The intraoperative hip range of motion in total hip arthroplasty predicts postoperative patient's satisfaction for cutting toenails and putting on sock

BackgroundRestricted hip range of motion (ROM) has been proposed as a useful diagnostic tool for osteoarthritis. The relations between the intraoperative hip ROM under anesthesia in total hip arthroplasty (THA) and recovery of clinical mobility outcomes were unclear. This study evaluated the association between the intraoperative hip ROM under anesthesia in THA and the postoperative recovery of clinical mobility, including cutting toenails and putting on socks after THA.MethodsThe study was performed as a prospective cohort study and included 93 hips in 85 patients who underwent primary anterior-based muscle-sparing THA in the supine position. The hip ROM was evaluated under anesthesia before skin incision and intraoperative stability test. The Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire (JHEQ) was evaluated. A questionnaire on whether and how patients could cut toenails and putting on socks was assessed. The relationship between hip ROM at intraoperative stability tests and JHEQ moving score, cutting toenails, and putting on socks scores were evaluated statistically.ResultsWe observed a week positive correlation between intraoperative hip ROM and the total of JHEQ mobility score. A moderate positive correlation was observed between external rotation angle with flexion 90°and cutting toenails and putting on socks score oh JHEQ. 94.6% and 96.8% of the patients could cut their toenails and putting on socks by themselves after surgery. The optimum cutoff range for high patient satisfaction for putting on socks and cutting toenails was 110° for flexion and 35°–40° for the external rotation angle in the intraoperative stability test.ConclusionHip ROM during intraoperative stability testing, especially the external rotation angle can predict postoperative outcomes and patient satisfaction for cutting toenails and putting on socks. We suggested that the capsule or capsular ligament release around the hip was increased to provide sufficient ROM without compromising stability.     

足嵌甲的整复手术治疗研究

作为临床常见足部疾病,足嵌甲可导致足趾甲周围剧烈疼痛,同时对患者日常活动和生活造成 严重影响。目前临床治疗足嵌甲的方法较多,但对于采取何种治疗方式尚未统一,如治疗方式选取不当, 不但无法发挥理想治疗效果,而且患者治疗后易复发。因此,需根据患者疾病情况和患者实际情况采取科 学治疗方案,从而实现有效治疗。本文主要对足嵌甲症病因和分期、治疗方案的选择进行综述,以期为足 嵌甲临床治疗提供思路。     

Partial matrix excision or orthonyxia for ingrowing toenails

BACKGROUND: We wanted to evaluate whether partial matrix excision and orthonyxia are equally effective in the treatment of ingrown toenails of the hallux. STUDY DESIGN: We conducted a prospective randomized clinical trial with 12-month observer-blinded followup, in the surgical outpatient department of a teaching hospital. We randomized 105 consecutive patients with a total of 109 ingrown toenails to either partial matrix excision (n=58) or an orthonyxia procedure (n=51). The main outcomes measurements were rate of recurrence after 12 months, postoperative morbidity, and time to complete recovery. RESULTS: The 12-month followup was completed in 55 of 58 patients undergoing partial matrix excision and 47 of 51 patients having orthonyxia. There were four ingrown toenails, four recurrences in the partial matrix excision group, and eight in the orthonyxia group (NS, p=0.14). Postoperative morbidity parameters (redness, pus, postoperative bleeding); time to complete recovery, wearing shoes (p < 0.01), and performing activities of daily living and hobbies; postoperative symptoms; and patient satisfaction all favored orthonyxia. CONCLUSIONS: Partial matrix excision and orthonyxia are equally effective treatments for ingrown toenails. But the orthonyxia procedure showed better results, with less postoperative morbidity, shorter time to complete recovery, fewer postoperative symptoms, and greater patient satisfaction.     

