Introduction: The management of fractures of the tibia shaft is an important aspect of orthopaedic care, and the selection of the surgical method for fixation can substantially impact patient outcomes. The current rev...Introduction: The management of fractures of the tibia shaft is an important aspect of orthopaedic care, and the selection of the surgical method for fixation can substantially impact patient outcomes. The current review aims to compare the outcomes of adult tibia fractures treated with solid nails to those treated with hollow nails. Methods: A search on Scopus, PubMed, and Cochrane Library, using three keywords (Outcome, Tibia shaft fractures, Nail) was conducted in April 2023. Results were compiled and two independent reviewers screened and selected eligible articles After removing duplicates, titles and abstracts were read to exclude ineligible studies. Full-text articles of the remaining papers were read to select eligible studies which were further critically appraised to ascertain their methodological quality. The data extracted from the selected papers were synthesized using a combination of pooling of results, tests of statistical difference (t-test and chi-square) and narrative synthesis methods. Results: A total of 2295 articles were obtained from the databases and citation searching. A total of 9 papers were identified as eligible and included in the review. Findings revealed that there is no statistical difference in the outcomes of tibia fractures treated with either solid or hollow nail groups such as duration of surgery (p = 0.541), rate of delayed and non-union (p = 0.342), and rate of surgical site infections (p = 0.395). Conclusion: Intramedullary nailing of tibia shaft fractures with either solid or hollow nails have similar functional outcomes.展开更多
BACKGROUND Femoral lengthening is a procedure of great importance in the treatment of congenital and acquired limb deficiencies.Technological advances have led to the latest designs of fully implantable motorized intr...BACKGROUND Femoral lengthening is a procedure of great importance in the treatment of congenital and acquired limb deficiencies.Technological advances have led to the latest designs of fully implantable motorized intramedullary lengthening nails.The use of these nails has increased over the last few years.AIM To review and critically appraise the literature comparing the outcome of femoral lengthening in children using intramedullary motorized lengthening nails to external fixation.METHODS Electronic databases(MEDLINE,CINAHL,EMBASE,Cochrane)were systematically searched in November 2019 for studies comparing the outcome of femoral lengthening in children using magnetic lengthening nails and external fixation.The outcomes included amount of gained length,healing index,complications and patient reported outcomes.RESULTS Of the 452 identified studies,only two(retrospective and non-randomized)met the inclusion criteria.A total of 91 femora were included.In both studies,the age of patients treated with nails ranged from 15 to 21 years compared to 9 to 15 years for patients in the external fixation group.Both devices achieved the target length.Prevalence of adverse events was less in the nail(60%-73%)than in the external fixation(81%-100%)group.None of the studies presented patient reported outcomes.CONCLUSION The clinical effectiveness of motorized nails is equivalent or superior to external fixation for femoral lengthening in young patients.The available literature is limited and does not provide evidence on patient quality of life or cost effectiveness of the interventions.展开更多
The microstructure,mechanical properties and corrosion behavior of quaternary degradable Mg−1Zn−0.2Ca−xAg(x=1,2,4 wt.%)alloy wires,intended as anastomotic nails,were investigated.It was found that these Ag-containing ...The microstructure,mechanical properties and corrosion behavior of quaternary degradable Mg−1Zn−0.2Ca−xAg(x=1,2,4 wt.%)alloy wires,intended as anastomotic nails,were investigated.It was found that these Ag-containing alloy wires mainly consist of Mg matrix and Ag17Mg54 phase,characterized by SEM,EDS,XRD and TEM.Tensile and knotting tests results demonstrate the superior mechanical properties of these alloy wires.Especially,Mg−1Zn−0.2Ca−4Ag alloy exhibits the highest mechanical properties,i.e.an ultimate tensile strength of 334 MPa and an elongation of 8.6%.Moreover,with increasing Ag content,the corrosion rates of these alloy wires remarkably increase due to the formation of more micro-galvanic coupling between Mg matrix and Ag17Mg54 phase,shown by mass loss and scanning Kelvin probe force microscopy(SKPFM)results.The present alloy can be completely degraded within 28 d,satisfying the property requirements of anastomotic nails.展开更多
In recent times,there had been reported cases of Pb poisoning in Anka gold mining area,Northwest Nigeria.Therefore,this study was carried out to determine the extent of bioaccumulation of heavy metals in the hairs and...In recent times,there had been reported cases of Pb poisoning in Anka gold mining area,Northwest Nigeria.Therefore,this study was carried out to determine the extent of bioaccumulation of heavy metals in the hairs and nails of children in the area.Forty samples(twenty nails and twenty hairs)samples were collected from ten boys and ten girls of ages 5–9 residing in the area.To ascertain the sources of heavy metals in children,15 soils samples,15 groundwater samples,5 samples of mine tailings,and 5 plants samples were collected.Hair and nails of the subjects were collected using internationally acceptable techniques.All samples were kept in uncontaminated ziplock bags prior to laboratory preparation and analysis.The samples were cleaned using nonionic detergent(triton X-100)and deionized water.The hairs and nails were digested with 10 mL of 6:1 mixture of nitric acid and perchloric acid.The soils,mine tailings,and plants were air-dried at room temperature,sieved,and chemically digested using the aqua regia method.The concentrations of metals in all the samples were determined using highperformance liquid chromatography–inductively coupled plasma–mass spectrometry.Statistical analysis was employed to unravel potential sources of metals in the media.Results showed that heavy metals in children of the area are above results from similar studies and pathological ranges for heavy metals in hairs and nails.Also,heavy metals in environmental media are above the recommended standards.Multivariate analysis showed that the metals are mainly from mining and other anthropogenic sources.Results of correlation between heavy metals in hairs and nails with those in geological samples revealed that heavy metal that bioaccumulates in the children of this area are mostly from contaminated environmental media.It is recommended that complete remediation and effective health education be carried out in the area.展开更多
