Nail Size Research Articles

光点刺激の観察による釘打ち動作と道具の知覚

Twenty participants observed and interpreted 16 nail-hammering movies, each of which was composed of motion of four point-lights that were attached to an actor's hand, elbow, and shoulder and the hammer head. Each participant judged the length and the weight of hammers, the sizes of the nails, and the degree of hammering skill, and rated the actor's motion in terms of briskness, lightness, regularity, smoothness, quickness, stability, complexity, and politeness. The results showed the following perceptual characteristics. A higher angular velocity of the hammer at the hand contributed to the perception of the hammering action as more skillful and brisk, whereas an increase in linear velocity of the point at the shoulder was judged as less skilled. The judgment of nail size was positively correlated with the linear velocity of the points at the hand. The judgment of hammer weight was negatively correlated with the linear velocity of the points at the hammer. The different roles that linear and angular velocities of light points play in biological motion perception were discussed.

Treatment of diaphyseal nonunion of the femur and tibia using an expandable nailing system

Introduction We evaluated the efficacy of the expandable nailing system for treating femur and tibia shaft nonunions. Patients and methods Records of 24 patients (25 fractures) were retrospectively reviewed: 16 with femur and 8 with tibia nonunions. The bones underwent reaming, and the largest possible nail sizes were inserted during re-operation. Bone debris obtained from the reaming was used for bone graft at the site of the nonunion. Results The mean age of the patients was 32 years for the tibia group and 49 years for the femur group. The respective intervals between trauma and re-operation were 11 and 13 months, the operation times 60 and 78 min, and the fluoroscopy times 21 and 32 s. Twenty-four of the 25 nonunions healed satisfactorily without requiring additional procedures. In 1 case, demineralised bone matrix was injected percutaneously and the femoral nonunion resolved. Healing time was 23 weeks (6–52) and 17 weeks (6–40) in the tibia and femur groups, respectively. We were able to reduce the need of an autologous bone graft to only two cases by using reamed debris in 17 of the 19 patients who required grafting. Conclusions Our results demonstrated satisfactory healing for the treatment of diaphyseal nonunions of the femur and tibia. The expandable nail offers the theoretical advantages of improved load sharing and rotational control without the need for interlocking screws. We recommend expandable nail systems for femur and tibia shaft nonunions and the use of reamed debris in order to decrease the use of autogenous bone graft.

Technical Notes and Tips: A Simple Technique for Easy Removal of Titanium Elastic Nails

Titanium elastic nails are becoming increasingly popular in the treatment of paediatric long bone fractures. Once inserted, the nails are buried under the skin to reduce the risk of infection. In order to avoid tenting the skin and causing irritation, they are often cut off close to the bone before the stab incision is closed over the top. However, this may cause problems as the tip of the nail is difficult to grip when trying to remove the nail. This is facilitated by the use of a free-hand hollow reamer, from the damaged screw set. These can be matched to the size of the nail. The drill tip is inserted over the tip of the nail to clear any bony growth and to clear the tip of the nail. The hollow reamer can also be used to add a slight bend to the tip of the nail to enable easier grasping. Figure 1 Intra-operative radiographs of a paediatric radius and ulna titanium elastic nails. (A) Prior to removal of nail. (B) The hollow reamer being inserted over the tip of the nail. (C) The increase in bend on the tip can clearly be seen. (D) Easy grasping ...

Tratamento de unha em telha pela técnica de Zook: relato de cinco casos

O pinçamento do leito ungueal gerado pela hipercurvatura transversa da unha é chamado de unha em pinça e pode provocar dor e constituir problema estético. A unha em pinça pode apresentar três tipos clínicos, mais comuns, sendo a unha em telha um deles. As causas podem ser hereditárias ou adquiridas. Os dedos dos pés são acometidos com maior freqüência. Os tratamentos conservadores são os preferidos pelos pacientes, porém, os tratamentos cirúrgicos produzem os melhores resultados. Das técnicas cirúrgicas, a técnica de Zook é opção diferente, pois, preserva a matriz e o tamanho da unha. Os autores apresentam cinco pacientes com unha em telha, tratados com a técnica de Zook.

