Complications Of Nailing Research Articles

Kierunki niepożądanych działań leków przeciwdepresyjnych w obrębie skóry i jej przydatków

The side effects of many drug classes cover a wide range of skin reactions. One of the most commonly diagnosed diseases nowadays is depression also, antidepressants are widely used in other indications. Therefore, paying attention to the possible undesirable effects of this group of drugs is worth. In the practice of an occupational medicine physician, unfavorable manifestations of the drugs used in the area of the skin should be skillfully differentiated from occupational skin diseases. The aim of this article was to review the types of skin, hair and nail complications in patients treated with antidepressants. For this purpose, online databases were reviewed and case reports, research and review reports were analyzed. The characteristics of severe skin complications generated with antidepressants were presented, as well as case studies of their occurrence after starting the treatment. Complications of a lower severity were also reviewed. Examples of actions in the area of hair and nails were indicated. In the literature on the subject, there are

Antegrade flexible intramedullary nailing through the greater trochanter in paediatric femur shaft fractures

Aims: To determine whether an antegrade approach, through the tip of the greater trochanter, in femoral shaft fractures in children, is safe, achieves adequate union and results in significant proximal femoral growth complications. Patients and methods: The case records and radiographs of 23 paediatric patients aged 7 to 12 years with femur shaft fractures managed with stainless steel antegrade flexible nailing were reviewed retrospectively. Pre-operative radiographs were reviewed for fracture pattern, level and comminution. Post-operative radiographs were reviewed to assess for union, alignment, osteonecrosis of the femoral head and epiphysiodesis of the greater trochanter. Morphological changes of the proximal femur were assessed by comparing the neck shaft angle and articulo-trochanteric distance with the opposite hip. Case records were reviewed for post-operative complications, patient-reported complaints and leg length discrepancy. Clinical outcomes were assessed with the criteria established by Flynn. Results: All patients achieved union, and none had evidence of osteonecrosis of the femoral head on follow-up. Three patients had malalignment and two patients had radiographic evidence of greater trochanteric epiphysiodesis. Two patients had morphological changes of the proximal femur, with one having an increased neck shaft angle and one an increased articulo-trochanteric distance. One patient had a leg length discrepancy of 2 cm. Fifteen patients had excellent clinical outcomes, five had satisfactory outcomes and three had poor outcomes according the criteria established by Flynn. Conclusion: Antegrade entry through the tip of the greater trochanter does not appear to compromise the blood supply to the femoral head or increase the risk of clinically significant morphological changes to the proximal femur. All patients achieved adequate union. Furthermore, antegrade insertion avoided skin problems and prominent nail complications around the knee seen with retrograde insertion. Level of evidence: Level 4

Observation of the effect of external fixator combined with limited internal fixation in the treatment of adolescents distal tibial fracture involving the metaphysis

Objective To evaluate the clinical indications, complications and curative effects of external fixation combined with limited internal fixation in the treatment of adolescents distal tibial fracture involving the metaphysis. Methods From February 2013 to June 2017, 18 adolescent patients of distal tibial fracture involving stem epiphyseal in Luzhong Hospital of Beida Care were treated with external fixator combined with limited internal fixation.All 18 cases were closed fractures, according to Salter-Harris classification: type Ⅱ 8 cases, type Ⅲ 8 cases, type Ⅳ 2 cases.The fracture healing time, postoperative patients with limb full weight-bearing time, postoperative ankle function grading, postoperative incision of the skin, deep tissue and nail complications such as infection were observed. Results All patients received postoperative 12 to 24 months follow-up, with average of 16 months, the average postoperative fracture healing time was (8.4±3.2)weeks, the full load time of affected limb after operation was average (8.8±2.2)weeks, the ankle joint function score according to Kofoed score: 6 weeks after operation, Kofoed score was (86.6±6.8)points, excellent in 15 cases, good in 3 cases, and the excellent and good rate was 100%, 1 case with nail way out at postoperative 1 week, after the demolition of external fixator nail healed, no other blade and deep infection and other complications occurred. Conclusion The external fixation combined with limited internal fixation in the treatment of adolescents distal tibial fracture involving the metaphysic can avoid fracture end blood supply damage caused by open surgery, it is quick with small incision, fracture healing, fewer complications, and the advantages of ankle joint function restore is good, has good clinical therapeutic effect. Key words: Tibial fractures; Epiphyses; Fracture fixation, internal; External fixators; Adolescent

Comparative study of treatment of fracture shaft femur by intramedullary interlocking nails through piriform fossa entry and tip of the greater trochanter entry approach