Tests of the capacity of shear connections consisting of nails in a row placed at distances 7, 10 and 14d, “d” being the cross-sectional dimension of the nail, versus single nail capacities, were executed. The perfo...Tests of the capacity of shear connections consisting of nails in a row placed at distances 7, 10 and 14d, “d” being the cross-sectional dimension of the nail, versus single nail capacities, were executed. The performed tests do support the connotation that no reduction should be required for nails of diameter 2.8 mm or less in a row, provided that nails are spaced sufficiently far apart for wood cracking not to occur. At the ultimate capacity of the joint, all such thin nails in a row will be yielding, having developed plastic hinges, i.e. each single nail will have developed its ultimate capacity. Hence, the ultimate capacity of the connection will be each nail’s capacity times the number of nails in the row. The force pr. nail increases subsequent to the development of a plastic hinge. This is likely due to the axial pullout-force, i.e. the ultimate capacity of a shear connection is higher than the force required for developing plastic hinges in the nails. This additional capacity-reserve may also partly be attributed to the rotational resistance of nails. The number of nails in a row should make insignificant difference in the pr. nail capacity, as long as no wood cracking takes place. Thus, applying elastic theory to nails in a row does not seem relevant. This is in contrast to bolt-connections.展开更多
Objective： To report 32 cases of femur supracondylar fracture treated with retrograde interlocking intramedullary nails in elderly patients. Methods： According to the AO classification, all of 32 cases were classifi...Objective： To report 32 cases of femur supracondylar fracture treated with retrograde interlocking intramedullary nails in elderly patients. Methods： According to the AO classification, all of 32 cases were classified as extra-articular type A. 32 cases were treated with interlocking intramedullary nail by closed insertion from intercondylar fossa of the knee. All cases accepted CPM exercise as early as possible after operation. Results： Following up 5 to 15 months, all fractures united within an average duration of 5.3 months （4-7 months）. According to the Shelbourne scale, the excellent rate of the knee function was 86.3%. Conclusion： Retrograde interlocking intramedullary nail is useful alternative implant for the treatment of osteoporotic supracondylar fracture of femur, particularly of the type A fracture in the elderly population. Its merits include stable fixation, high rate of fracture union and few complications.展开更多
In the present work, elements concentration in fingernails samples of volunteers of different ages (males, females) were determined using atomic absorption spectroscopy (AAS) Perkin-Elmer, spectrophotometer. Fingernai...In the present work, elements concentration in fingernails samples of volunteers of different ages (males, females) were determined using atomic absorption spectroscopy (AAS) Perkin-Elmer, spectrophotometer. Fingernails samples of different groups were analyzed to determine the trace elements Ca, Mg, Mn, Fe, Ni, Cu, Co, Zn and Pb. Standards materials were prepared for concentration assessment that adjacent to samples from two cities in different location in eastern province of Sudan for elements concentrations finding. In addition, samples of hands fingernails and toenails were analyzed for comparison and method validation. Consequently, the significant levels of elements concentration in nails samples of Jabiat residents compared to Port Sudan resident’s area due to soil dispersion are supporting the possibility of external contamination. The data of component matrix and rotated component matrix of varimax normalization using principal component analysis revealed important predictors of nails elements Mg, Mn, Fe, Cu and Zn concentrations in soil of both areas under study. However, the Pb, Ni, Ca, and Co are possible to be indication of different sources associated with environmental contamination. The significant correlation and principal component analysis of the elements of nails concentrations in the two categories supported the probability of different expose environmental contamination.展开更多
BACKGROUND Proximal femoral nails(PFNs)are the most common method for the treatment of unstable intertrochanteric femoral fractures(IFFs),but postoperative bed rest is required.There is a large amount of blood loss du...BACKGROUND Proximal femoral nails(PFNs)are the most common method for the treatment of unstable intertrochanteric femoral fractures(IFFs),but postoperative bed rest is required.There is a large amount of blood loss during the operation.Osteoporosis in elderly patients may cause nonunion of fractures and other complications.Arthroplasty can give patients early weight bearing and reduce financial burden,but whether it can replace PFNs remains controversial.AIM To compare the clinical outcomes of arthroplasty and PFNs in the treatment of unstable IFFs in elderly patients.METHODS A search was conducted in the PubMed,Embase,and Cochrane Library databases and included relevant articles comparing arthroplasty and PFN.The search time was limited from January 1,2005 to November 1,2020.Two investigators independently screened studies,extracted data and evaluated the quality according to the inclusion and exclusion criteria.According to the research results,the fixed effect model or random effect model were selected for analysis.The following outcomes were analyzed:Harris Hip score,mortality,complications,operation time,blood loos,hospital stay,weight-bearing time,fracture classification and type of anesthesia.RESULTS We analyzed four randomized controlled trials that met the requirements.A total of 298 patients were included in these studies.According to the AO/OTA classification,there are 20 A1 types,136 A2 types,42 A3 types and 100 unrecorded types.Primary outcome:The Harris Hip Score at the final follow-up of the PFN group was higher[mean difference(MD):9.01,95%confidence interval(CI):16.57 to 1.45),P=0.02].There was no significant difference between the two groups in the rate of overall mortality[risk ratio(RR):1.44,P=0.44]or the number of complications(RR:0.77,P=0.05).Secondary outcomes:blood loss of the arthroplasty group was higher(MD:241.01,95%CI:43.06–438.96,P=0.02);the operation time of the PFN group was shorter(MD:23.12,95%CI:10.46–35.77,P=0.0003);and the length of hospital stay of the arthroplasty group was shorter[MD:0.97,95%CI:1.29 to 0.66),P<0.00001].There was no difference between the two groups in the type of anesthesia(RR:0.99).There were only two studies recording the weight-bearing time,and the time of full weight bearing in the arthroplasty group was significantly earlier.CONCLUSION Compared with PFN,arthroplasty can achieve weight bearing earlier and shorten hospital stay,but it cannot achieve a better clinical outcome.Arthroplasty cannot replace PFNs in the treatment of unstable IFFs in elderly individuals.展开更多
