FR2674119A1 - Device for guiding the sliding of the osteosynthesis screws for an intracapsular fracture of the neck of the femur - Google Patents

Device for guiding the sliding of the osteosynthesis screws for an intracapsular fracture of the neck of the femur Download PDF

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Publication number
FR2674119A1
FR2674119A1 FR9103533A FR9103533A FR2674119A1 FR 2674119 A1 FR2674119 A1 FR 2674119A1 FR 9103533 A FR9103533 A FR 9103533A FR 9103533 A FR9103533 A FR 9103533A FR 2674119 A1 FR2674119 A1 FR 2674119A1
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France
Prior art keywords
femur
distal
thread
screw
anchoring
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Granted
Application number
FR9103533A
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French (fr)
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FR2674119B1 (en
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Fixano SA
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Fixano SA
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Priority to FR9103533A priority Critical patent/FR2674119B1/en
Publication of FR2674119A1 publication Critical patent/FR2674119A1/en
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Publication of FR2674119B1 publication Critical patent/FR2674119B1/en
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Expired - Fee Related legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/74—Devices for the head or neck or trochanter of the femur
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/72—Intramedullary pins, nails or other devices
    • A61B17/7233—Intramedullary pins, nails or other devices with special means of locking the nail to the bone
    • A61B17/7258—Intramedullary pins, nails or other devices with special means of locking the nail to the bone with laterally expanding parts, e.g. for gripping the bone
    • A61B17/7266—Intramedullary pins, nails or other devices with special means of locking the nail to the bone with laterally expanding parts, e.g. for gripping the bone with fingers moving radially outwardly
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/32—Joints for the hip
    • A61F2/36—Femoral heads ; Femoral endoprostheses
    • A61F2/3601—Femoral heads ; Femoral endoprostheses for replacing only the epiphyseal or metaphyseal parts of the femur, e.g. endoprosthetic femoral heads or necks directly fixed to the natural femur by internal fixation devices
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30535—Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30579—Special structural features of bone or joint prostheses not otherwise provided for with mechanically expandable devices, e.g. fixation devices
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30535—Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30594—Special structural features of bone or joint prostheses not otherwise provided for slotted, e.g. radial or meridian slot ending in a polar aperture, non-polar slots, horizontal or arcuate slots
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/32—Joints for the hip
    • A61F2/36—Femoral heads ; Femoral endoprostheses
    • A61F2/3609—Femoral heads or necks; Connections of endoprosthetic heads or necks to endoprosthetic femoral shafts
    • A61F2002/3625—Necks

Abstract

The object of the present invention is to guide and centre the sliding of the screw or screws used for osteosynthesis of intracapsular fractures of the neck of the femur. The device is a cylinder (B) introduced around the headless and cylindrical distal part of the screw (A). The cylinder (B) is blocked by being screwed into the osseous orifice for introduction of the equipment. The screwing is achieved by means of a thread situated on the outer surface of the distal sector of the cylinder, the pitch increasing in the proximodistal direction.

Description

DISPOSITIF DE GUIDAGE DU GLISSEMENT
DES VIS D'OSTEOSYNTHESE
POUR FRACTURE INTRA-CAPSULAIRE DU COL DU FEMUR
I - Le dispositif (figure 1) vise à guider et centrer au niveau de l'orifice d'entrée du fémur, la vis (A) d'ostéosynthèse pour fracture du col du fémur au cours de son glissement progressif post-opératoire. Ce dispositif est composé d'un cylindre (B), introduit autour de la partie distale de la vis démunie de tête. Il est introduit par l'orifice osseux (1) agrandi et il est vissé dans le tissu osseux cortical.SLIDING GUIDE DEVICE
OSTEOSYNTHESIS SCREWS
FOR INTRA-CAPSULAR FRACTURE OF THE FEMUR'S NECK
I - The device (FIG. 1) aims to guide and center, at the level of the femur entry orifice, the screw (A) for osteosynthesis for fracture of the neck of the femur during its progressive post-operative sliding. This device is composed of a cylinder (B), introduced around the distal part of the headless screw. It is introduced through the enlarged bone opening (1) and is screwed into the cortical bone tissue.

