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Predictive accuracy of a general-purpose artificial intelligence model for cut-out following proximal femoral nailing.

INTRODUCTION: Cut-out is the most consequential mechanical complication after proximal femoral nailing and requires prompt recognition. General-purpose artificial intelligence (AI) models with image-interpretation capability are increasingly accessible, yet their diagnostic performance for this task is unknown. We evaluated ChatGPT's accuracy for predicting cut-out following proximal femoral nailing and compared TFNA and Gamma nail subgroups. MATERIALS AND METHODS: In this retrospective predictive-accuracy study, 989 patients (683 TFNA, 306 Gamma nail; mean age 83.8 years; cut-out prevalence

Intramedullary Nailing Versus Modular Megaprosthesis in Pathological Humeral Fractures: A 10-Year Retrospective Comparative Study.

BACKGROUND: Pathological fractures of the humerus secondary to metastatic disease represent a significant cause of pain, disability, and reduced quality of life in oncologic patients. Surgical management aims to restore stability, reduce pain, and allow early mobilization. However, the optimal strategy between intramedullary nailing and modular megaprosthesis remains debated, particularly in relation to functional outcomes and long-term results. METHODS: A retrospective observational study was conducted on 48 patients treated for pathological or impending humeral fractures between January 201

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… Intramedullary nailing is less invasive and allows rapid functional recovery, making it particularly suitable for patients with limited life expectancy. … Patients were divided into two groups based on the surgical treatment performed: Intramedullary nailing group (IMN group, n = 26; 54.2%) Patients underwent fixation with locked intramedullary nails. …

Implant Survivorship and Functional Recovery Utilizing a Modern Knee Fusion Nail Spacer for Periprosthetic Joint Infection.

BACKGROUND: Traditional indications for static spacers include substantial bone loss, ligamentous insufficiency, extensor mechanism dysfunction, or severe soft-tissue compromise. However, conventional designs are associated with high complication rates and morbidity. A knee fusion nail spacer (FNS) construct combines mechanical stability with targeted antibiotic delivery. This study aimed to (1) describe outcomes of FNS use in terms of total knee arthroplasty (TKA) reimplantation, infection eradication, and limb salvage; (2) determine FNS survivorship with reinfection as the endpoint; and (3)

Incidence of Complications in Proximal Femoral Nailing for Comminuted Intertrochanteric Femur Fractures in a Rural Population: A Retrospective Analysis.

BACKGROUND: Unstable intertrochanteric fractures (AO Foundation/Orthopaedic Trauma Association (AO/OTA) 31-A2 and 31-A3) are technically demanding. In rural care pathways, delays to presentation and surgery, limited implant/operating resources, and restricted access to structured rehabilitation and follow-up may increase the risk of mechanical failure, wound complications, and delayed functional recovery. METHODS: We retrospectively screened consecutive adults treated with proximal femoral nailing (PFN) for intertrochanteric femur fractures between January 2024 and December 2025. Stable AO/OT

Area-to-Length Ratio: a significant predictor of nonunion following intramedullary nailing of comminuted femoral shaft fractures.

BACKGROUND: The relationship between fragment characteristics and nonunion risk in comminuted femoral shaft fractures remains controversial. This study aimed to investigate the relationship between radiographic fragment features and fracture union outcomes to assist clinical assessment. PATIENTS AND METHODS: A retrospective analysis was conducted on 91 femoral shaft fractures from 89 patients. Patient demographics, injury characteristics, and radiographic parameters-including fragment size, displacement, gap area, nail-to-canal diameter ratio, and ALR (gap area/major fragment length)-were ana

Removal of broken solid intramedullary nail of femur: A case report on removal technique in a resource-limited setup.

INTRODUCTION: Intramedullary nail is the mainstay of treatment for femur shaft fracture. One of the potential complications of intramedullar … mis using another broken nail after an entry hole was made over the piriformis. DISCUSSION: Broken nails far from the previous fracture or nonunion site are quite difficult to remove at the distal end. It is a technically demanding procedure that requires different techniques and special extraction tools. Several techniques have been described, mostly …

Comparison of nail-plate and double-plate fixation in primary and periprosthetic distal femur fractures in older adults.