Pullout resistance of a soil nail is a critical parameter in design and analysis for geotechnical engineers. Due to the complexity of field conditions, the pullout behaviour of cement grouted soil nail in field is not...Pullout resistance of a soil nail is a critical parameter in design and analysis for geotechnical engineers. Due to the complexity of field conditions, the pullout behaviour of cement grouted soil nail in field is not well investigated. In this work, a number of field pullout tests of pressure grouted soil nails were conducted to estimate the pullout resistance of soil nails. The effective bond lengths of field soil nails were accurately controlled by a new grouting packer system. Typical field test results and the related comparison with typical laboratory test results reveal that the apparent coefficient of friction （ACF） decreases with the increase of overburden soil pressure when grouting pressure is constant, but increases almost linearly with the increase of grouting pressure when overburden pressure （soil depth） is unchanged. Water contents of soil samples at soil nail surfaces show obvious reductions compared with the results of soil samples from drillholes. After soil nails were completely pulled out of the ground, surface conditions of the soil nails and surrounding soil were examined. It is found that the water content values of the soil at the soil/nail interfaces decrease substantially compared with those of soil samples extracted from drillholes. In addition, all soil nails expand significantly in the diametrical direction after being pulled out of ground, indicating that the pressurized cement grout compacts the soil and penetrates into soil voids, leading to a corresponding shift of failure surface into surrounding soil mass significantly.展开更多
Objective:To compare the outcomes of dynamic hip screws(DHS)and intramedullary nailing(IMN)in the treatment of extra-capsular metastatic carcinoma of the proximal femur.Methods:A retrospective case analysis method was...Objective:To compare the outcomes of dynamic hip screws(DHS)and intramedullary nailing(IMN)in the treatment of extra-capsular metastatic carcinoma of the proximal femur.Methods:A retrospective case analysis method was used to examine data of patients with proximal metastatic cancer of the femur who were treated with internal fixation in Department of Orthopaedics,Beijing Friendship Hospital,from January 2007 to December 2018.Blood loss,postoperative pain,functional score,length of stay,and survival rates were compared,and postoperative complications were assessed.Results:Complete follow-up data were available for 33 patients.The mean follow-up period was 12.2±3.6(range:9-32)months and the average age was 72.3±4.7(range:59-83)years old.There were 20 females and 13 males.Twenty-three patients had undergone IMN and 10 DHS,according to bone defects and the patient’s overall condition.The median survival time was 10 months in the IMN group and 11 months in the DHS group.Duration of surgery(t=-7.366,P<0.001)and length of hospital stay(t=-3.509,P<0.001)differed significantly between the two groups.There was one case of breakage of internal fixation in the IMN group.Conclusions:There was no significant difference between DHS and IMN in terms of surgical efficacy.IMN and DHS were different in terms of surgical time and hospital stay.However,due to the limited number of cases in this study,multi-factor analysis has not been performed and needs to be further verified in future analysis.When developing a surgical plan,it is recommended to consider the patient’s condition and the surgeon’s experience.展开更多
Background: Management of femoral diaphyseal fractures in the age group 616 years is controversial. There has been a resurgence worldwide for operative fixation. Material and methods: Twenty children (15 boys, 5 girls...Background: Management of femoral diaphyseal fractures in the age group 616 years is controversial. There has been a resurgence worldwide for operative fixation. Material and methods: Twenty children (15 boys, 5 girls) aged 616 years with femoral diaphyseal fractures (20 fractures, one in each) were stabilized with Titanium Elastic Nail (TEN). Patients underwent surgery within ten days of their injury. The results were evaluated using Flynn’s Scoring Criteria.Two nails were used in each fracture. Results: All 20 patients were available for evaluation and follow up for a mean duration of 24 months (1532 months). Radiological union in all cases was achieved in a mean time of 8 weeks. Full weight bearing was possible in a mean time of 10 weeks (812 weeks). The results were excellent in 14 patients (70%) and successful in 6 patients (30%). Few complications that occurred were infection (in 2 cases), knee joint stiffness(in 4 cases), angulation less than 10 degrees( in 4 cases), shortening less than 10 mm(in 4 cases). Conclusion: Intramedullary fixation by TEN is an effective treatment of fracture of femur in properly selected patients of the 616 years age group.展开更多
The aim of this article was to report a case of toe nails disorder associated with metformin use in an elderly patient with type2diabetes. Two years ago, after receiving metformin 0.5 g three times daily for 6 months,...The aim of this article was to report a case of toe nails disorder associated with metformin use in an elderly patient with type2diabetes. Two years ago, after receiving metformin 0.5 g three times daily for 6 months, a 60-year-old Chinese man found his ten toe nails gradually thickened and yellowed (especially two thumbs). The symptoms improved and recovered after metformin discontinuance. Half year ago, metformin 0.5 g three times daily adopted again and toe nails disorder occurred again. Physician modified the therapy plan and replaced metformin with acarbose to control blood glucose level of this patient. According to the follow up 3 months after his discharge, ten toe nails recovered significantly and new parts of the nails were normal. Nail disorder was rarely reported in the worldwide, but the physicians should keep awareness of this adverse drug reaction (ADR), proper actions should be taken once it occurred to avoid unnecessary suffering of the patient.展开更多
Surgical management of femoral shaft fractures with intramedullary nails has become the standard ofcare,with multiple options for entry point described,including piriformis entry,trochanter entry andretrograde femoral...Surgical management of femoral shaft fractures with intramedullary nails has become the standard ofcare,with multiple options for entry point described,including piriformis entry,trochanter entry andretrograde femoral nails.Our present review describes the surgical anatomy of the proximal and distalfemur and its relation to different entry points for intramedullary femoral nails.In addition,we reviewedrelative indications for each technique,difficulties associated and possible complications.展开更多
