, and the potential role of fibular nailing. In this update, we concisely review these topics and what to expect in the future literature. Read More
Introduction: "On-top" and "side-to-side" plasties are techniques used for treating thumb duplications in which one thumb is adequate proximally and the other thumb contains a better pulp and nail distally. The detailed functional results of these techniques have not been reported in the literature. We report on two cases. Read More
Introduction: Exchange nailing is most acceptable for treating hypertrophic non-union of the long bones, requiring the removal of previously fixed implant. However, its main effect of mechanical stabilization is controversial in non-isthmal area. We hypothesized that minimally invasive plate augmentation over the non-union site may have a better option, without the need of bone grafting or removing pre-existing implants. Read More
This study aims to describe the complications of elastic stable intramedullary nailing (ESIN) in the treatment of both-bone forearm diaphyseal fractures in the child. Between January 2009 and December 2013, 87 children with both-bone forearm diaphyseal fractures were treated by elastic stable intramedullary nailing with Métaizeau nails. 76 boys and 11 girls, with an average age of 12 years, were enrolled in the study. Read More
A pediatric patient presenting with an open forearm fracture with segmental defect is rare, and the pediatric orthopedic literature to guide treatment is sparse. There are several described methods to treat the defect, including bone grafting and bone transport techniques. In addition, there are reports of fibular regeneration after resection if the periosteum is left intact. Read More
This study examined the incidence and risk factors associated with lateral helical blade migration and trochanteric pain with the trochanteric fixation nail. A retrospective review was performed of 141 cases of pertrochanteric femur fracture treated with a trochanteric fixation nail at a level I trauma center over a period of 42 months. Exclusion criteria included follow-up of less than 60 days, preexisting osteonecrosis of the femoral head, and prophylactic trochanteric fixation nail treatment. Read More
Background: Hidden blood loss is a major concern for patients undergoing hip surgery for intertrochanteric fracture. The objective of this study was to investigate whether tranexamic acid (TXA) could reduce postoperative hidden blood loss in patients undergoing hip surgery for intertrochanteric fracture.
Methods: A total of 77 patients with intertrochanteric fracture were enrolled in this randomized controlled study. Read More
Pediatr Dermatol 2017 Sep 14;34(5):e254-e256. Epub 2017 Aug 14.
Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida.
A 14-year-old Hispanic boy presented with a 0.25-mm wide, sharply demarcated, dark brown band of longitudinal melanonychia of the left thumbnail. A clinical diagnosis of nail matrix nevus was made and the boy was scheduled for follow-up. Read More
Background: Femoral diaphyseal non-unions present difficult scenario to manage. There are multiple options but most of them still report varying incidences of failure. We combined the principles of augmented plating and exchange nailing and aim to study the effectiveness of this technique. Read More
Background: Unstable intertrochanteric fractures present a challenge to orthopaedic surgeons, with varied geometry of the fractures and a wide choice of implants and techniques. The patients are usually osteoporotic, with multiple co-morbidities and poor tolerance for complications and re-operations. Lateral wall reconstruction and stability of the trochanteric fragments are considered important in providing a better outcome of these difficult injuries. Read More
Introduction: The purpose of this study was to demonstrate the effectiveness of controlled telescoping system for lateral hip pain caused by sliding of the blade following intramedullary nailing of trochanteric fractures.
Materials And Methods: A retrospective cohort study was performed to compare the controlled telescoping system (Compression Hip Nail; CHN) with the conventional sliding system (Proximal Femoral Nail Antirotation; PFNA) for trochanteric fractures. 74 cases in the PFNA group and 77 cases in the CHN group were included from two university hospitals in this study. Read More
Background: Intramedullary fixation of comminuted mid-shaft clavicle fractures has traditionally been employed with satisfactory clinical outcomes; however, pins with smooth surfaces may protrude from the bone and are prone to migration, while some threaded pins are difficult to remove post-operatively. The aim of this proof-of-concept study was to develop and evaluate the biomechanical strength of a novel intramedullary Echidna pin device designed to maintain fracture reduction, resist migration and facilitate ease of post-operative removal.