Il - Le modèle de base (figure 2) est donc un cylindre (B) de longueur variable, mais au moins inférieure à la moitié de la longueur du segment non fileté de la vis. La surface extérieure présente 2 parties : les 2 tiers proximaux (2) sont faits d'une surface lisse, introduits dans la partie la plus profonde du fémur. Le tiers distal (3) est muni d'un filetage acéré dont la hauteur des filets croit dans le sens proximo-distal. C'est la partie qui sera vissée dans l'orifice osseux du fémur (1) et assurera un ancrage du cylindre.II - The basic model (Figure 2) is therefore a cylinder (B) of variable length, but at least less than half the length of the unthreaded segment of the screw. The outer surface has 2 parts: the 2 proximal thirds (2) are made of a smooth surface, inserted into the deepest part of the femur. The distal third (3) is provided with a sharp thread whose height of the threads increases in the proximo-distal direction. This is the part that will be screwed into the bone opening of the femur (1) and will anchor the cylinder.

La surface intérieure (figure 3) est entièrement cylindrique et lisse (4), de diamètre légèrement supérieur au corps lisse de la vis, permettant ainsi un jeu de glissement de la vis (A) dans la pièce guide (B).The internal surface (FIG. 3) is entirely cylindrical and smooth (4), with a diameter slightly greater than the smooth body of the screw, thus allowing a play of sliding of the screw (A) in the guide part (B).

III - Le modèle de base (B) peut être remplacé par tout autre dispositif capable d'améliorer l'ancrage du cylindre dans l'orifice osseux fémoral. III - The basic model (B) can be replaced by any other device capable of improving the anchoring of the cylinder in the femoral bone orifice.

Ainsi, (figure 4) cette pièce (C) gardant les mêmes caractéristiques générales que la pièce (B), présente en plus des fentes longitudinales (5) dans la partie proximale, site du filetage. Ces fentes délimitent des lames (6) qui. donnent au dispositif des forces d'expansion radiaires accentuant le blocage de la pièce dans l'orifice osseux si une pince de serrage maintient celle-ci en position de fermeture lors de son vissage (figure 5).Thus, (Figure 4) this part (C) keeping the same general characteristics as the part (B), has in addition longitudinal slots (5) in the proximal part, site of the thread. These slots delimit blades (6) which. give the device radial expansion forces accentuating the blocking of the part in the osseous orifice if a clamp keeps it in the closed position when it is screwed (Figure 5).

IV - Un autre dispositif peut être envisagé à la place des pièces (B) et (C) : le dispositif d'expansion distal est compos de 2 pièces (D) et (E) (figure 6).IV - Another device can be envisaged in place of parts (B) and (C): the distal expansion device is made up of 2 parts (D) and (E) (Figure 6).

La pièce (D) (figure 7) est un cylindre de taille et de forme semblable à la pièce (B), mais elle est munie sur son tiers distal de 3 ou 4 fentes (7) longitudinales, délimitant 3 ou 4 lames (8) pouvant s'écarter de l'axe central de la pièce. La surface extérieure de chacune des lames est munie d'un système d'ancrage dans l'os : aileron longitudinal (X9) et crénelure (10).The part (D) (figure 7) is a cylinder of size and shape similar to the part (B), but it is provided on its distal third with 3 or 4 slots (7) longitudinal, delimiting 3 or 4 blades (8 ) which can deviate from the central axis of the part. The outer surface of each of the blades is provided with an anchoring system in the bone: longitudinal fin (X9) and notch (10).

La surface intérieure des lames présente un filetage (11).The inner surface of the blades has a thread (11).

L'écartement des lames et leur ancrage dans l'orifice osseux est assure par vissage de la pièce (E) (figure 8). C'est un anneau globalement cylindrique de longueur 10 à 15 mm, muni sur sa surface extérieure d'un filetage dont les filets croissent en hauteur dans le sens proximo-distal (12). Sa surface intérieure (figure 9) est lisse (13) et rigoureusement cylindrique. Son diamètre est légèrement supérieur à celui du corps de la vis (A). L'écartement des lames (8) de la pièce (D) est assuré en introduisant la pièce (E) autour de la vis (A). Le vissage de la pièce (E) assure ainsi l'ancrage de la pièce (D) dans le tissu osseux.  The spacing of the blades and their anchoring in the bone opening is ensured by screwing the part (E) (Figure 8). It is a generally cylindrical ring of length 10 to 15 mm, provided on its outer surface with a thread whose threads grow in height in the proximo-distal direction (12). Its interior surface (Figure 9) is smooth (13) and strictly cylindrical. Its diameter is slightly greater than that of the body of the screw (A). The spacing of the blades (8) of the part (D) is ensured by introducing the part (E) around the screw (A). The screwing of the part (E) thus ensures the anchoring of the part (D) in the bone tissue.