Treatment of Recurrent Ingrown Great Toenail Associated with Granulation Tissue by Partial Nail Avulsion Followed by Matricectomy with Sharpulse Carbon Dioxide Laser

BACKGROUND: The effectiveness of partial nail avulsion followed by matricectomy with carbon dioxide (CO2) laser for the treatment of ingrown great toenails remains unclear. OBJECTIVE: This study sought to determine the effectiveness of partial nail avulsion followed by matricectomy with sharpulse CO2 laser in the treatment of recurrent ingrown great toenails associated with granulation tissue. MATERIALS AND METHODS: Fourteen patients with a total of 18 recurrent ingrown great toenails were randomly selected for participation in this study. Partial nail avulsions followed by matricectomy with sharpulse CO2 laser were performed on the involved nails. After at least 6 months, we evaluated the recurrence of ingrown toenails, regrowth of the nail spike, duration of post-treatment pain and post-treatment infection. RESULTS: Partial nail avulsion followed by matricectomy with sharpulse CO2 laser in the treatment of ingrown toenails resulted in a high cure rate, short postoperative pain duration and low risk of postoperative infection. CONCLUSION: This method we advocate is convenient and effective for the treatment of recurrent ingrown great toenail associated with granulation tissue.     

Conservative treatment of ingrowing toenails

A combination of conservative measures was used to treat 105 patients with 119 ingrowing toenails. The method proved to be simple and cheap, but time consuming. Post-treatment discomfort and the time taken to return to normal activities were acceptable; the cosmetic result was good. Two-year follow-up revealed that the success rate of the method in less advanced cases (stages I and II) was high (96 per cent), although in the long term there was a tendency to recurrence in stage II cases. The failure rate in advanced cases (stage III) was high (up to 62 per cent). Conservative treatment can be used successfully in mild cases of ingrowing toenails.     

A novel modified Winograd surgical tricks and tips with a “bird flap” for the treatment of ingrown toenails

BackgroundThe Winograd technique is the most commonly used surgical treatment for ingrown toenails. We describe a novel modified approach, more effective and simpler to perform with a better cosmetic outcome.MethodsWe retrospectively included 45 and 39 patients with 67 and 58 ingrown toenails who underwent our modified Winograd technique and the Winograd technique, respectively, from July 2017 to June 2020, and obtained data after 3, 6, and 12 months of follow-up.ResultsNo significant differences in the postoperative time taken to return to regular activities in the modified Winograd and traditional Winograd groups (p = 0.103) and regarding the recurrence in both groups (p = 0.055) were found. The extent of proximal germinal matrix exposure with the modified Winograd technique was significantly more clearly revealed than in the traditional Winograd method contextually (p < 0.05). The postoperative appearance satisfaction rate was significantly higher in the modified Winograd group than in the traditional Winograd group (p = 0.029).ConclusionThe modified Winograd technique is effective in treating ingrown toenails.     

Partial matrix excision or segmental phenolization for ingrowing toenails

OBJECTIVE: To decide whether partial nail extraction with phenolisation or with partial excision of the matrix should be the standard treatment in patients with ingrowing toenails of the hallux. DESIGN: Randomized clinical trial with 12-month follow-up evaluations performed by observers who did not know which procedure was applied. SETTING: Outpatient department of a surgical teaching hospital. PATIENTS: Fifty-eight consecutive patients with a total of 63 ingrowing toenails were randomized. INTERVENTION: Thirty-four partial matrix excisions ("matrix" group) and 29 phenolizations ("phenol" group) were performed. MAIN OUTCOME MEASURES: Recurrence rate, postoperative morbidity (pain, wound exudates, and scar discomfort), and time to complete recovery (wearing shoes, performing normal activities/work). RESULTS: Recurrences were seen after 7 procedures in the matrix group and also after 7 procedures in the phenol group, of which patients were symptomatic and required a second operation in 4 and 3 instances, respectively. None of the observed differences in wound healing, postoperative pain, and recovery were statistically significant. CONCLUSIONS: Partial matrix excision and phenolization are equally effective in treating ingrowing toenails. Because the use of the toxic agent phenol should be avoided, partial matrix excision is the preferable procedure. But in view of the high recurrence rate, there is a need for further improvement of the treatment of ingrowing toenails.     

