Use of Modified Tension Band Sutures for Fingernail Disruptions

2007 ◽  
Vol 32 (6) ◽  
pp. 668-674 ◽  
Author(s):  
H. S. PATANKAR
Keyword(s):  
Nail Plate ◽  
Distal Phalanx ◽  
Tension Band ◽  
Age Group ◽  
Simple Method ◽  
Nail Bed ◽  
Finger Nail ◽  
Wire Fixation ◽  
Displaced Fracture

A series of 66 patients, aged between 1 and 70 years, with 70 disruptive injuries to finger nails was reviewed. The injuries were treated by cleaning of the finger, evacuation of haematoma and anatomical replacement of the nail plate, or a substitute, which was secured with a modified dorsal tension band suture without formal repair of the nail bed. K-wire fixation of the distal phalanx was employed only in the event of displaced fracture of the distal phalanx, complete absence of the nail plate and laceration extending to the distal pulp. This simple method, which bypasses the injured and friable, but vital nail structures resulted in uncomplicated reformation of the normal nail plate in all of the cases. Removal of the nail plate and formal repair of the nail bed is not necessary in any age group with finger nail disruptions.

The Use of Chloramphenicol Ointment as an Adhesive for Replacement of the Nail Plate after Simple Nail Bed Repairs

2004 ◽  
Vol 29 (6) ◽  
pp. 634-635 ◽  
Author(s):  
C. PASAPULA ◽  
M. STRICK
Keyword(s):  
Antibacterial Effect ◽  
Nail Plate ◽  
Simple Method ◽  
Nail Bed

Fingertip injuries are common and are often repaired. The nail plate is replaced to protect the repair and maintain the alignment of the nail bed edges after repair. Once replaced, this can be secured by any means and often a suture is used. We advocate that a small bleb of chloramphenicol provides a simple method of securing the nail plate. It is fast, easy and secure. In addition it provides an antibacterial effect, which may be of some benefit.

Reconstruction of the Great Toe Ski-Slope, Sunken-Nail Deformity with a Buried Adipofascial Flap

2004 ◽  
Vol 94 (6) ◽  
pp. 578-582
Author(s):  
Thomas S. Roukis ◽  
Adam S. Landsman
Keyword(s):  
Nail Plate ◽  
Surgical Excision ◽  
Distal Phalanx ◽  
Great Toe ◽  
Nail Bed ◽  
Adipofascial Flap ◽  
Nail Deformity ◽  
Complete Surgical Excision ◽  
Surgical Options ◽  
Normal Architecture

Development of a ski-slope deformity following loss of the great toe nail plate is a problematic condition with few conservative or surgical options available. The condition becomes more difficult to treat when the distal, medial, and lateral labial nail folds are hypertrophied, creating the appearance of a sunken nail. We present a case of ski-slope, sunken-nail deformity following multiple attempts at chemical nail matrixectomy. The patient’s persistent pain and deformity were managed through 1) nail plate avulsion and complete surgical excision of the germinal nail matrix, 2) remodeling of the distal phalanx, and 3) elevation of an adipofascial flap from the plantar tuft of the great toe, which was brought from plantar to dorsal and interposed between the dorsal aspect of the distal phalanx and the overlying nail bed in buried fashion. The combination of these procedures elevated the nail bed, which restored normal architecture to the great toe and relieved the pain associated with the chronic deformity. This case demonstrates a potential complication of a commonly performed procedure and a salvage technique useful for dealing with the resultant ski-slope, sunken-nail deformity (J Am Podiatr Med Assoc 94(6): 578–582, 2004)

DISTAL PHALANGEAL RECONSTRUCTION FOR RECURRENT INTRAOSSEOUS EPIDERMOID CYST OF THE FINGER — A CASE REPORT

Hand Surgery ◽  
2011 ◽  
Vol 16 (03) ◽  
pp. 375-377 ◽  
Author(s):  
Kazuya Kurosawa ◽  
Ryoichi Kobayashi ◽  
Kenji Takagishi
Keyword(s):  
Case Report ◽  
Epidermoid Cyst ◽  
Nail Plate ◽  
Ring Finger ◽  
Distal Phalanx ◽  
Nail Bed ◽  
Distal Half ◽  
Longitudinal Incision ◽  
Bone Fusion ◽  
And Function