Avaliação do uso de haste bloqueada e bloqueio transcortical no reparo de fraturas diafisárias de fêmur em felinos

As hastes bloqueadas além de permitirem estabilização rígida de fraturas, possuem vantagens biomecânicas quando comparadas a outras técnicas de imobilização, por atuar ao longo do eixo mecânico central do osso, além de preservar os conceitos de padrões biológicos de osteossíntese . O uso limitado de hastes bloqueadas em gatos se atribui ao fato da cavidade intramedular ser pequena, limitando o tamanho e diâmetro dos pinos. Relatam-se casos de 10 felinos que apresentavam fraturas fechadas simples ou múltiplas da diáfise femoral. Os animais pesavam entre 3,5 e 5 kg, o que permitiu a utilização de hastes de 4,0mm e 4,7mm de diâmetro. Para inserção da haste, adotou-se a via retrógrada ou a normógrada e foram realizados bloqueios com quatro parafusos de titânio de 2,0 mm de diâmetro. Complicações intra-operatórias não ocorreram, entretanto um animal sofreu fratura de colo femoral e fratura transversa distal ao implante, três dias após o ato cirúrgico, devido a novo trauma. Os animais foram submetidos a exames radiográficos até quatro meses após a intervenção, evidenciando-se formação de calo ósseo secundário e consolidação óssea em período de 61-89 dias. Clinicamente, ocorreu esporadicamente alteração na marcha por leve claudicação de apoio definida por escala de claudicação, entretanto os animais iniciaram o apoio adequado entre três e oito dias após o ato operatório. Complicações pósoperatórias ocorreram referentes ao animal que sofreu novo trauma, entretanto notou-se consolidação do foco primário tratado pelo implante com 61 dias e consolidação da nova fratura num período total de 150 dias do início do tratamento conservativo por penso esparadrapado e tala. Conclui-se que o uso de haste bloqueada em felinos foi adequado uma vez que houve consolidação óssea em todos os casos, com retorno precoce da função do membro, permitindo a deambulação.

Differences in biomechanical stability of femur fracture fixation when using titanium nails of increasing diameter

The purpose of this study was to compare the biomechanical stability generated when utilizing increasing sizes of titanium (Ti) flexible nails for fixation of simulated comminuted femur fractures. Five synthetic adolescent-sized femur models were reamed to create a 9-mm canal. A 2-cm section was removed in the mid-diaphysis to simulate comminution. Each femur was first stabilized with bilateral, retrograde 3.0-mm titanium elastic nails. Femurs were tested in axial rotation and axial compression. The constructs were removed, and femurs were re-nailed with 3.5-mm nails. Identical testing was conducted. These nails were then removed, and femurs were re-nailed with 4.0-mm nails. This provided data on "canal fill" representing 67, 78 and 89% of the reamed canal diameter. Data for axial rotation (degrees) and failure load (N) required to produce 5 mm of fracture shortening were analyzed with a one-way ANOVA (P < 0.05) and a Tukey's post-hoc test for multiple comparisons. For axial rotation, there were statistically significant improvements in rotational control for each increase in nail size. For axial stability, each increase in nail size resulted in increased axial failure loads to 5 mm, although these data were not statistically different. A specific comparison between 3.0- and 3.5-mm nails for compressive stability found significantly greater stability afforded by using 3.5-mm nails. Data from this study demonstrate that increasing the amount of canal fill provides significant improvements in rotational control. The largest improvement was seen when increasing from 3.0- to 3.5-mm nails. While increasing the nail size from 3.5 to 4.0 mm again provided greater stability, larger nails may be more difficult to insert. Thus, increasing the nail size for femoral fracture fixation should be considered after measuring the diameter of the canal and evaluating the potential difficulty of insertion as well as specific demands of the fracture pattern.

I Have a Nail “Stuck” In My Hand

Nail guns are commonly used in the construction industry in order to drive various sizes of nails into wood or concrete. These devices are publically available and in use by general public. Safety and handling instructions present with the tool may not be read or could be easily forgotten by users.