Interpretation of radiologic abnormalities in patients with chronically infected ingrown toenails with regard to a possible exogenic osteomyelitis

Background

Chronic infection of ingrown toenails may lead to exogenous osteomyelitis. Therefore, plain x-rays are commonly taken in children with significant inflammation. We evaluated the preoperative radiologic findings and their clinical significance, especially with regard to exogenic osteomyelitis.

Patients and methods

We retrospectively evaluated all patients who underwent surgery for infected ingrown toenails during a 5-year period. Data collection included the history of infection, preoperative laboratory tests, preoperative x-rays, and intraoperative presentation.

Findings

One hundred thirty-four patients with infected ingrown nails of the hallux underwent 161 surgical procedures. Mean age at surgery was 14.1 years. Preoperative x-rays were taken in 113 (70.2%) cases. The treating surgeon classified 76 (67.2%) x-rays as negative (no bone affection), 16 (14.2%) as positive (definite bone affection), and 21 (18.6%) as suspicious for bone affection. Only 11 (30%) of 37 children with positive or suspicious x-rays showed bone affection during surgery, which presented as a softening of the cortical bone. None of the children had significantly elevated inflammation markers in the preoperative laboratory tests. Children with positive or suspicious x-rays had a significant longer history of infection compared to those without radiologic abnormalities (8 vs 4.5 weeks mean; P = .024). A reevaluation of the x-rays by an experienced radiologist was undertaken and revealed no case of definite osteolysis.

Conclusion

In about one third of all infected ingrown toenails, radiologic changes of the distal phalanx occur. These changes primarily represent periostal reactions. A typical osteomyelitis as a complication of chronically infected ingrown toenails is rare.     

Direct access surgery.

Evolving surgical practice in the UK is imposing increasing pressures on surgical outpatient clinics. A Direct Access Surgery (DAS) programme was evaluated in which otherwise healthy patients with simple surgical conditions presenting little diagnostic difficulty were referred directly to hospital for surgical operation without attending the outpatient department. Specific referral criteria for DAS were devised. Appropriate surgical conditions or procedures included hernias, vasectomies, cystic scrotal swellings, subcutaneous lumps and skin lesions, symptomatic gallstones, varicose veins and ingrowing toenails. Over a 12 month period, 105 patients were referred for DAS and 102 underwent operation. There was a low incidence of inaccurate diagnosis (< 2%) and inappropriate referral (< 1%). DAS was well received by both General Practitioners (GPs) and patients. Implementation of such programmes may result in considerable savings of outpatient time and resources.     

A prospective randomized comparison of the Zadik procedure and chemical ablation in the treatment of ingrown toenails

BACKGROUND: We present the results of a prospective randomized trial of the Zadik procedure versus chemical ablation by sodium hydroxide for the treatment of ingrowing toenails. METHODS: Thirty-eight patients had the Zadik procedure, and 45 patients had chemical ablation by sodium hydroxide. Mean followup was 12.45 months for the Zadik group and 11.69 months for the chemical ablation group. RESULTS: In the Zadik group, the average return to normal shoe-wear was 2.13 weeks and in the chemical ablation group 3.73 weeks. Average return to normal activity was 2.18 weeks for the Zadik group and 3.89 weeks for the chemical ablation group. The median number of dressings were 3 and 8 for the Zadik and chemical ablation groups, respectively. The pain score, using the visual analogue scale were not statistically significant between the two groups. The recurrence rates were 23 recurrences in the Zadik group (60.5%) and seven recurrences in the chemical ablation group (15.6%). CONCLUSION: The use of chemical ablation by sodium hydroxide in the treatment of ingrowing toenails shows statistically significant (p < 0.05) reduction in recurrence rates of ingrowing toenails compared to the Zadik procedure.     