Intraosseous epidermoid cyst of the finger phalanx is rare. We report a case of postoperative recurrent intraosseous epidermoid cyst of the distal phalanx of the ring finger. To prevent further recurrence while maintaining morphology and function, the distal half of the distal phalanx that included the epidermoid cyst was resected to completely remove the lesion. The distal phalanx was then reconstructed by grafting corticocancellous bone from the ilium and shaped into a distal phalanx. The operation was performed using a through-the-nail approach, temporarily removing the nail and placing a longitudinal incision in the nail bed to approach the phalanx. Postoperatively, bone fusion was achieved without recurrence and the shape of the distal phalanx was normal. Distal phalangeal hypertrophy and nail plate deformity also normalized and excellent results were obtained.

scholarly journals Nail changes in construction site workers: an observational study

2020 ◽  
Vol 9 (1) ◽  
pp. 84
Author(s):  
Nidhi Kamra ◽  
Sahil Sardana
Keyword(s):  
Observational Study ◽  
Preventive Measures ◽  
Nail Plate ◽  
Age Group ◽  
Construction Site ◽  
Nail Bed ◽  
Nail Changes ◽  
Group 10

Background: Nail changes are common in occupational labourers but no studies have been done pertaining to construction site workers. We studied nail changes in labourers working at various construction sites.Methods: 50 labourers of age group 10-65 years and both sexes were enrolled for the study. Changes in nail apparatus were studied by dividing into nail plate, nail bed and nail fold changes.Results: Males outnumbered females in our study. Most of the labourers were in age group of 10-25 years. Most common nail plate changes were Longitudinal ridging and discoloration of nail plate; nail bed were onycholysis, subungual hemorrhage, onycholysis and nail fold changes were absent cuticle and hang nail.Conclusions: Adequate preventive measures are required at construction site workplace to prevent long standing nail sequalae.

scholarly journals Should the nail plate be replaced or discarded after nail bed repair in children? Nail bed INJury Analysis (NINJA) randomised controlled trial: a health economic and statistical analysis plan

Trials ◽  
2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Jamie R. Stokes ◽  
May Ee Png ◽  
Abhilash Jain ◽  
Aina V. H. Greig ◽  
Beverly A. Shirkey ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Surgical Site Infection ◽  
Controlled Trial ◽  
Nail Plate ◽  
Site Infection ◽  
Nail Bed ◽  
Finger Nail ◽  
Cosmetic Appearance ◽  
Randomised Controlled ◽  
Post Randomisation

Abstract Background Nail bed trauma is one of the most common surgically treated paediatric hand injuries in the UK. Despite surgeons generally expressing a preference to replace the nail plate after repairing the nail bed, there is limited evidence to support this practice. We describe a statistical and health economic analysis plan (SHEAP) for the Nail bed INJury Analysis (NINJA) randomised controlled trial. Methods/design NINJA is a multicentre, pragmatic, superiority, parallel group randomised controlled trial of the treatment of nail bed injury in participants 16 years old or younger. The study aims to evaluate the efficacy and cost-effectiveness of replacing the nail plate compared to discarding it following the repair of a nail bed injury. Surgical site infection at 7–10 days post-randomisation and cosmetic appearance of the nail are the co-primary outcomes for NINJA. Surgical site infection at 7–10 days post-randomisation will be evaluated using a logistic regression model adjusting for site as the sole stratification factor and allowing for intra-site correlation. Cosmetic appearance will be assessed via the newly developed Oxford Finger Nail Appearance Score and will be evaluated by use of a Mann-Whitney U test. An ordinal logistic regression model will also be used to assess the Oxford Finger Nail Appearance Score, adjusting for site and allowing for intra-site correlation. Secondary outcomes are measured at 7–10 days and 4 months and include the EQ-5D-Y questionnaire, pain at first dressing change, cost-effectiveness, late surgical site infection, and participant/parent satisfaction with nail healing. Missing primary outcome data will be summarised by treatment arm and investigated through a sensitivity analysis. Full details of the planned methods of analysis and descriptive statistics are described in this paper. The NINJA study protocol has been published previously. Discussion The planned analysis strategy for the NINJA trial has been set out here to reduce the risk of reporting bias and data-driven analysis. Any deviations from the SHEAP described in this paper will be detailed and justified fully in the final report of the trial. Trial registration ISRCTN, ISRCTN44551796. Registered on 23 April 2018.

Osteomyelitis of the distal phalanx following trauma to the nail. A case report

1992 ◽  
Vol 82 (10) ◽  
pp. 542-544 ◽  
Author(s):  
IM Fox
Keyword(s):  
Case Report ◽  
Chronic Osteomyelitis ◽  
Nail Plate ◽  
Distal Phalanx ◽  
Nail Bed ◽  
Phalangeal Fracture

A case in which inadequate treatment of a nail plate injury resulted in chronic osteomyelitis has been described. Because of its distinct anatomy, trauma to the nail and its associated structures should not be summarily dismissed as an innocuous injury but should be thoroughly examined for phalangeal fracture and laceration of the nail bed.