With the aging population,intertrochanteric femur fracture in the elderly has become one of the most serious public health issues and a hot topic of research in trauma orthopedics.Due to the limitations of internal fi...With the aging population,intertrochanteric femur fracture in the elderly has become one of the most serious public health issues and a hot topic of research in trauma orthopedics.Due to the limitations of internal fixation techniques and the insufficient mechanical design of nails,the occurrence of complications delays patient recovery after surgical treatment.Design of a proximal femur bionic nail(PFBN)based on Zhang’s N triangle theory provides triangular supporting fixation,which dramatically decreases the occurrence of complications and has been widely used for clinical treatment of unstable intertrochanteric femur fracture worldwide.In this work,we developed an equivalent biomechanical model to analyze improvement in bone remodeling of unstable intertrochanteric femur fracture through PFBN use.The results show that compared with proximal femoral nail antirotation(PFNA)and InterTan,PFBN can dramatically decrease the maximum strain in the proximal femur.Based on Frost’s mechanostat theory,the local mechanical environment in the proximal femur can be regulated into the medium overload region by using a PFBN,which may render the proximal femur in a state of physiological overload,favoring post-operative recovery of intertrochanteric femur fracture in the elderly.This work shows that PFBN may constitute a panacea for unstable intertrochanteric femur fracture and provides insights into improving methods of internal fixation.展开更多
BACKGROUND Among the most frequent hip fractures are trochanteric fractures,which usually occur from low-energy trauma like minor falls,especially in older people with osteoporotic bones.AIM To evaluate the treatment ...BACKGROUND Among the most frequent hip fractures are trochanteric fractures,which usually occur from low-energy trauma like minor falls,especially in older people with osteoporotic bones.AIM To evaluate the treatment efficacy of dynamic condylar screws(DCS)and proximal femoral nails(PFN)for unstable intertrochanteric fractures.METHODS To find pertinent randomized controlled trials and retrospective observational studies comparing PFN with DCS for the management of unstable femoral intertrochanteric fractures,a thorough search was carried out.For research studies published between January 1996 and April 2024,PubMed,EMBASE,Scopus,Web of Science,Cochrane Library,and Google Scholar were all searched.The complete texts of the papers were retrieved,vetted,and independently examined by two investigators.Disputes were settled by consensus,and any disagreements that persisted were arbitrated by a third author.RESULTS This study included six articles,comprising a total of 173 patients.Compared to the DCS,the PFN had a shorter operation time[mean difference(MD):-41.7 min,95%confidence interval(95%CI):-63.04 to-20.35,P=0.0001],higher success rates with closed reduction techniques[risk ratio(RR):34.05,95%CI:11.12-104.31,P<0.00001],and required less intraoperative blood transfusion(MD:-1.4 units,95%CI:-1.80 to-1.00,P<0.00001).Additionally,the PFN showed shorter fracture union time(MD:-6.92 wk,95%CI:-10.27 to-3.57,P<0.0001)and a lower incidence of reoperation(RR:0.37,95%CI:0.17-0.82,P=0.01).However,there was no discernible variation regarding hospital stay,implant-related complications,and infections.CONCLUSION Compared to DCS,PFN offers shorter operative times,reduces the blood transfusions requirements,achieves higher closed reduction success,enables faster fracture healing,and lowers reoperation incidence.展开更多
BACKGROUND The traditional Gamma3 nail is a mainstream treatment for femoral intertrochanteric fractures.Literature reports that the Gamma3U-blade system can increase the stability of the Gamma3 nail and reduce compli...BACKGROUND The traditional Gamma3 nail is a mainstream treatment for femoral intertrochanteric fractures.Literature reports that the Gamma3U-blade system can increase the stability of the Gamma3 nail and reduce complication incidence.However,comparative studies between the Gamma3U-blade and Gamma3 systems are limited;hence,this meta-analysis was performed to explore the clinical efficacy of these two surgical methods.AIM To investigate the clinical efficacy of Gamma3 and Gamma3 U-blade for intertrochanteric fractures.METHODS A computerized search for Chinese and English literature published from 2010 to 2022 was conducted in PubMed,Cochrane,CNKI,Wanfang,and VIP databases.The search keywords were gamma 3,gamma 3 U blade,and intertrochanteric fracture.Additionally,literature tracking was performed on the references of published literature.The data were analyzed using Revman 5.3 software.Two individuals checked the inputs for accuracy.Continuous variables were described using mean difference and standard deviation,and outcome effect sizes were expressed using ratio OR and 95%confidence interval(CI).High heterogeneity was considered at(P<0.05,I2>50%),moderate heterogeneity at I2 from 25%to 50%,and low heterogeneity at(P≥0.05,I2<50%).RESULTS Following a comprehensive literature search,review,and analysis,six articles were selected for inclusion in this study.This selection comprised five articles in English and one in Chinese,with publication years spanning from 2016 to 2022.The study with the largest sample size,conducted by Seungbae in 2021,included a total of 304 cases.Statistical analysis:A total of 1063 patients were included in this meta-analysis.The main outcome indicators were:Surgical time:The Gamma3U blade system had a longer surgical time compared to Gamma3 nails(P=0.006,I2=76%).Tip-apex distance:No statistical significance or heterogeneity was observed(P=0.65,I2=0%).Harris Hip score:No statistical significance was found,and low heterogeneity was detected(P=0.26,I2=22%).Union time:No statistical significance was found,and high heterogeneity was detected(P=0.05,I2=75%).CONCLUSION Our study indicated that the Gamma3 system reduces operative time compared to the Gamma3 U-blade system in treating intertrochanteric fractures.Both surgical methods proved to be safe and effective for this patient group.These findings may offer valuable insights and guidance for future surgical protocols in hip fracture patients.展开更多
In this editorial,I present my comments on the article by Solarino et al.Conversion hip arthroplasty,which is an optional salvage procedure performed following unsuccessful fixation of intertrochanteric femur fracture...In this editorial,I present my comments on the article by Solarino et al.Conversion hip arthroplasty,which is an optional salvage procedure performed following unsuccessful fixation of intertrochanteric femur fractures in elderly pati-ents,entails more complex processes and higher rates of operative complications than primary arthroplasty.Hence,it is important to consider the appropriateness of the primary treatment choice,as well as the adequacy of nailing fixation for intertrochanteric fractures.This article briefly analyzes the possible factors contributing to the nailing failure of intertrochanteric fractures and attempts to find corresponding countermeasures to prevent fixation failures.It also analyzes the choice of treatment between nailing fixation and primary arthroplasty for intertrochanteric fractures.展开更多
BACKGROUND Severe skeletal class II malocclusion is the indication for combined orthodontic and orthognathic treatment.CASE SUMMARY A woman with a chief complaint of a protruding chin and an inability to close her lip...BACKGROUND Severe skeletal class II malocclusion is the indication for combined orthodontic and orthognathic treatment.CASE SUMMARY A woman with a chief complaint of a protruding chin and an inability to close her lips requested orthodontic camouflage.The treatment plan consisted of extracting the right upper third molar,right lower third molar,left lower second molar,and left upper third molar and moving the maxillary dentition distally using a convenient method involving microimplant nail anchors,push springs,long arm traction hooks,and elastic traction chains.After 52 months of treatment,her overbite and overjet were normal,and her facial profile was favorable.CONCLUSION This method can be used for distal movement of the maxillary dentition and to correct severe skeletal class II malocclusion in adults.展开更多