Surgical options in the management of ingrown toenails in paediatric age group

Background and objectiveThe problem of ingrown toenails is worldwide, affecting all age groups. The aim of this study was to review the different surgical modalities for ingrown toenails in the paediatric age group in a hospital.MethodsWe reviewed case series of 66 children with 89 affected toes, under 16 years of age. The patients were followed up for up to 18 months. The treatment methods practised were: (1) nail avulsion with or without nail matrix ablation using phenol and (2) wedge excision with or without nail matrix ablation using phenol or thermal ablation.ResultsWe found a recurrence rate of 3% for those treated with wedge excision alone compared to 30% when treated with wedge excision and phenol ablation (p = 0.001). Infection rate was also higher for wedge excision with phenol ablation. We achieved cure rate of 97% when using wedge excision alone and 70% when phenol was used for nail matrix ablation.ConclusionWe advocate wedge excision as primary treatment of ingrown toenails in children. We would not recommend phenol ablation of the nail matrix in younger patients as it increases both infection and recurrence rates. The results of nail bed ablation with diathermy appear promising.     

Surgical treatments for ingrowing toenails

Background: Ingrowing toenails are a common condition which, when recurrent and painful, are often treated surgically.Objectives: To evaluate the effectiveness of methods of the surgical treatment of ingrowing toenails.Search strategy: Electronic database searching (Cochrane Controlled Trials Register (CCTR), MEDLINE, EMBASE, CINAHL) followed by investigation of reference lists of the papers identified from the initial search.Selection criteria: Any randomized (or quasi-randomized) controlled trial which compares one form of surgical removal of all or part of a toenail due to its impact on the soft tissues to another or others. Studies must have a minimum follow period of 6 months and aim to permanently remove the troublesome portion of the nail.Data collection and analysis: Data extraction was carried out independently by the two reviewers using a pre-derived data extraction form and entered into RevMan. Categorical outcomes were analysed as odds ratios with 95% confidence intervals.Main results:

• •Avulsion with phenol versus surgical excision
• •Phenolization combined with simple avulsion of a nail is more effective than the use ofmore invasive excisional surgical procedures to prevent symptomatic recurrence at 6months or more (OR 0.44 CI 95% 0.24–0.80)
• •Avulsion with phenol versus avulsion without phenol
• •The addition of phenol, when performing a total or partial nail avulsion dramatically reduces the rate of symptomatic recurrence (OR 0.07 95% CI 0.04–0.12). This is offset byasignificant increase in the rate of post-operative infection when phenol is used (OR5.69 95% CI 1.93–16.77)

Conclusions: The evidence suggests that simple nail avulsion combined with the use of phenol, compared to surgical excisional techniques without the use of phenol, is more effective at preventing symptomatic recurrence of ingrowing toenails. The addition of phenol when simple nail avulsion is performed dramatically decreases symptomatic recurrence, but at the cost of increased post-operative infection.     

微创甲母质刮除术治疗嵌甲性甲沟炎206例术后疗效调查

目的：采用减少创伤,清除仅与疾病有关的肉芽、甲板、甲母质(nail matrix,或甲基质onychostroma)等病变组织术式治疗嵌甲性甲沟炎,并随访评估疗效。 方法：2010年-2013年6月,门诊手术治疗206例嵌甲性甲沟炎患者。术中剪除病变侧甲板3-4mm,并刮除与之相关的甲母质,刮出炎性肉芽,术后换药。 结果 术后随访6月-2年,复发13例,术后3月复发人数最多,复发率6.3%,优良率：93.6% 结论：微创甲母质刮出术,创伤小,手术简单,疗效满意,建议推广。     

The effect of phenol on ingrown toenail excision in children

Purpose

Ingrown toenails in children are a common problem with a high recurrence rate. The objective of this retrospective data review was to compare simple excision of the nail matrix with excision plus phenol (EPP) application in the treatment of ingrown toenails.