Mechanical Failure in Intramedullary Interlocking Nails

To study clinical and mechanical factors that predispose to failure of interlocking nails. Between October 1996 and December 2002, 286 femoral fractures, 211 tibial fractures, and 47 humeral fractures were repaired using variously designed interlocking nails. Fracture pattern, level and site, nail size and type, weight bearing after nailing, and union status were reviewed after a mean follow-up of 22 months. Nail failure occurred in 27 fracture repairs (17 femoral, 9 tibial, and one humeral; 13 from our institution and 14 referred from elsewhere). In 55% of failed repairs, the fracture was distal. A high rate of tibial nail failure was noted. Distal fractures and stress concentration at the distal screws predispose to interlocking nail failure and can be prevented by protected weight bearing combined with the use of longer and larger nails. Routine supplementary cancellous bone grafting is unnecessary during renailing surgery when adequate reaming and a larger nail are used.

A new surgical method for treating lateral ray polydactyly with brachydactyly of the foot: lengthening the reconstructed fifth toe

Lateral ray polydactyly is the most common anomaly of the foot. However, when both the fifth and sixth toes are markedly shorter than a normal toe, reconstruction of a normal-length fifth toe has not been performed, because the toe rarely serves a functional purpose. The authors devised a new method whereby the fifth toe could be lengthened using the excess toe as a composite flap. Fifteen patients (15 toes) underwent our procedures and were evaluated in this study. The stepladder island flap is used. The decision as to which toe to use as the flap was made preoperatively based on nail size, and its morphologic and radiographic conditions. Stepladder incision lines were designed on the dorsal and plantar sides of the duplication. Care was taken to preserve the neurovascular bundle with the subcutaneous pedicle and osteotomies were made at the middle phalanx of the flap and the distal or middle phalanx of the recipient in almost all cases. The elevated composite toe flap was advanced and the bone was fixed rigidly for 1-2 months after the operation. During our follow-up periods, the reconstructed toes grew normally, and good aesthetic results had been achieved apart from the bulkiness of the reconstructed toes. There was no deficiency in circulation or function for walking, running, or shoe-fitting in this series.

Finger nail plate shape and size for personal identification – a possible low technology method for the developing world - Preliminary report

There is much documented information on abnormal fingernail shapes- acquired or congenital. There is a dearth of information on the shapes of the clinically healthy fingernail in medical textbooks and scientific journals. A study was carried out to determine the possible shapes of the healthy fingernails and the prevalence of each shape in the locality, i.e. in Ibadan, south-western Nigeria and to consider if there would be enough diversity in the shapes and sizes and their distribution on the different fingers to merit consideration for personal identification. The population included 496 consenting individuals, four family units and four sets of monozygotic twins. The latter two population samples were studied to assess the combinations possible within families and in monozygotic twins. Seven gross fingernail shapes were identified in the study population. Examination showed variations within members of the families i.e. no two members had identical shapes in the pair of hands. Examination of 4 sets of identical twins showed no difference in the shapes and sizes of the fingernails on each finger. It would appear that the finger nail plate shapes/sizes of the hands show diversities similar to finger prints and therefore can be considered and developed further for personal identification in developing countries such as Africa.

Titanium Elastic Nailing of Pediatric Femur Fractures

In the last 3 decades, there has been a very strong trend for pediatric orthopedic traumatologists to use some form of fixation to mobilize the school-aged child with a femur fracture . Titanium elastic nailing of pediatric femur fractures is a widely adopted technique that has stood the test of time. Perhaps the most attractive features of this technique for pediatric femur fracture management are the low rate of serious complications and the relatively easy and safe learning curve for most surgeons. There are several pitfalls to the titanium elastic nail technique that should be emphasized. In multiple series, the most common problem is irritation caused by the nails at their entry site. To avoid this most common complication, the nail should not be bent away from the distal femur , and only 1 to 2 cm of nail should be left outside the cortex of the bone. It is essential to follow the principles that were outlined years ago by the French developers of elastic nailing. The nail entry site, nail size and nail length should be symmetric. The nails should be prebent so that they have good cortical contact at the fracture site, as this cortical contact is a key factor in stability. The nails should be used cautiously in length-unstable fractures and in patients older than 12 years of age or who are heavier than 50 kg.