文摘Introduction: The management of fractures of the tibia shaft is an important aspect of orthopaedic care, and the selection of the surgical method for fixation can substantially impact patient outcomes. The current review aims to compare the outcomes of adult tibia fractures treated with solid nails to those treated with hollow nails. Methods: A search on Scopus, PubMed, and Cochrane Library, using three keywords (Outcome, Tibia shaft fractures, Nail) was conducted in April 2023. Results were compiled and two independent reviewers screened and selected eligible articles After removing duplicates, titles and abstracts were read to exclude ineligible studies. Full-text articles of the remaining papers were read to select eligible studies which were further critically appraised to ascertain their methodological quality. The data extracted from the selected papers were synthesized using a combination of pooling of results, tests of statistical difference (t-test and chi-square) and narrative synthesis methods. Results: A total of 2295 articles were obtained from the databases and citation searching. A total of 9 papers were identified as eligible and included in the review. Findings revealed that there is no statistical difference in the outcomes of tibia fractures treated with either solid or hollow nail groups such as duration of surgery (p = 0.541), rate of delayed and non-union (p = 0.342), and rate of surgical site infections (p = 0.395). Conclusion: Intramedullary nailing of tibia shaft fractures with either solid or hollow nails have similar functional outcomes.
基金Supported by Children’s Hospital Charity and Industry(Nuvasive,CA,United States),No.5431.
文摘BACKGROUND Femoral lengthening is a procedure of great importance in the treatment of congenital and acquired limb deficiencies.Technological advances have led to the latest designs of fully implantable motorized intramedullary lengthening nails.The use of these nails has increased over the last few years.AIM To review and critically appraise the literature comparing the outcome of femoral lengthening in children using intramedullary motorized lengthening nails to external fixation.METHODS Electronic databases(MEDLINE,CINAHL,EMBASE,Cochrane)were systematically searched in November 2019 for studies comparing the outcome of femoral lengthening in children using magnetic lengthening nails and external fixation.The outcomes included amount of gained length,healing index,complications and patient reported outcomes.RESULTS Of the 452 identified studies,only two(retrospective and non-randomized)met the inclusion criteria.A total of 91 femora were included.In both studies,the age of patients treated with nails ranged from 15 to 21 years compared to 9 to 15 years for patients in the external fixation group.Both devices achieved the target length.Prevalence of adverse events was less in the nail(60%-73%)than in the external fixation(81%-100%)group.None of the studies presented patient reported outcomes.CONCLUSION The clinical effectiveness of motorized nails is equivalent or superior to external fixation for femoral lengthening in young patients.The available literature is limited and does not provide evidence on patient quality of life or cost effectiveness of the interventions.
基金The authors are grateful for the financial supports from the National Natural Science Foundation of China(51671017 and 51971020)the Beijing Municipal Natural Science Foundation,China(2202033)+2 种基金Beijing Laboratory of Metallic Materials and Processing for Modern Transportation,China,the Fundamental Research Funds for the Central Universities,China(FRF-IC-19-015)the Major State Research and Development Program of China(2016YFB0300801)the Opening Research Fund of State Key Laboratory for Advanced Metals and Materials,China(2018-Z04).
文摘The microstructure,mechanical properties and corrosion behavior of quaternary degradable Mg−1Zn−0.2Ca−xAg(x=1,2,4 wt.%)alloy wires,intended as anastomotic nails,were investigated.It was found that these Ag-containing alloy wires mainly consist of Mg matrix and Ag17Mg54 phase,characterized by SEM,EDS,XRD and TEM.Tensile and knotting tests results demonstrate the superior mechanical properties of these alloy wires.Especially,Mg−1Zn−0.2Ca−4Ag alloy exhibits the highest mechanical properties,i.e.an ultimate tensile strength of 334 MPa and an elongation of 8.6%.Moreover,with increasing Ag content,the corrosion rates of these alloy wires remarkably increase due to the formation of more micro-galvanic coupling between Mg matrix and Ag17Mg54 phase,shown by mass loss and scanning Kelvin probe force microscopy(SKPFM)results.The present alloy can be completely degraded within 28 d,satisfying the property requirements of anastomotic nails.
基金sponspored by research opening fund of State Key Laboratory of Environmental Geochemistry,Guiyang,Guizhou Province,China with grant No.SKLEG2017910。
文摘In recent times,there had been reported cases of Pb poisoning in Anka gold mining area,Northwest Nigeria.Therefore,this study was carried out to determine the extent of bioaccumulation of heavy metals in the hairs and nails of children in the area.Forty samples(twenty nails and twenty hairs)samples were collected from ten boys and ten girls of ages 5–9 residing in the area.To ascertain the sources of heavy metals in children,15 soils samples,15 groundwater samples,5 samples of mine tailings,and 5 plants samples were collected.Hair and nails of the subjects were collected using internationally acceptable techniques.All samples were kept in uncontaminated ziplock bags prior to laboratory preparation and analysis.The samples were cleaned using nonionic detergent(triton X-100)and deionized water.The hairs and nails were digested with 10 mL of 6:1 mixture of nitric acid and perchloric acid.The soils,mine tailings,and plants were air-dried at room temperature,sieved,and chemically digested using the aqua regia method.The concentrations of metals in all the samples were determined using highperformance liquid chromatography–inductively coupled plasma–mass spectrometry.Statistical analysis was employed to unravel potential sources of metals in the media.Results showed that heavy metals in children of the area are above results from similar studies and pathological ranges for heavy metals in hairs and nails.Also,heavy metals in environmental media are above the recommended standards.Multivariate analysis showed that the metals are mainly from mining and other anthropogenic sources.Results of correlation between heavy metals in hairs and nails with those in geological samples revealed that heavy metal that bioaccumulates in the children of this area are mostly from contaminated environmental media.It is recommended that complete remediation and effective health education be carried out in the area.