Methods

The charts of 69 children who underwent surgical treatment of one or more ingrown toenails from 1994 to 2000 were reviewed. The primary procedure was noted (excision alone [EA] vs EPP) and dates of recurrences and reoperations were recorded. Parents were then surveyed by phone regarding complications, cosmetic outcome, and overall satisfaction with the procedure. Five scale categories, ranging from “strongly agree” to “strongly disagree”, were used, with responses of “strongly agree” and “agree” considered as a good outcome. Either Student's t test or the χ² test (P < .05 considered significant) was used for analysis.

Results

Thirty-one patients (45%) were in the EPP group whereas the remaining 38 had EA. Mean length of follow-up was 4.3 years for the EA group and 2.1 years for the EPP group. There was no difference in age at operation or length of follow-up between the 2 groups. Boys were predominant in both groups. The survey response rate was 50/69 (73%). The recurrence rate of ingrown toenails in the EA group was 42% vs 4% in the EPP group (P = .003). There were no significant differences in parental response with regard to operative experience (P = .31) and the cosmetic result (P = .13), with most of the respondents (78%) indicating a good outcome for both questions.

Conclusions

The addition of phenol to the surgical excision of ingrown toenail significantly reduced the incidence of recurrence, with similar patient satisfaction and an equivalent cosmetic result.     

Soft-tissue nail-fold excision: a definitive treatment for ingrown toenails

Background

Ingrown toenail, or onychocryptosis, is a common source of morbidity worldwide. The current standard of care focuses on the nail as the causative agent, and, in cases that are resistant to medical management, surgical correction via nail avulsion and phenol matrix ablation is used. Unfortunately, this treatment leads to poor cosmetic results, high rates of recurrence and low patient satisfaction.

Methods

We retrospectively reviewed a case series of 124 consecutive patients who underwent surgical correction of ingrown toenails from 1988 to 2004. We recorded the operative technique and postoperative wound healing via photographs. We assessed outcomes and patient satisfaction using self-reports and 7-point Likert scale questionnaires.

Results

Our surgical approach involved the excision of excessive nail-fold granulation tissue with preservation of the nail and its matrix. In total, 72.5% of patients were under the age of 29 (69.4% men). Before surgical intervention, 78.8% of patients scored their pain as severe, 69.9% had difficulty wearing normal footwear and 64.3% had difficulty with normal activities because of their ingrown toenails. A total of 212 surgical sites were analyzed, with a median follow-up of 8 years. No recurrences were identified in any patients (100%, n = 124). Overall, 94.3% (n = 116) stated that they were highly satisfied with the procedure. Only 1.6% (n = 2) reported a loss of sensation at the surgical site.

Conclusion

Surgical correction of ingrown toenails via soft-tissue excision of the nail folds, coupled with preservation of the nail and its matrix, had excellent cosmetic results, no recurrences and high rates of patient satisfaction.Ingrown toenails are frequently encountered in clinical practice, with an estimated 10 000 new cases per year in the United Kingdom.¹ Young men are most frequently affected, and the associated morbidities have significant economic impact, secondary to decreased mobility and work absenteeism.^1,2 Currently, a wide variety of treatment options exist; however, they are associated with poor cosmetic results, low rates of patient satisfaction and high rates of recurrence.^1–5Initial treatment of an ingrown toenail, or onychocryptosis, is conservative management, including avoiding tight-fitting shoes and using warm water baths and soft compresses.⁶ Surgical intervention is ultimately required in refractory cases. Many approaches have been described, with most targeting the nail as the causative agent. Partial nail avulsion coupled with chemical destruction of the nail matrix (matricectomy) with phenol remains the most preferred surgical technique.^1,6–8Vandenbos and Bowers⁹ suggested that pressure necrosis of the soft tissue surrounding the nail contributes to the pathogenesis of ingrown toenails. Indeed, increased nail-fold skin width in patients with ingrown toenails, greater weight-bearing on the soft tissue of the nail fold and repetitive rotation of the toe have all been suggested to be important contributing factors.^8–10 A study by Pearson and colleagues¹¹ helped to draw the focus away from the nail as the causative agent. They reported no differences in the shape of the toenails among patients with ingrown toenails and healthy controls. It is tempting to speculate that the current surgical interventions that target the nail (i.e., nail avulsion and matricectomy) do not directly address the causative soft-tissue pathology.In this study, we used a modification of the surgical approach described by Vandenbos and Bowers⁹ in a large patient population to show that soft-tissue nail-fold resection leads to surgical correction of ingrown toenails. Our approach yields excellent cosmetic results with no recurrences and high rates of patient satisfaction. The treatment is cost effective, technically simple and can be performed easily in any physician’s office.     