INTRODUCTION: Distal femur fractures in the geriatric age group have a one-year mortality rate similar to hip fractures. Like hip fractures, treatment should focus on early mobilization to reduce morbidity and mortality. Nail-Plate Combination (NPC) and Double-Plate Combination (DPC) are suggested to allow early mobilization with low mechanical complication rates. This study aimed to compare the clinical and radiological outcomes of NPC and DPC in elderly patients with distal femur fractures. METHODS: After the inclusion and exclusion criteria, 28 patients treated with NPC and 24 patients tre

The course of treatment in nonunions of long bones: can we predict when exchange nailing may fail?

PURPOSE: Exchange nailing is often used to treat femoral and tibial nonunions. Its success rate varies with reports of 50-100% success. We sought to determine the trajectory of healing and identify factors associated with the failure of exchange nailing in the treatment of nonunion. METHODS: This was a retrospective chart review at two level I trauma centers. Patients with aseptic femoral and tibial nonunions treated with exchange nailing were included. The primary outcome was union prior to or at 1 year following treatment. Treatment failure was defined as lack of union (defined as lack of b

Functional Outcomes of Minimally Invasive Titanium Elastic Nailing for Displaced Midshaft Clavicle Fractures: A Prospective Study.

BACKGROUND: Displaced midshaft clavicle fractures account for the majority of all clavicular injuries. Titanium elastic nailing system (TENS) offers a minimally invasive alternative to plate fixation. The primary objective was to assess the efficacy and safety of minimally invasive TENS by evaluating functional, clinical, and radiological outcomes, including union and complication rates, in displaced midshaft clavicle fractures. METHODS: This prospective study included 30 patients (25 male and five female patients; mean age 38.06 years) with displaced midshaft clavicle fractures treated with

Tibiotalocalcaneal hindfoot nailing for failed pilon fractures in neuropathic patients: a prospective case series and treatment rationale.

Failed pilon fractures in patients with peripheral neuropathy present a complex reconstructive challenge due to poor bone quality, impaired healing, and high rates of fixation failure. When standard revision fixation is unlikely to succeed, treatment options are limited and amputation is frequently considered. This prospective case series evaluates the role of tibiotalocalcaneal arthrodesis using retrograde hindfoot nailing as a limb-preserving strategy in this difficult subgroup and clarifies patient selection criteria. Between January 2022 and June 2024, fifteen consecutive patients with fai

Clinical outcomes of cement gun-assisted intramedullary nailing for femoral bone metastases: a retrospective case series.

BACKGROUND: Surgical stabilization for femoral bone metastases is commonly performed to prevent or treat pathological fractures; however, local tumor progression may result in implant failure and reoperation. Cement gun-assisted intramedullary nailing (CG-IMN) allows extensive polymethylmethacrylate (PMMA) filling within the medullary canal, providing enhanced mechanical stability and facilitating early weight-bearing. This study aimed to evaluate the clinical outcomes of CG-IMN for femoral bone metastases. METHODS: We retrospectively reviewed 11 consecutive patients who underwent CG-IMN for

Occult cement plug causing femoral canal obstruction during nailing after TKA: a case report.

With the aging global population, periprosthetic and post-arthroplasty femoral shaft fractures are becoming increasingly common. Although intramedullary nailing remains one of the classic surgical procedures for treating femoral shaft fractures in many cases, the presence of an unexpected space-occupying lesion within the medullary canal may often increase the surgical difficulty. This paper reports a case of a femoral fracture occurring 10 years after ipsilateral total knee arthroplasty in an 83-year-old female. On preoperative plain radiographs and CT, no clear intramedullary lesion was iden

Advancements in Managing Bone Defects with Limb Length Discrepancies with a Motorized Intramedullary Combined Transport and Lengthening Nail.

Large bone defects that coexist with limb length discrepancy present a challenging problem in limb reconstruction. Historically, management has required complex circular fixation constructs, staged procedures, or separate devices to independently address each problem. However, the development of motorized intramedullary nails capable of performing both bone transport and limb lengthening with a single implant represent a paradigm shift. This review traces the evolution of internal bone transport technology from the initial foundational principles of distraction osteogenesis through first gener…

New Technology for the Treatment of Bone Defects and Limb Length Discrepancies with a Motorized Intramedullary Bone Transport Nail.