Treatment costs of three nail lacquers used in onychomycosis

Objective: To assess the daily treatment costs and the average cost‐effectiveness of three topical onychomycosis therapies – amorolfine 5% and ciclopirox 8% nail lacquers and tioconazole 28% nail solution – when used as indicated in France, the UK, Germany and Italy. Methods: The quantity of drug required and nail size measurements were investigated and, knowing the cost per bottle of each study drug, used to calculate the average treatment cost per patient. Using the prevalence of infection data, the weighted average total treatment cost per patient and hence the weighted average daily treatment cost and cost per patient cured, were calculated. Results: Amorolfine was consistently more cost‐effective in terms of weighted average daily treatment cost and cost per patient cured than ciclopirox and tioconazole, when all therapies were used as indicated to treat onychomycosis. In France, for example, the weighted average daily treatment cost of amorolfine was found to be €0.23 and €0.40 when used once and twice a week, respectively; the cost per patient cured for amorolfine was €84. By comparison, the weighted average daily treatment cost of ciclopirox was found to be €0.81; the cost per patient cured was €252. Conclusions: When used as indicated, amorolfine 5% nail lacquer is more cost‐effective than ciclopirox 8% and tioconazole 28% for onychomycosis of toenail, fingernail or both in males and females in France, UK, Germany and Italy.

Complications of Titanium Elastic Nails for Pediatric Femoral Shaft Fractures

Limited data exist about complications of titanium elastic nails (TNs) for femur fracture management in pediatric patients. Thirty-nine patients with 43 femoral shaft fractures were identified whose average age was 6.0 years. There were 21 complications (1 intraoperative, 20 postoperative) in 43 femur fractures (49%). There were two major postoperative complications: one septic arthritis after nail removal and one hypertrophic nonunion. Minor postoperative complications were pain at the nails in 13 extremities, nail erosion through the skin in 4, and one delayed union. There was an association between the prominence of TNs and nail pain or skin erosion. Fracture angulation and outcome were associated with the patient's weight and size of the nails implanted. Technical pitfalls exist with this implant and can be minimized by leaving less than 2.5 cm of nail out of the femur and by using the largest nail sizes possible.

An easy and accurate preoperative method for determining tibial nail lengths

Estimating the correct nail length for solid tibial nails can be problematic. Most techniques reported in the literature for determining tibial nail length are not accurate. In a retrospective study of 16 patients in our unit, only three had ideal nail sizes. In these patients, as part of phase I of our study, we measured their normal leg’s length from knee joint line to ankle joint line. An ideal nail length for each of these patients was estimated from a whole length radiograph of the nailed tibia. Comparing these two data, we found that deducting 20 mm from the leg measurement gave appropriate nail lengths. We also compared this with three other anthropometric measurements; tibial tuberosity to medial malleolus, joint line to medial malleolus and olecranon to head of V metacarpal head distance. The joint line to joint line measurement was the most reliable and showed the best correlation with ideal nail lengths (0.982). In phase II, a prospective study on 15 patients, we used the joint line to joint line measurement to determine nail sizes. A postoperative review of the radiographs showed all the nails to be of adequate length. This strengthened the fact that the joint line to joint line measurement is the most accurate and easy method to determine tibial nail lengths.

Study on half-scale model test for light-frame shear wall

A half-scale model of a light-frame shear wall was developed to evaluate the racking performance of a fullscale shear wall (prototype). The effect of nail size on the performance of the shear wall was also investigated using models constructed with three types of nail. Materials for the model were determined through experimental methods, which included nail-head push-through, stud-to-sheathing nail connection, and static bending tests. Materials with which the model was made to be “in similarity” to the prototype were three-layer 4.8-mm plywood, 39.72-mm long nails, and 1 × 2 lumber cut from 2 × 4 studs. In accordance with ASTM E 72 and ASTM E 564, racking resistance tests were conducted on 20 shear walls. The results showed that the maximum load capacities of the prototype walls could be evaluated by the model without significantly different failure modes. Tests on the effect of nail size revealed that increasing the nail head diameter may improve the performance of shear walls.