Ingrowing toenails: the results of treatment.

Completed questionnaires were received from 208 patients on whom 245 operations for ingrowing toenails had been performed at King's College Hospital. Avulsion of a strip of nail had an 83 per cent recurrence rate, total nail avulsion 70 per cent, Zadik operations 28 per cent and wedge resections 29 per cent. It is recommended that immediate avulsion of ingrown toenails should not be a routine practice.     

废弃指骨或髂骨与皮管、指(趾)甲复合移植Ⅰ期再造部分手指

目的探讨一种新式部分手指再造的手术方法.方法自1996年2月～1999年10月对因离断伤及脱套伤而无再植条件的25例28指,利用废弃指指骨或髂骨,取对侧腋下管状皮管加游离废弃指指甲或取足趾趾甲再造部分手指.结果再造28指的皮瓣全部成活,游离指(趾)甲完全成活22指,部分成活4指,失败2指.经术后6个月～3年半随访,再造手指功能良好,外形美观.结论此术式方法简单、设计合理,不吻合血管及神经就能恢复良好的外形及功能,尤其对末节以远离断是很好的适应证. ,     

甲板及甲基质部分切除联合拇趾腹重建甲沟治疗嵌甲性甲沟炎

目的探讨甲板及甲基质部分切除联合拇趾腹重建甲沟治疗嵌甲性甲沟炎的临床疗效。方法对76例嵌甲性甲沟炎患者采用甲板及甲基质部分切除联合拇趾腹重建甲沟术治疗,评价治疗效果。结果 76例均获随访,时间8~12个月。2例复发残甲,总有效率达97.4%。结论采用甲板及甲基质部分切除联合拇趾腹重建甲沟术治疗嵌甲性甲沟炎操作简便,对趾甲损伤小,患者痛苦轻,并发症少,治愈率高。     

Randomized, prospective study of nail bed ablation for recurrent ingrowing toenails

A consecutive series of 31 recurrent ingrowing toenails, which had previously undergone at least two surgical procedures, were recruited to this study over a 1-year period. Patients were randomly allocated to one of two treatment groups. Group A underwent nail bed excision whilst group B had nail bed phenolization in addition to excision. Patients were reviewed 2 weeks and 1 year after operation. Seven toes (41%) in group A developed postoperative infection compared with only one (7%) in group B (P less than 0.01). Recurrent nail spicules occurred in ten patients (59%) in group A and six patients (43%) in group B 1 year after operation. High failure rates for ablation of recurrent ingrowing toenails should encourage greater efforts towards adequate treatment at the first presentation.     

Approach to ingrowing toenails: the wedge resection/segmental phenolization combination treatment

One hundred and seventy procedures were performed on one hundred and forty patients with ingrowing toenails. Each patient was randomly allocated to one of three treatment groups. There were 55 wedge resections (WR), 53 segmental phenolizations (SP) and 62 wedge resection/segmental phenolization combination treatments (WR/SP). All patients were followed up for 6 months. The duration and intensity of postoperative pain was assessed and the recurrence rate monitored. Postoperative pain was less in the WR/SP group (9.4 +/- 13.5 h) than in the WR group (30.0 +/- 37.6 h, P less than 0.001). There were seven recurrences in the WR group, four in the SP group, and none in the WR/SP group. The results in the WR/SP group were statistically significant when compared with the WR group (P less than 0.01) and with the SP group (P less than 0.05). We conclude that the WR/SP combination procedure is a superior form of treatment for ingrowing toenails.