V - Le modèle de base et ses 2 variantes sont applicables pour tout type d'ostéosynthèse par vis du col du fémur basé sur le principe du glissement post-opératoire progressif, quel que soit la taille et le nombre de vis utilisés (figures 10, 11 et 12). V - The basic model and its 2 variants are applicable for any type of osteosynthesis using a femoral neck screw based on the principle of progressive post-operative sliding, regardless of the size and number of screws used (Figures 10, 11 and 12).

Claims (5)

REVENDICATIONS 1 - Dispositif adjoint aux vis (A) utilisées dans l'ostéosynthèse des fractures intra-capsulaires du col du fémur et dont la fonction est d'assurer leur centrage distal lors de leur glissement progressif après leur mise en place. Le dispositif est un cylindre (B) introduit autour de la partie distale lisse et cylindrique de la vis et ancré par vissage dans l'orifice osseux d'introduction dans le fémur.1 - Device attached to the screws (A) used in osteosynthesis of intra-capsular fractures of the neck of the femur and whose function is to ensure their distal centering during their gradual sliding after their placement. The device is a cylinder (B) introduced around the smooth and cylindrical distal part of the screw and anchored by screwing in the osseous orifice for introduction into the femur. 2 - Dispositif selon la revendication 1 caractérisé en ce que la pièce (B) est munie à sa partie distale de sa surface extérieure d'un filetage dont les filets sont de hauteur croissante dans le sens proximo-distal, tandis que le reste de la surface extérieure de la pièce est lisse.2 - Device according to claim 1 characterized in that the part (B) is provided at its distal part of its outer surface with a thread whose threads are of increasing height in the proximo-distal direction, while the rest of the outer surface of the workpiece is smooth. 3 - Dispositif selon la revendication 2 caractérisé en ce que l'ancrage osseux de la pièce (B) peut être accentué en utilisant une pièce (C) munie d'un dispositif d'expansion distale grâce à des fentes longitudinales séparant des lames pouvant s'écarter de l'axe central de la pièce grâce à des forces radiaires.3 - Device according to claim 2 characterized in that the bone anchoring of the part (B) can be accentuated by using a part (C) provided with a distal expansion device thanks to longitudinal slots separating blades which can s '' deviate from the central axis of the room thanks to radiating forces. 4 - Dispositif selon les revendications 1, 2 et 3 caractérisé en ce que le mode d'ancrage de la pièce cylindrique utilise un autre dispositif comportant 2 pièces - La pièce (D) cylindrique comporte à sa partie distale des fentes longitudinales (7). La surface extérieure des lames ainsi délimitée (8) est munie d'ailerons (9) et de crénelures (10) afin d'améliorer l'ancrage dans l'orifice osseux. La surface intérieure quant à elle, est munie d'un filetage. 4 - Device according to claims 1, 2 and 3 characterized in that the anchoring mode of the cylindrical part uses another device comprising 2 parts - The cylindrical part (D) has at its distal part longitudinal slots (7). The outer surface of the blades thus delimited (8) is provided with fins (9) and notches (10) in order to improve the anchoring in the bone orifice. The interior surface is provided with a thread. - La pièce (E) est un anneau de 10 à 15 mm de longueur. Sur sa surface extérieure, il y a un filetage de hauteur croissante (12) qui sera vissé dans le pas de vis de la surface intérieure de la partie distale du cylindre (D). La surface intérieure de la pièce (E) est lisse. Ainsi, en vissant la pièce (E) autour du corps de la vis (A), on crée un processus d'écartement progressif des lames, ce qui assure un dosage de l'ancrage du dispositif dans l'orifice osseux du fémur. - The part (E) is a ring 10 to 15 mm long. On its outer surface, there is a thread of increasing height (12) which will be screwed into the thread of the inner surface of the distal part of the cylinder (D). The interior surface of the part (E) is smooth. Thus, by screwing the part (E) around the body of the screw (A), a process of progressive separation of the blades is created, which assures a dosage of the anchoring of the device in the bone opening of the femur. 5 - Dispositif selon les revendications de 1 à 4 caractérisé en ce que les dispositifs présentés sont applicables à toute vis capable de glisser après ostéosynthèse pour fracture intra-capsulaire du col du fémur, quel que soit la taille et le nombre de vis utilisés. 5 - Device according to claims from 1 to 4 characterized in that the devices presented are applicable to any screw capable of sliding after osteosynthesis for intra-capsular fracture of the neck of the femur, whatever the size and the number of screws used.
FR9103533A 1991-03-22 1991-03-22 DEVICE FOR GUIDING THE SLIDING OF OSTEOSYNTHESIS SCREWS FOR INTRA-CAPSULAR FRACTURE OF THE FEMUR'S NECK. Expired - Fee Related FR2674119B1 (en)

Priority Applications (1)

Application Number Priority Date Filing Date Title
FR9103533A FR2674119B1 (en) 1991-03-22 1991-03-22 DEVICE FOR GUIDING THE SLIDING OF OSTEOSYNTHESIS SCREWS FOR INTRA-CAPSULAR FRACTURE OF THE FEMUR'S NECK.