Background: Several techniques and tools are available for achieving fracture reduction during antegrade intramedullary nailing of femur fractures. Aims: To compare results of femoral shaft fracture treatment with nailing through the greater trochanter to nailing through the piriformis fossa (PF). Materials and Methods: The present pilot project was conducted in a time span of 1-year. The patients admitted with femoral diaphyseal fractures were alternately selected for antegrade nailing through PF group and greater trochanter entry (GTE group) approach. Total number of patient in each group was 15 (n = 15). Results: Complications of nailing: PE group - 6.7% infection, 20% malunion, 20% delayed union, 20% restriction of hip range of motion (ROM), 6.7% restriction of knee ROM, 13.3% limb length discrepancy, 13.3% hardware prominence. GTE group - 13.3% malunion, 13.3% delayed union, 33.3% Restriction of hip ROM, 6.7% restriction of knee ROM, 20% limb length discrepancy, 26.7% hardware prominence. Radiological union time in PE was 12-15 weeks in 5 patients, 16-19 weeks in 8 patients, 20-23 weeks in 1 and >24 weeks in 1 patient. Radiological union time in GTE was 12-15 weeks in 4 patients, 16-19 weeks in 9 patients, 20-23 weeks in 2 patients. Need for dynamization was 20% in the PE group and 13.3% in GTE group. Thoresen's scoring system showed no significant difference between the two groups. Conclusion: Femoral nailing through the greater trochanter with specifically designed nails and with attention to specific techniques for such insertion should be considered a rational alternative to femoral nailing through the PF with the benefit of reduced requirement for fluoroscopy and decreased operative time.

Methods to avoid gamma nail complications

Femoral neck fractures are progressively increasing, due to higher survival rates, particularly among the female population. The gamma nail was created to treat intertrochanteric fracture types 31-A1, 31-A2 and 31-A3 and in some cases basicervical fractures of type 31-B2-1. Complications can be classified as intraoperative and postoperative. The intraoperative might be related to the nail's introduction site, lag and distal locking screw positions. Postoperative complications depend mostly on an incorrect surgical technique, which can lead to an inaccurate nail position and consequent implant failure. We rarely observe failures caused by severe bone osteoporosis.

Complications of Nailing in Closed Tibial Fractures

Reamed intramedullary nailing was used to treat 102 closed tibial shaft fractures. Although a high rate of union was achieved (98%), we noted a higher incidence of complications than previously reported. Thirty-five (37%) patients exhibited one or more components of malunion. In 17 (18%) patients, further operative procedures were required to achieve union or to correct malalignment. New, postoperative peroneal nerve lesions were found in 19 (19%) patients, of which four (4%) failed to resolve. Acute compartment syndrome, requiring fasciotomy, developed in seven (7%) cases after surgery. Two patients developed an atrophic nonunion. In spite of these complications, the overall results were good and we continue to recommend this method of treatment for the displaced, unstable tibial shaft fracture.

Skin complications other than pressure ulcers following spinal cord injury

This study identifies skin and nail complications other than pressure ulcers after spinal cord injury and correlate these complications to the level of injury. A prospective study was performed at the time of 679 annual spinal cord injury clinic visits from 1988 to 1991 at which time the skin and nails were examined for changes or other lesions. Clinical skin thickening and nail hypertrophy were the most frequent findings. Skin thickening occurred in 57.9% of cervical injuries, 31.6% of higher thoracic injuries, 23.6% of lower thoracic injuries, and 16.0% of thoracolumbar injuries, p < .0001. Skin thickening was also seen more commonly with increasing time after injury, 20.3% at 1 year and 51.2% at 5 years, p < .0001. Nail hypertrophy occurred in the lower extremities and was not correlated with the level of injury. Denervation and autonomic dysfunction may be implicated in these changes.

Tibial cast wedging: a simple and effective technique

THE JOURNAL OF BONE AND JOINT SURGERY Frohlich-type body and anatomical variations such as excess retroversion. In contrast, bilateral cases are most common during treatment for hypothalamo-pituitary axis failure, during which hormone replacement can result in a rapid gain in height and weight. Another cause is hyperparathyroidism, either primary or secondary to chronic renal failure. ‘In-situ’ pinning has been used for a mild or moderate slip but in this young age group complications such as growth arrest are numerous. Leg-length discrepancy is often less than should theoretically occur; in some cases the contralateral physis also undergoes premature fusion, as a result of the underlying constitutional disorder or from asymptomatic slip. Chondrolysis is another possible complication of nailing, and avascular necrosis may follow any type of manipulative reduction. Severe slips have a poorer long-term prognosis for arthritic degeneration but the theoretical advantages of improving the biomechanics are outweighed by the complications of osteotomy in this young age group. Spica-cast treatment has not been associated with chondrolysis in this age group, and has been shown to stabilise the slip and leave excellent potential for remodelling (Clarke and Harrison 1986).