A method to modify angle-stable intramedullary nail construct compliance.

Traditional interlocked intramedullary (IM) nails have recently been modified to provide enhanced angular stability. These so-called 'angle-stable' IM nails are designed to eliminate construct toggle and also provide increased axial, bending, and torsional stiffness. While this added stability is needed for small fracture gaps to heal, angle-stable nails may be too stiff for large fracture gaps to unite. Even though relative stability is recommended for large fracture gaps, recent in vivo data indicates that traditional nails may allow for too much motion for healing to occur. The current study evaluated a modified technique for implanting an angle-stable nail which allows for an intermediate amount of stability. The compliance of the nail construct was adjusted by over-drilling the near cortex interlocking hole. This led to increased construct motion in torsion, but less so in axial compression and bending. This modification creates stability which is partway between angle-stable and traditional IM nail designs. These findings were unchanged after 50,000 fatigue loading cycles. By carefully selecting the magnitude of over-drilling, the compliance of the construct can easily be modified as it is being implanted. This design modification may lead to more reliable fracture union since the surgeon can tailor the nail compliance to the injury and bone quality.

Cutaneous lymphangioma.

Cutaneous lymphangiomas from 158 patients were studied clinically and pathologically. Lymphangiomas show a predilection for the neck and axilla, breasts and chest, and buttocks and thighs, but may occur on almost any area of skin. They show highest incidence of onset in infancy, the majority are present by age 5 years, but they may appear spontaneously in adolescence or adult life. No correlation among cutaneous lymphangioma, mucous membrane lymphangioma, internal lymphangioma, or lymphangiosarcoma was found. No familial histories of lymphangioma were elicited. Single surgical excision cured 75% of cutaneous lymphangiomas and reexcision cured an additional 12%. The cutaneous lymphangiomas are divided into superficial "lymphangioma circumscriptum" and deep "lymphangioma cavernosum." No specific histologic criteria could be found to differentiate lymphangioma from "bloodless" hemangioma, primary from secondary lymphangioma (lymphangiectasia), or cystic cavernous lymphangoma from cystic hygroma.