A 13-year-old girl sustained severe atlantoaxial rotatory subluxation. She presented at the treating facility after 3 months of pain and upper limb numbness. The case was successfully treated with halo traction, followed by posterior C1-C2 triangle-shaped fixation. The surgical technique of halo traction followed by posterior C1-C2 triangle-shaped fixation is effective for stabilizing and correcting atlantoaxial rotatory subluxation.
Background: Intramedullary nailing is the standard treatment for femoral shaft fractures, but mechanical implant failure—particularly bent-nail deformity—is rare and poses significant technical challenges during extraction. Conventional removal methods may be ineffective or risky, necessitating innovative strategies for controlled deformity correction and safe revision. Materials and Methods: A 35-year-old male presented with pain and deformity in a previously nailed femur following a fall, 2 months postoperatively. Imaging revealed nail bending, cerclage wire failure, and refracture. Initial attempts at closed and instrument-assisted manipulation were unsuccessful due to dense medial callus and cortical collapse at the bend apex. A novel modified reduction F-tool, E-Joystick, using a 3-point lever-pivot-counterforce configuration with an adjustable bend was developed intraoperatively to enable controlled distraction osteoclasis and realignment under fluoroscopy, followed by exchange nailing. Results: Deformity correction and safe nail extraction were successfully achieved, and a larger-diameter intramedullary nail was implanted. Structured rehabilitation with staged loading resulted in radiographic union, full hip and knee motion, no limb-length discrepancy, and pain-free ambulation at long-term follow-up. Discussion: The modified E-Joystick technique provides a controlled, minimally disruptive alternative when conventional extraction of bent nails fails, potentially expanding surgical options for early implant failure in complex femoral nonunion cases.
Objective: The aim of this study was to evaluate the effect of a postoperative nail edge fixation device on clinical outcomes in patients undergoing surgical treatment for ingrown toenails. Materials and Methods: A total of 110 patients who underwent surgical treatment for ingrown toenails between 2018 and 2020 were retrospectively reviewed. All patients underwent partial matrixectomy using curettage and electrocautery. In 1 group, an additional fixation device was applied to the operated nail, elevating the lateral and medial edges by 1 mm above the surrounding soft tissue, and was maintained for 14 days. The groups were compared in terms of operative time, infection, serous exudate, erythema, number of dressings, healing time, and recurrence rate. Results: There was no statistically significant difference between the groups in terms of age, gender, disease stage, lesion location, or follow-up duration ( P >0.05). The mean operative time was significantly longer in the fixation group (20.6 vs. 17.9 min, P <0.05). However, no statistically significant differences were observed between the groups regarding the duration of postoperative erythema (2.79 vs. 2.48 d, P >0.05), serous discharge (4.46 vs. 3.98 d, P >0.05), number of dressings required (3.87 vs. 3.57, P >0.05), total healing time (14.29 vs. 13.95 d, P >0.05), or recurrence rate (10% vs. 19%, P >0.05). Conclusion: While the use of a fixation device prolonged the operative time, it did not lead to a significant improvement in clinical outcomes such as infection, healing time, or recurrence. Further large-scale prospective studies are needed to determine whether routine use of nail fixation provides clinical benefit. Level of Evidence: Level III.