文摘Tests of the capacity of shear connections consisting of nails in a row placed at distances 7, 10 and 14d, “d” being the cross-sectional dimension of the nail, versus single nail capacities, were executed. The performed tests do support the connotation that no reduction should be required for nails of diameter 2.8 mm or less in a row, provided that nails are spaced sufficiently far apart for wood cracking not to occur. At the ultimate capacity of the joint, all such thin nails in a row will be yielding, having developed plastic hinges, i.e. each single nail will have developed its ultimate capacity. Hence, the ultimate capacity of the connection will be each nail’s capacity times the number of nails in the row. The force pr. nail increases subsequent to the development of a plastic hinge. This is likely due to the axial pullout-force, i.e. the ultimate capacity of a shear connection is higher than the force required for developing plastic hinges in the nails. This additional capacity-reserve may also partly be attributed to the rotational resistance of nails. The number of nails in a row should make insignificant difference in the pr. nail capacity, as long as no wood cracking takes place. Thus, applying elastic theory to nails in a row does not seem relevant. This is in contrast to bolt-connections.
文摘Objective： To report 32 cases of femur supracondylar fracture treated with retrograde interlocking intramedullary nails in elderly patients. Methods： According to the AO classification, all of 32 cases were classified as extra-articular type A. 32 cases were treated with interlocking intramedullary nail by closed insertion from intercondylar fossa of the knee. All cases accepted CPM exercise as early as possible after operation. Results： Following up 5 to 15 months, all fractures united within an average duration of 5.3 months （4-7 months）. According to the Shelbourne scale, the excellent rate of the knee function was 86.3%. Conclusion： Retrograde interlocking intramedullary nail is useful alternative implant for the treatment of osteoporotic supracondylar fracture of femur, particularly of the type A fracture in the elderly population. Its merits include stable fixation, high rate of fracture union and few complications.
文摘In the present work, elements concentration in fingernails samples of volunteers of different ages (males, females) were determined using atomic absorption spectroscopy (AAS) Perkin-Elmer, spectrophotometer. Fingernails samples of different groups were analyzed to determine the trace elements Ca, Mg, Mn, Fe, Ni, Cu, Co, Zn and Pb. Standards materials were prepared for concentration assessment that adjacent to samples from two cities in different location in eastern province of Sudan for elements concentrations finding. In addition, samples of hands fingernails and toenails were analyzed for comparison and method validation. Consequently, the significant levels of elements concentration in nails samples of Jabiat residents compared to Port Sudan resident’s area due to soil dispersion are supporting the possibility of external contamination. The data of component matrix and rotated component matrix of varimax normalization using principal component analysis revealed important predictors of nails elements Mg, Mn, Fe, Cu and Zn concentrations in soil of both areas under study. However, the Pb, Ni, Ca, and Co are possible to be indication of different sources associated with environmental contamination. The significant correlation and principal component analysis of the elements of nails concentrations in the two categories supported the probability of different expose environmental contamination.
文摘BACKGROUND Proximal femoral nails(PFNs)are the most common method for the treatment of unstable intertrochanteric femoral fractures(IFFs),but postoperative bed rest is required.There is a large amount of blood loss during the operation.Osteoporosis in elderly patients may cause nonunion of fractures and other complications.Arthroplasty can give patients early weight bearing and reduce financial burden,but whether it can replace PFNs remains controversial.AIM To compare the clinical outcomes of arthroplasty and PFNs in the treatment of unstable IFFs in elderly patients.METHODS A search was conducted in the PubMed,Embase,and Cochrane Library databases and included relevant articles comparing arthroplasty and PFN.The search time was limited from January 1,2005 to November 1,2020.Two investigators independently screened studies,extracted data and evaluated the quality according to the inclusion and exclusion criteria.According to the research results,the fixed effect model or random effect model were selected for analysis.The following outcomes were analyzed:Harris Hip score,mortality,complications,operation time,blood loos,hospital stay,weight-bearing time,fracture classification and type of anesthesia.RESULTS We analyzed four randomized controlled trials that met the requirements.A total of 298 patients were included in these studies.According to the AO/OTA classification,there are 20 A1 types,136 A2 types,42 A3 types and 100 unrecorded types.Primary outcome:The Harris Hip Score at the final follow-up of the PFN group was higher[mean difference(MD):9.01,95%confidence interval(CI):16.57 to 1.45),P=0.02].There was no significant difference between the two groups in the rate of overall mortality[risk ratio(RR):1.44,P=0.44]or the number of complications(RR:0.77,P=0.05).Secondary outcomes:blood loss of the arthroplasty group was higher(MD:241.01,95%CI:43.06–438.96,P=0.02);the operation time of the PFN group was shorter(MD:23.12,95%CI:10.46–35.77,P=0.0003);and the length of hospital stay of the arthroplasty group was shorter[MD:0.97,95%CI:1.29 to 0.66),P<0.00001].There was no difference between the two groups in the type of anesthesia(RR:0.99).There were only two studies recording the weight-bearing time,and the time of full weight bearing in the arthroplasty group was significantly earlier.CONCLUSION Compared with PFN,arthroplasty can achieve weight bearing earlier and shorten hospital stay,but it cannot achieve a better clinical outcome.Arthroplasty cannot replace PFNs in the treatment of unstable IFFs in elderly individuals.