Staged Management of Severely Displaced Calcaneal Fractures With Transarticular Pinning: A Damage Control Strategy

2021 ◽  
pp. 107110072110130
Author(s):  
Kyeong-Hyeon Park ◽  
Chang-Wug Oh ◽  
Joon-Woo Kim ◽  
Hee-June Kim ◽  
Dong-Hyun Kim ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Internal Fixation ◽  
Kirschner Wire ◽  
Wound Complications ◽  
Calcaneal Fractures ◽  
Simple Method ◽  
Wire Fixation ◽  
The Mean ◽  
Radiographic Union

Background: Severely displaced calcaneal fractures can result in considerable morphology derangement and may be accompanied by soft tissue compromise. Delayed operative restoration of the calcaneal morphology may result in acute retensioning of the damaged soft tissue with associated wound-related complications. In this study, we describe a staged treatment of displaced intra-articular calcaneal fractures that uses temporary transarticular Kirschner wire (K-wire) fixation and staged conversion to definite fixation. Methods: We identified all of the patients who were treated at our institution for calcaneal fractures between 2015 and 2019. A total of 17 patients with 20 calcaneal fractures were selectively treated with 2-stage management. Temporary transarticular K-wire fixation was performed 24 hours after the injury to restore calcaneal morphology and the surrounding soft tissue. After the soft tissue was considered safe, delayed open reduction and internal fixation was performed. The time to definite surgery, radiographic alignment, wound complications, time to radiographic union, and hindfoot American Orthopaedic Foot & Ankle Society (AOFAS) scores were recorded. Results: The average follow-up period was 17 months (range, 12-43). The average Böhler angle increased from a mean of −22 degrees (range, −109 to 25) to 25 degrees (range, 0 to 47) after temporary transarticular K-wire fixation. The mean time from temporary pinning to conversion to definite internal fixation was 20 (range, 10-32) days. There were no immediate postoperative complications. The average time to radiographic union was 13.7 (range, 10-16) weeks. The mean AOFAS score was 87 (range, 55-100). No infections or wound complications were reported during the follow-up period. Conclusion: Temporary transarticular pinning for staged calcaneal fracture treatment is safe and effective in restoring the calcaneal morphology. This novel and relatively simple method may facilitate delayed operation and decrease wound-related complications. Level of Evidence: Level IV, retrospective case series.

scholarly journals Ultrasound Evaluation of the Effectiveness of the Use of Acitretin in the Treatment of Nail Psoriasis

2021 ◽  
Vol 10 (10) ◽  
pp. 2122
Author(s):  
Magdalena Krajewska-Włodarczyk ◽  
Zbigniew Żuber ◽  
Agnieszka Owczarczyk-Saczonek
Keyword(s):  
Morphological Changes ◽  
Nail Plate ◽  
Clinical Signs ◽  
Extensor Tendon ◽  
Control Group ◽  
Nail Bed ◽  
Nail Psoriasis ◽  
Ultrasound Evaluation ◽  
Tendon Thickness ◽  
Retinoid Treatment

The study aimed to evaluate the effect of retinoid treatment on the morphological changes in the nail apparatus in patients with nail psoriasis. Material and methods: 41 patients aged 32 to 64 with nail psoriasis, without clinical signs of psoriatic arthritis, started on acitretin 0.6 to 0.8 mg kg b.w./d, for six months and 28 people in the control group were included in the study. Both groups had ultrasound examination of fingernails and digital extensor tendon in the distal interphalangeal joints. In psoriatic patients, US examination was conducted before starting the treatment and after six months. A total of 685 nails were examined. Results: After six months of treatment, there was a reduction in the thickness of the nail bed and nail matrix (p = 0.046 and p = 0.031, respectively). The thickness of the nail plates decreased, although it was statistically insignificant (p = 0.059) and it was higher than in the control group (p = 0.034). The reduced severity of clinical nail changes after six months of retinoid treatment did not correlate with the reduction in extensor tendon thickness in any group of patients. Conclusions: In patients with nail psoriasis, acitretin treatment resulted in a rapid decrease in the thickness of the nail bed and matrix, but it did not affect the thickness of the nail plate after six months. There was no effect of acitretin on the digital extensor tendon thickness or the increased blood supply to the tendon area. The results of the study may indicate the usefulness of ultrasound nail examinations in patients with nail psoriasis not only to assess the advancement of morphological changes and response to treatment, but also to choose the potential treatment.

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