Methods: Thirty human clavicle specimens were harvested and fractured in a comminuted mid-shaft butterfly configuration. Read More
Introduction: Radiation exposure from intra-operative fluoroscopy in orthopaedic trauma surgery is a common occupational hazard. References for fluoroscopy use in the operating room for commonly performed operations have not been reported adequately. This study aimed to report appropriate intra-operative fluoroscopy use in orthopaedic trauma and compare the effect of surgery type and surgeon grade on radiation exposure. Read More
A computer-aided 3-dimensional (3D) visualization operation simulation system based on computer-aided design (CAD) Unigraphics NX and Mimics software was established to provide orthopedic surgeons with an actual and reliable system in treating of distal femoral fracture.According to the preoperative CT data, 3D reconstruction of the distal femoral fracture could be achieved by the Mimics software. Then, the CAD Unigraphics NX software was used to measure the model function of all the related surgical instruments, including less invasive stabilization system (LISS) and retrograde intramedullary nail fixation. Read More
Department of Orthopaedics, The Ohio State University Wexner Medical Centery, Columbus, Ohio.
Background: Malignant hip lesions can be managed operatively by intramedullary (IM) nail fixation and hemiarthroplasty.
Methods: A retrospective review was performed on 86 patients who underwent hemiarthroplasty (n = 22) or IM nail fixation (n = 64) for prophylactic treatment of impending pathologic fracture due to malignant lesions of the hip. Cox proportional hazards and logistic regression modeling were performed to determine risk of death, fixation failure, pain relief, and return to ambulation without gait aids. Read More
Background: Expandable nails achieve stability only by hydraulic expansion; therefore suggest less radiation exposure and operation time. In this study, we aimed to compare the results of expandable femoral nails with locked intramedullary nails in the treatment of diaphyseal fractures of femur.
Materials And Methods: Isolated closed AO = Arbeitsgemeinschaft für Osteosynthesefragen type 32. Read More
Objectives: Intramedullary fixation is considered the most stable treatment for pertrochanteric fractures of the proximal femur and cut-out is one of the most frequent mechanical complications. In order to determine the role of clinical variables and radiological parameters in predicting the risk of this complication, we analysed the data pertaining to a group of patients recruited over the course of six years.
Methods: A total of 571 patients were included in this study, which analysed the incidence of cut-out in relation to several clinical variables: age; gender; the AO Foundation and Orthopaedic Trauma Association classification system (AO/OTA); type of nail; cervical-diaphyseal angle; surgical wait times; anti-osteoporotic medication; complete post-operative weight bearing; and radiological parameters (namely the lag-screw position with respect to the femoral head, the Cleveland system, the tip-apex distance (TAD), and the calcar-referenced tip-apex distance (CalTAD)). Read More
We present a 35-year-old male patient with Bureau-Barrière syndrome. Bureau-Barrière syndrome is an ulcero-mutilating acropathy almost invariably associated with excessive alcohol intake. It presents with a triad of trophic skin changes with recurrent ulcerations, bone lesions and nerve damage. Read More
A 60-year-old male patient presented with complaints of persistent red to a brown-colored plaque on his scrotum, with duration of approximately three years. The patient had been treated with oral and topical antifungals for inguinal tinea for several months and after that with topical corticosteroids for eczema for several more months. None of the regimens achieved any therapeutic effect. Read More
Background: Tumours of the nail bed are rare. Squamous cell carcinoma is the most frequent among them. Chronic infection, chemical or physical trauma/microtrauma, genetic disorders such as congenital ectodermal dysplasia, radiation, tar, arsenic or exposure to minerals, sun exposure, immunosuppression, and previous HPV infection have all been discussed as etiologic factors. Read More
Subungual pigmentation may have a variety of underlying pathologies, but clinicians should consider malignancies such as subungual melanoma or metastasis, even if they are not common. A delayed diagnosis can dramatically worsen the prognosis. Therefore, histologic examination is highly recommended. Read More
We designed a study to compare the efficacy of five main therapeutic options, including external fixation, open reduction and plate osteosynthesis (ORPO), minimally invasive plate osteosynthesis (MIPO), dynamic compression plate (DCP), and intramedullary nail (IMN) in treating humeral shaft fractures. Our results indicated that MIPO and IMN were recommended as the optimal treatments for clinical use.
Purpose: Nowadays, five main therapeutic options are used in treating humeral shaft fractures: external fixation, open reduction and plate osteosynthesis (ORPO), minimally invasive plate osteosynthesis (MIPO), dynamic compression plate (DCP), and intramedullary nail (IMN). Read More
Background: The optimal fixation strategy for unstable pediatric tibia fractures is unclear with some favoring elastic intramedullary nails (EIN) and others favoring plate and screws [open reduction internal fixation (ORIF)]. The purpose of this study was to compare outcomes and complications of skeletally immature patients undergoing surgical stabilization of the tibia with either EIN or ORIF.
Methods: A retrospective review was performed on all patients undergoing EIN or ORIF of a diaphyseal fracture at a single pediatric level I trauma center between 2010 and 2016. Read More