基金Foundation item： Project（NTF 12015） supported by the Scientific Research Foundation for Talent of Shantou University, China Project（PolyU 5320107E） supported by the Research Grants Committee General Research Fund, China
文摘Pullout resistance of a soil nail is a critical parameter in design and analysis for geotechnical engineers. Due to the complexity of field conditions, the pullout behaviour of cement grouted soil nail in field is not well investigated. In this work, a number of field pullout tests of pressure grouted soil nails were conducted to estimate the pullout resistance of soil nails. The effective bond lengths of field soil nails were accurately controlled by a new grouting packer system. Typical field test results and the related comparison with typical laboratory test results reveal that the apparent coefficient of friction （ACF） decreases with the increase of overburden soil pressure when grouting pressure is constant, but increases almost linearly with the increase of grouting pressure when overburden pressure （soil depth） is unchanged. Water contents of soil samples at soil nail surfaces show obvious reductions compared with the results of soil samples from drillholes. After soil nails were completely pulled out of the ground, surface conditions of the soil nails and surrounding soil were examined. It is found that the water content values of the soil at the soil/nail interfaces decrease substantially compared with those of soil samples extracted from drillholes. In addition, all soil nails expand significantly in the diametrical direction after being pulled out of ground, indicating that the pressurized cement grout compacts the soil and penetrates into soil voids, leading to a corresponding shift of failure surface into surrounding soil mass significantly.
基金Capital’s Funds for Health Improvement and Research(No.2018-1-2072)。
文摘Objective:To compare the outcomes of dynamic hip screws(DHS)and intramedullary nailing(IMN)in the treatment of extra-capsular metastatic carcinoma of the proximal femur.Methods:A retrospective case analysis method was used to examine data of patients with proximal metastatic cancer of the femur who were treated with internal fixation in Department of Orthopaedics,Beijing Friendship Hospital,from January 2007 to December 2018.Blood loss,postoperative pain,functional score,length of stay,and survival rates were compared,and postoperative complications were assessed.Results:Complete follow-up data were available for 33 patients.The mean follow-up period was 12.2±3.6(range:9-32)months and the average age was 72.3±4.7(range:59-83)years old.There were 20 females and 13 males.Twenty-three patients had undergone IMN and 10 DHS,according to bone defects and the patient’s overall condition.The median survival time was 10 months in the IMN group and 11 months in the DHS group.Duration of surgery(t=-7.366,P<0.001)and length of hospital stay(t=-3.509,P<0.001)differed significantly between the two groups.There was one case of breakage of internal fixation in the IMN group.Conclusions:There was no significant difference between DHS and IMN in terms of surgical efficacy.IMN and DHS were different in terms of surgical time and hospital stay.However,due to the limited number of cases in this study,multi-factor analysis has not been performed and needs to be further verified in future analysis.When developing a surgical plan,it is recommended to consider the patient’s condition and the surgeon’s experience.
文摘Background: Management of femoral diaphyseal fractures in the age group 616 years is controversial. There has been a resurgence worldwide for operative fixation. Material and methods: Twenty children (15 boys, 5 girls) aged 616 years with femoral diaphyseal fractures (20 fractures, one in each) were stabilized with Titanium Elastic Nail (TEN). Patients underwent surgery within ten days of their injury. The results were evaluated using Flynn’s Scoring Criteria.Two nails were used in each fracture. Results: All 20 patients were available for evaluation and follow up for a mean duration of 24 months (1532 months). Radiological union in all cases was achieved in a mean time of 8 weeks. Full weight bearing was possible in a mean time of 10 weeks (812 weeks). The results were excellent in 14 patients (70%) and successful in 6 patients (30%). Few complications that occurred were infection (in 2 cases), knee joint stiffness(in 4 cases), angulation less than 10 degrees( in 4 cases), shortening less than 10 mm(in 4 cases). Conclusion: Intramedullary fixation by TEN is an effective treatment of fracture of femur in properly selected patients of the 616 years age group.
文摘The aim of this article was to report a case of toe nails disorder associated with metformin use in an elderly patient with type2diabetes. Two years ago, after receiving metformin 0.5 g three times daily for 6 months, a 60-year-old Chinese man found his ten toe nails gradually thickened and yellowed (especially two thumbs). The symptoms improved and recovered after metformin discontinuance. Half year ago, metformin 0.5 g three times daily adopted again and toe nails disorder occurred again. Physician modified the therapy plan and replaced metformin with acarbose to control blood glucose level of this patient. According to the follow up 3 months after his discharge, ten toe nails recovered significantly and new parts of the nails were normal. Nail disorder was rarely reported in the worldwide, but the physicians should keep awareness of this adverse drug reaction (ADR), proper actions should be taken once it occurred to avoid unnecessary suffering of the patient.
文摘Surgical management of femoral shaft fractures with intramedullary nails has become the standard ofcare,with multiple options for entry point described,including piriformis entry,trochanter entry andretrograde femoral nails.Our present review describes the surgical anatomy of the proximal and distalfemur and its relation to different entry points for intramedullary femoral nails.In addition,we reviewedrelative indications for each technique,difficulties associated and possible complications.
基金supported by the National Natural Science Foundation of China(32130052,82072447,and 82272578)the Fundamental Research Funds for the Central Universities,Nankai University(730-C02922112 and 730-DK2300010314).
文摘With the aging population,intertrochanteric femur fracture in the elderly has become one of the most serious public health issues and a hot topic of research in trauma orthopedics.Due to the limitations of internal fixation techniques and the insufficient mechanical design of nails,the occurrence of complications delays patient recovery after surgical treatment.Design of a proximal femur bionic nail(PFBN)based on Zhang’s N triangle theory provides triangular supporting fixation,which dramatically decreases the occurrence of complications and has been widely used for clinical treatment of unstable intertrochanteric femur fracture worldwide.In this work,we developed an equivalent biomechanical model to analyze improvement in bone remodeling of unstable intertrochanteric femur fracture through PFBN use.The results show that compared with proximal femoral nail antirotation(PFNA)and InterTan,PFBN can dramatically decrease the maximum strain in the proximal femur.Based on Frost’s mechanostat theory,the local mechanical environment in the proximal femur can be regulated into the medium overload region by using a PFBN,which may render the proximal femur in a state of physiological overload,favoring post-operative recovery of intertrochanteric femur fracture in the elderly.This work shows that PFBN may constitute a panacea for unstable intertrochanteric femur fracture and provides insights into improving methods of internal fixation.