Bone defects are among the most challenging problems treated by limb reconstruction surgeons and orthopaedic traumatologists. Bone transport is a biological reconstruction technique which harnesses distraction osteogenesis to create new bone in critical bone defect. This technique has been successfully performed with a variety of internal and external solutions. This work introduces a newly available technology which provides a fully implantable, all-internal solution (eg, without the need for external fixation) for bone transport with the option to simultaneously address residual limb length

Cephalomedullary nailing of trochanteric fractures in geriatric patients restores natural hip geometry - a retrospective radiological analysis.

BACKGROUND: Trochanteric fractures are common in geriatric patients, and cephalomedullary nailing is widely used. However, its ability to restore and maintain native hip geometry over time remains unclear. METHODS: In this retrospective single-center study, patients aged ≥ 75 years treated with cephalomedullary nailing between June 2022 and August 2024 were included. Centrum-collum-diaphyseal (CCD) angle, femoral offset, and leg length discrepancy (LLD) were assessed on the operated and contralateral sides postoperatively and at final follow-up (minimum 6 weeks). Changes over time and correla

Case of implant failure following osteosynthesis for an intertrochanteric femoral fracture using a carbon fiber intramedullary nail.

Carbon fiber-reinforced polyetheretherketone (CFR-PEEK) materials are radiolucent and produce fewer metallic artifacts during radiological examinations, making them a subject of growing interest as osteosynthesis materials in the field of orthopedics. However, clinical reports on carbon intramedullary nails are still limited, and there are few reports on postoperative complications. The present case report describes a 55-year-old female patient who sustained an unstable intertrochanteric fracture of the left femur and underwent open reduction and internal fixation using a CFR-PEEK intramedulla…

Formal joint preparation appears to not be necessary for surgical treatment of ankle fractures with tibiotalocalcaneal nailing: a systematic review.

PURPOSE: The purpose of this study is to examine clinical outcomes among patients who underwent TTC nailing without any formal joint preparation to guide surgical decision-making. METHODS: This study was a systematic review using three databases queried through December 27th, 2025. Articles were included if they reported outcomes for at least one cohort of patients undergoing TTC nail for ankle fractures without formal joint preparation. Clinical outcomes examined included reported fracture union rates, complications (infection, hardware related, and amputation), as well as the need for reope

Recurrence of Bilateral Pleural Effusions in a Case of Yellow Nail Syndrome 12 Years After Surgical Pleurodesis.

Yellow nail syndrome (YNS) is a rare disorder characterized by yellow dystrophic nails, lymphedema, and recurrent pleural effusions (PEs). Given its rarity, and limited understanding, few options exist for the management and follow-up of patients who suffer from PEs. While pleurodesis and decortication are effective in most cases, recurrence is still possible, although usually within weeks to months of initial intervention. We present a case of recurrent loculated PE attributed to YNS over 10 years after initial treatment, requiring repeat video-assisted thoracic surgery (VATS) and pleurodesis…

Low resource federated learning for classification of nail disease by deploying cross-silo and heterogeneously dataset distributions.

Nail diseases, including such common conditions as fungus, and more serious issues like melanoma, may be important clues to the overall health and require a clear diagnosis to be treated. The purpose of the paper is to create a nail disease detection system based on the advanced machine learning methods, including transfer learning and federated learning. The research seeks to show how machine learning and federated learning can be combined to detect nail disease performance with high accuracy without having to share data. The data include pictures of diverse nail conditions including Acral Le

An Assessment of the Antifungal Efficacy of a Novel Topical Onychomycosis Treatment Using Human Nail and Skin Infection Models.

Onychomycosis, a fungal nail infection, affects about 4% of the global population. Current topical antifungals like ciclopirox and amorolfin … atophytes, non-dermatophyte fungi, and yeast. The results showed that WSNS-PO effectively permeated nails and reduced and prevented the colonization of human nail fragments by T. rubrum ex vivo, demonstrating an efficacy comparable to ciclopirox and amorolfine. WSNS-PO also prevented the transfer of T. rubrum infection between nails and inhibited the fu …