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Custom Antibiotic-Coated Intramedullary Nails for Infected Tibial and Femoral Nonunions: Retrospective Cohort Study and Surgical Technique.

Chow Vanessa Jane VJ, Mannambeth Rejith R

To evaluate the safety and effectiveness of a standardized, custom PMMA-coated antibiotic-eluting interlocking nail (Abx-IMN) for chronically infected femoral and tibial nonunion, quantifying infection eradication, radiographic union, and limb preservation. This was a retrospective cohort (single center) with consecutive adults with infected tibial or femur nonunions undergoing limb salvage with a custom PMMA-coated, antibiotic-eluting interlocking nail (Abx-IMN) between 1 January, 2021, and 31 August, 2024. The technique used an ECMO tube mold to cast a uniform ∼1.5 to 2 mm mantle around a standard interlocking nail with 1.5 mm to 2 mm canal over-reaming and protected interlocking windows. The primary end points were radiographic union and limb preservation (analyzed per limb) and infection eradication (analyzed per patient). Proportions were reported with exact 95% confidence intervals. Fourteen limbs in 13 patients were included. Radiographic union occurred in 11/14 limbs (0.78; 95% CI, 0.49 to 0.95). Infection eradication was achieved in 12/13 patients (0.92; 95% CI, 0.64 to 0.99). Limb preservation was maintained in 13/14 limbs (0.93; 95% CI, 0.66 to 0.99). Unplanned revision surgery occurred in 3/14 limbs (0.21; 95% CI, 0.05 to 0.51). The cohort represented a high-risk population with severe soft-tissue injury and a substantial burden of multidrug-resistant organisms. A standardized custom Abx-IMN is a pragmatic, immediately available consolidating strategy for complex infected nonunion, coupling locked intramedullary stability with organism-matched local antibiotics. In a high-risk real-world cohort, it achieved clinically meaningful rates of infection control, union, and limb preservation, with an expected revision surgery burden driven by biology rather than the device. Findings support broader evaluation in multicenter, protocol-driven comparative studies against commercial coatings and frame-based reconstruction.

Comparative Diagnostic Accuracy of Clinical Pallor at Different Anatomical Sites for Detecting Anemia in Pregnant Women Using HemoCue® as the Reference Standard.

Jegadeesan Dhivagar D, Rajendran Vijaykumar V, Rajamanickam Saranya S

Background Anemia during pregnancy remains a major public health problem in low-resource settings. Although hemoglobin estimation using portable devices such as the HemoCue® Hb 201 System (HemoCue AB, Ängelholm, Sweden) is reliable, clinical assessment of pallor continues to be widely used in primary care because of its simplicity, feasibility, and low cost. However, evidence comparing the diagnostic accuracy of pallor at different anatomical sites among pregnant women is limited. Objective This study aimed to determine and compare the diagnostic accuracy of clinical pallor at different anatomical sites for detecting anemia among pregnant women using HemoCue® hemoglobin estimation as the reference standard. Methods A cross-sectional diagnostic accuracy study was conducted among 186 pregnant women attending the Rural Health Training Centre (RHTC) in Barwala, Delhi. Clinical pallor was assessed under natural light at the palpebral conjunctiva, nail bed, palm, and palmar crease. Hemoglobin concentration was measured using HemoCue® as the reference standard. Diagnostic accuracy measures, including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), likelihood ratios, and Cohen's kappa (κ), were calculated for detecting anemia (hemoglobin <11 g/dL). Results Among the 186 pregnant women enrolled, 139 (74.7%) were anemic based on HemoCue® hemoglobin estimation. Palpebral conjunctival pallor demonstrated the highest sensitivity (98.6%) and specificity (93.6%), with excellent agreement (κ = 0.92). Nail bed pallor showed a sensitivity of 81.3% and a specificity of 42.6%, while palmar pallor demonstrated a sensitivity of 71.9% and a specificity of 78.7%. Palmar crease pallor had the lowest sensitivity (46.0%) but a specificity of 78.7%. Palpebral conjunctival pallor also showed the highest positive LR (LR+; 15.45) and the lowest negative LR(LR-; 0.02). Conclusion Palpebral conjunctival pallor demonstrated the highest diagnostic accuracy for detecting anemia in pregnant women and may serve as a reliable screening method in primary care settings where hemoglobin estimation is unavailable. Palm and palmar crease examination may provide complementary clinical information but are less accurate than conjunctival assessment.

Comparison of positive detection rates between fluorescent staining and traditional KOH wet mount methods in the diagnosis of superficial fungal skin infections and analysis of factors associated with missed diagnosis.

Zhou Li L, Hu Lihua L, Pan Lu L, Lin Feng F et al.

Superficial fungal skin infections represent one of the most prevalent dermatological conditions worldwide, necessitating accurate and rapid laboratory diagnosis for appropriate therapeutic management. This retrospective study aimed to compare the positive detection rates between fluorescent staining and traditional KOH wet mount methods in patients with clinically suspected superficial fungal infections and to identify factors associated with missed diagnosis. A total of 151 patients with clinically suspected superficial fungal skin infections presenting to our dermatology department between January 1, 2025, and June 30, 2025, were enrolled. All specimens underwent parallel examination using both fluorescent staining (calcofluor white) and traditional 10% KOH wet mount methods. Diagnostic performance parameters including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Multivariate logistic regression analysis was performed to identify independent risk factors for missed diagnosis. The fluorescent staining method demonstrated a significantly higher positive detection rate (78.81%, 119/151) compared to the KOH wet mount method (58.28%, 88/151) (χ2 = 15.73, P < 0.001). Using fungal culture as the gold standard, fluorescent staining achieved a sensitivity of 94.35% versus 73.39% for KOH (P < 0.01), with specificities of 91.67 and 95.83%, respectively. Multivariate analysis revealed that prior antifungal treatment (OR = 3.84, 95% CI: 1.62-9.11, P = 0.002), inadequate specimen collection (OR = 2.76, 95% CI: 1.18-6.45, P = 0.019), and nail specimen type (OR = 2.31, 95% CI: 1.04-5.13, P = 0.039) were independent risk factors for missed diagnosis with KOH wet mount examination. Fluorescent staining provides superior diagnostic performance compared to traditional KOH wet mount for superficial fungal infections, with significantly higher sensitivity and comparable specificity.

Dynamic Nail-Bed Phenotyping in Onycholysis: Diagnostic Accuracy Remains Untested.

Gallo Giuseppe G, Quaglino Pietro P, Ribero Simone S