文摘BACKGROUND Among the most frequent hip fractures are trochanteric fractures,which usually occur from low-energy trauma like minor falls,especially in older people with osteoporotic bones.AIM To evaluate the treatment efficacy of dynamic condylar screws(DCS)and proximal femoral nails(PFN)for unstable intertrochanteric fractures.METHODS To find pertinent randomized controlled trials and retrospective observational studies comparing PFN with DCS for the management of unstable femoral intertrochanteric fractures,a thorough search was carried out.For research studies published between January 1996 and April 2024,PubMed,EMBASE,Scopus,Web of Science,Cochrane Library,and Google Scholar were all searched.The complete texts of the papers were retrieved,vetted,and independently examined by two investigators.Disputes were settled by consensus,and any disagreements that persisted were arbitrated by a third author.RESULTS This study included six articles,comprising a total of 173 patients.Compared to the DCS,the PFN had a shorter operation time[mean difference(MD):-41.7 min,95%confidence interval(95%CI):-63.04 to-20.35,P=0.0001],higher success rates with closed reduction techniques[risk ratio(RR):34.05,95%CI:11.12-104.31,P<0.00001],and required less intraoperative blood transfusion(MD:-1.4 units,95%CI:-1.80 to-1.00,P<0.00001).Additionally,the PFN showed shorter fracture union time(MD:-6.92 wk,95%CI:-10.27 to-3.57,P<0.0001)and a lower incidence of reoperation(RR:0.37,95%CI:0.17-0.82,P=0.01).However,there was no discernible variation regarding hospital stay,implant-related complications,and infections.CONCLUSION Compared to DCS,PFN offers shorter operative times,reduces the blood transfusions requirements,achieves higher closed reduction success,enables faster fracture healing,and lowers reoperation incidence.
基金Supported by The Clinical Medical Science and Technology Development Fund Project of Jiangsu University,No.JLY2021185.
文摘BACKGROUND The traditional Gamma3 nail is a mainstream treatment for femoral intertrochanteric fractures.Literature reports that the Gamma3U-blade system can increase the stability of the Gamma3 nail and reduce complication incidence.However,comparative studies between the Gamma3U-blade and Gamma3 systems are limited;hence,this meta-analysis was performed to explore the clinical efficacy of these two surgical methods.AIM To investigate the clinical efficacy of Gamma3 and Gamma3 U-blade for intertrochanteric fractures.METHODS A computerized search for Chinese and English literature published from 2010 to 2022 was conducted in PubMed,Cochrane,CNKI,Wanfang,and VIP databases.The search keywords were gamma 3,gamma 3 U blade,and intertrochanteric fracture.Additionally,literature tracking was performed on the references of published literature.The data were analyzed using Revman 5.3 software.Two individuals checked the inputs for accuracy.Continuous variables were described using mean difference and standard deviation,and outcome effect sizes were expressed using ratio OR and 95%confidence interval(CI).High heterogeneity was considered at(P<0.05,I2>50%),moderate heterogeneity at I2 from 25%to 50%,and low heterogeneity at(P≥0.05,I2<50%).RESULTS Following a comprehensive literature search,review,and analysis,six articles were selected for inclusion in this study.This selection comprised five articles in English and one in Chinese,with publication years spanning from 2016 to 2022.The study with the largest sample size,conducted by Seungbae in 2021,included a total of 304 cases.Statistical analysis:A total of 1063 patients were included in this meta-analysis.The main outcome indicators were:Surgical time:The Gamma3U blade system had a longer surgical time compared to Gamma3 nails(P=0.006,I2=76%).Tip-apex distance:No statistical significance or heterogeneity was observed(P=0.65,I2=0%).Harris Hip score:No statistical significance was found,and low heterogeneity was detected(P=0.26,I2=22%).Union time:No statistical significance was found,and high heterogeneity was detected(P=0.05,I2=75%).CONCLUSION Our study indicated that the Gamma3 system reduces operative time compared to the Gamma3 U-blade system in treating intertrochanteric fractures.Both surgical methods proved to be safe and effective for this patient group.These findings may offer valuable insights and guidance for future surgical protocols in hip fracture patients.
文摘In this editorial,I present my comments on the article by Solarino et al.Conversion hip arthroplasty,which is an optional salvage procedure performed following unsuccessful fixation of intertrochanteric femur fractures in elderly pati-ents,entails more complex processes and higher rates of operative complications than primary arthroplasty.Hence,it is important to consider the appropriateness of the primary treatment choice,as well as the adequacy of nailing fixation for intertrochanteric fractures.This article briefly analyzes the possible factors contributing to the nailing failure of intertrochanteric fractures and attempts to find corresponding countermeasures to prevent fixation failures.It also analyzes the choice of treatment between nailing fixation and primary arthroplasty for intertrochanteric fractures.
基金Supported by Medical Science Research Project Plan by Health Commission of the Hebei Province,No.20220063.
文摘BACKGROUND Severe skeletal class II malocclusion is the indication for combined orthodontic and orthognathic treatment.CASE SUMMARY A woman with a chief complaint of a protruding chin and an inability to close her lips requested orthodontic camouflage.The treatment plan consisted of extracting the right upper third molar,right lower third molar,left lower second molar,and left upper third molar and moving the maxillary dentition distally using a convenient method involving microimplant nail anchors,push springs,long arm traction hooks,and elastic traction chains.After 52 months of treatment,her overbite and overjet were normal,and her facial profile was favorable.CONCLUSION This method can be used for distal movement of the maxillary dentition and to correct severe skeletal class II malocclusion in adults.