Surgical Pearl: Hemostat-assisted nail avulsion revisited

J Am Acad Dermatol 2001;45:943-4.

Design capacities of joints with laterally loaded nails

Capacities of joints with laterally loaded nails may be predicted using "European yield" type models (EYMs) with various levels of complexity. EYMs presume that a nail and the wood on which it bears exhibit a rigid–plastic stress–strain response. Consideration is given in this paper to the "original" model published by K.W. Johansen in 1949, an empirical approximation proposed by L.R.J. Whale and coworkers in 1987, and a curtailed and "simplified" model proposed by H.J. Blass and coworkers in 1999. Predictions from the various EYMs are compared with experimentally determined ultimate capacities of single and double shear joints. Experiments covered a range of combinations of member thicknesses and two nail sizes. The impact of modelling assumptions is illustrated in the context of the Canadian timber design code. Suggestions are made regarding the necessary level of complexity for nailed joint models used in design.Key words: timber, joints, nails, yield model, ultimate limit state, design.

Antegrade or retrograde reamed femoral nailing

Retrograde femoral nailing is gaining in popularity. We report a prospective, randomised comparison of antegrade and retrograde procedures in 68 patients with 69 fractures of the femoral shaft. All nails were inserted after appropriate reaming. There was no difference in operating time, blood loss, technical complications, size of nail or reamer, or transfusion requirements. There were more problems of length and rotation using a retrograde technique on a radiolucent table than with an antegrade approach on a fracture table. All fractures in both groups healed and there was no difference in the time taken to achieve union. Although retrograde nailing is a promising technique the skills required need practice. A longer period of follow-up is necessary to determine whether there are long-term problems in the knee after such surgery.

Digit effects produced by prenatal exposure to antiepileptic drugs.

The hypothesis tested was that digit anomalies among individuals exposed in utero to antiepileptic drugs (AED) are best identified by a systematic search, including radiographs and dermatoglyphics, rather than relying only on visual inspection. A systematic search was made for five types of digit abnormalities in 46 AED-exposed individuals ages 5-29 years in comparison with controls: visible anomalies, size of fingernails, dermal ridge patterns, length of metacarpals and phalanges, and qualitative changes in the distal phalanges. Among the AED-exposed, nail size was not decreased. However, there was a 10.8% frequency of digit anomalies, a 12% frequency of three or more arch patterns, and significant shortening and qualitative changes in the distal phalanges, all of which are consistent with the fetal effects of AED. Among the 42 individuals who underwent all evaluations, 14.3% had two or more of these abnormalities, most of which would not be identified by clinical inspection. This frequency is much higher in these AED-exposed individuals than in the general population. Radiographs in 13 individuals over a period of several years showed that the changes in the phalanges and metacarpals persisted.

Proximal entry for intramedullary nailing of the tibia. The risk of unrecognised articular damage.

The risk of articular penetration during tibial nailing is well known, but the incidence of unrecognised damage to joint cartilage has not been described. We have identified this complication in the treatment of tibial fractures, described the anatomical structures at risk and examined the most appropriate site of entry for tibial nailing in relation to the shape of the bone, the design of the nail and the surgical approach. We studied the relationship between the intra-articular structures of the knee and the entry point used for nailing in 54 tibiae from cadavers. The results showed that the safe zone in some bones is smaller than the size of standard reamers and the proximal part of some nails. The structures at risk are the anterior horns of the medial and lateral menisci, the anterior part of the medial and lateral plateaux and the ligamentum transversum. This was confirmed by observations made after nailing 12 pairs of cadaver knees. A retrospective radiological analysis of 30 patients who had undergone tibial nailing identified eight at risk according to the entry point and the size of the nail. Unrecognised articular penetration and damage during surgery were confirmed in four. Although intramedullary nailing has been shown to be a successful method for treating fractures of the tibia, one of the most common problems after bony union is pain in the knee. Unrecognised intra-articular injury of the knee may be one cause of this.