The effect of an intramedullary biodegradable self-reinforced polyglycolic acid implant on tubular bone. An experimental study on growing dogs

The purpose of this study was to examine the effects of intramedullary self-reinforced polyglycolic acid (SR-PGA) implant to the femoral bone growth in a growing dog by using radiographic, microradiographic, oxytetracycline-fluorescence, histological, polariscopical and histomorphometric studies. Intramedullary reaming and SR-PGA implant did not cause any longitudinal overgrowth phenomenon, but resulted in a slight increase in femoral neck-angle. The bone histology showed normal features and blood cell counts were within normal limits.     

形状记忆合金弓齿钉治疗腕舟状骨腰部骨折

正2013年10月~2015年3月,我科采用腕掌侧切开复位形状记忆合金弓齿钉治疗17例腕舟状骨腰部骨折患者,疗效满意,报道如下。1材料与方法1.1病例资料本组17例,男15例,女2例,年龄16~42岁。左侧1例,右侧16例,均为闭合骨折。新鲜骨折16例,陈旧性骨折1例,合并桡骨茎突骨折1例。1.2治疗方法臂丛麻醉下手术。取     

Serum levels of anti‐Fcγ receptor IIB/C antibodies are increased in patients with systemic sclerosis

Systemic sclerosis (SSc) is a systemic autoimmune disorder that results in fibrosis of the skin and multiple internal organs. Although the precise mechanism is unknown, it appears to result from the overproduction of extracellular matrix proteins and aberrant immune activations. Receptors for the Fc region of immunoglobulin (Ig)G (FcγR) are members of the Ig superfamily that modulate both activation and inhibition of immune responses. FcγRIIB is the sole inhibitory member, which has an intrinsic cytoplasmic immunoreceptor tyrosine‐based inhibitory motif. The present study was undertaken to investigate the circulating concentrations of anti‐FcγRIIB/C antibodies (Ab) in patients with SSc. Serum levels of anti‐FcγRIIB/C Ab were significantly increased in patients with SSc compared to those in controls and in patients with localized scleroderma. Serum levels of anti‐FcγRIIB/C Ab in patients with limited cutaneous SSc were similar to those in patients with diffuse cutaneous SSc. Among SSc patients, serum levels of anti‐FcγRIIB/C Ab were increased in those with nail‐fold bleeding and decreased in those with diffuse pigmentation and calcinosis. These findings support the notion that increased serum anti‐FcγRIIB/C Ab levels are involved in aberrant immune responses in SSc.     

Prediction of tibial nonunion at the 6-week time point

IntroductionIntramedullary (IM) nail fixation is a common operative treatment, yet concerns regarding the frequency of complications, such as nonunion, remain. Treatment of tibial shaft fractures remains a challenge, and little evidence of prognostic factors that increase risk of nonunion is available. The aim of this study was to develop a predictive model of tibial shaft fracture nonunion 6 weeks after reamed intramedullary (IM) nail fixation based on commonly collected clinical variables and the radiographic union score for tibial fractures (RUST).MethodsA retrospective case-control study was conducted. All tibial shaft fractures treated at our level I trauma center from 2007 to 2014 were retrospectively reviewed. Only patients with follow-up until fracture healing or secondary operation for nonunion were included. Fracture gaps ≥3 mm were excluded. A total of 323 patients were included for study.ResultsInfection within 6 weeks of operation, standard RUST, and the Nonunion Risk Determination (NURD) score had statistically significant associations with nonunion (odds ratio > or < 1.0; p < 0.01). The NURD score was increasingly predictive of nonunion with decreasing RUST. All patients in the high RUST group (RUST ≥ 10), achieved union regardless of NURD score. In the medium RUST group (RUST 6–9), 25% of patients with a NURD score ≥7 experienced nonunion. In the low RUST group (RUST <6 or infection within 6 weeks), 69% of patients with a NURD score ≥7 experienced nonunion.ConclusionThree variables predicted nonunion. Based on these variables, we created a clinical prediction tool of nonunion that could aid in clinical decision making and discussing prognosis with patients.     

Comparative Anatomy of Mouse and Human Nail Units

Recent studies of mice with hair defects have resulted in major contributions to the understanding of hair disorders. To use mouse models as a tool to study nail diseases, a basic understanding of the similarities and differences between the human and mouse nail unit is required. In this study we compare the human and mouse nail unit at the macroscopic and microscopic level and use immunohistochemistry to determine the keratin expression patterns in the mouse nail unit. Both species have a proximal nail fold, cuticle, nail matrix, nail bed, nail plate, and hyponychium. Distinguishing features are the shape of the nail and the presence of an extended hyponychium in the mouse. Expression patterns of most keratins are similar. These findings indicate that the mouse nail unit shares major characteristics with the human nail unit and overall represents a very similar structure, useful for the investigation of nail diseases and nail biology. Anat Rec, 296:521–532, 2013. © 2013 Wiley Periodicals, Inc.     

Retrograde femoral nailing of periprosthetic fractures around total knee replacements

IntroductionThe incidence of primary total knee replacement (TKR) is increasing with a resultant rise in those patients sustaining distal femoral periprosthetic fractures around TKRs. The management of these fractures pose a significant challenge. The compatibility of retrograde femoral intramedullary (IM) nails with femoral TKR components needs to be considered preoperatively when this complex pathology is addressed. The aim of this study was to update the literature and assess the compatibility of the most commonly used primary TKR prostheses and retrograde femoral IM nails using a Sawbone anatomical model.Methods and materialsEight of the most commonly used primary TKR prostheses and four of the most commonly used retrograde femoral IM nails were identified. The femoral components of the TKRs were implanted onto left sided femoral Sawbones using the manufacturer's guides and cutting blocks and positioned appropriately. The retrograde IM nails were inserted using the conventional entry point and a nail was deemed compatible if this was possible through the femoral prosthesis. Details of whether a posterior entry point was required to allow insertion, whether the femoral nail was scratched by the femoral TKR prosthesis on insertion and whether excess force was required to insert the retrograde femoral IM nail were recorded.ResultsThe Biomet AGC Cruciate Retaining (CR) and Posterior Stabilised (PS) TKR were the only prostheses that were compatible with all the nails used. The other TKR prostheses were not compatible because of the force required to gain entry, scratching of the retrograde femoral IM nail or because a posterior entry point was required to gain entry through the intercondylar notch.ConclusionThe majority of standard sized retrograde femoral nails are technically feasible for insertion through most femoral TKR components but this study has found that they are not compatible due to excessive force required for insertion, damage to the nail during insertion or the risk of anterior cortex perforation. Further studies are required to update the compatibility table and cadaveric studies would confirm the findings and allow further mechanical testing.     

Regeneration of nails with artificial dermis

Abstract

We treated fingertips injured through the proximal half of the nail bed using artificial dermis in 22 patients from 2004 to 2009. We classified the injuries to the nail bed into three types according to where the wounds were. Type ? was localised to the nail bed with or without minor injury to the surrounding structure; type II was an avulsion and amputation of the fingertip including the nail bed, the finger pulp, and the distal phalanx at the level of the proximal nail bed; and type III was post-traumatic shortening of the nail, in which the pulp and distal phalanx were intact. Regeneration and elongation of the nail was achieved in every patient by applying artificial dermis. All patients were satisfied with the results.