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
FR9103533A FR2674119B1 (en) 1991-03-22 1991-03-22 DEVICE FOR GUIDING THE SLIDING OF OSTEOSYNTHESIS SCREWS FOR INTRA-CAPSULAR FRACTURE OF THE FEMUR'S NECK.

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FR2674119A1 true FR2674119A1 (en) 1992-09-25
FR2674119B1 FR2674119B1 (en) 1993-06-18

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Cited By (27)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO1994004086A1 (en) * 1992-08-25 1994-03-03 Alexandre Worcel Osteosynthesis device
FR2698261A1 (en) * 1992-11-24 1994-05-27 Lacaffiniere Jean Yves De Device for guiding a double screw of the neck of the femur for locked trochantero-diaphyseal nail.
US5409486A (en) * 1993-04-16 1995-04-25 Phoenix Surgical Products, Inc. Double threaded arthrodesis screw
FR2718200A1 (en) * 1994-03-30 1995-10-06 T2C Sarl Stabilised pin for insertion into fractured bones during surgery
WO1996015737A1 (en) * 1994-11-19 1996-05-30 Merck Patent Gmbh Joint prosthesis
WO1996032899A1 (en) * 1995-04-21 1996-10-24 Gerd Werding Nail for maintaining the location and shape of broken long bones
WO1997025930A1 (en) * 1996-01-18 1997-07-24 Synthes Ag Chur Threaded washer
FR2745709A1 (en) * 1996-03-08 1997-09-12 Caffiniere Jean Yves De Screw threaded retainer for bone fractures
NL1009831C2 (en) * 1998-08-10 2000-02-11 Novarticulate Bv Hip prosthesis as well as an assembly of a hip prosthesis and a clamping tool.
US6077265A (en) * 1995-04-21 2000-06-20 Werding; Gerd Nail for fixing the position and shape of broken long bones
US6127597A (en) * 1997-03-07 2000-10-03 Discotech N.V. Systems for percutaneous bone and spinal stabilization, fixation and repair
WO2000067652A3 (en) * 1999-05-11 2001-04-19 Gerhard Hehl Implant for operative treatment of femoral neck fractures and the like
WO2004030549A1 (en) * 2002-10-01 2004-04-15 Synthes Ag Chur Device for fixing bones
NL1026925C2 (en) * 2004-08-30 2006-03-01 Univ Delft Tech Joint prosthesis, blocking organ and method for bone fixation.
US7097648B1 (en) 1999-01-27 2006-08-29 Disc-O-Tech Medical Technologies Ltd. Expandable element delivery system
WO2008098728A3 (en) * 2007-02-12 2008-10-23 Stryker Trauma Gmbh Fixation device
US8809418B2 (en) 2004-03-21 2014-08-19 DePuy Synthes Products, LLC Methods, materials and apparatus for treating bone and other tissue
US8956368B2 (en) 2003-06-17 2015-02-17 DePuy Synthes Products, LLC Methods, materials and apparatus for treating bone and other tissue
US8992541B2 (en) 2003-03-14 2015-03-31 DePuy Synthes Products, LLC Hydraulic device for the injection of bone cement in percutaneous vertebroplasty
US9254153B2 (en) 2007-04-19 2016-02-09 Stryker Trauma Gmbh Hip fracture device with static locking mechanism allowing compression
US9259696B2 (en) 2005-11-22 2016-02-16 DePuy Synthes Products, Inc. Mixing apparatus having central and planetary mixing elements
US9642932B2 (en) 2006-09-14 2017-05-09 DePuy Synthes Products, Inc. Bone cement and methods of use thereof
US9839460B2 (en) 2003-03-31 2017-12-12 DePuy Synthes Products, Inc. Remotely-activated vertebroplasty injection device
US9918767B2 (en) 2005-08-01 2018-03-20 DePuy Synthes Products, Inc. Temperature control system
US10111697B2 (en) 2003-09-26 2018-10-30 DePuy Synthes Products, Inc. Device for delivering viscous material
USRE47427E1 (en) 1999-01-27 2019-06-11 Medtronic Holding Company Sárl Expandable intervertebral spacer
US10494158B2 (en) 2006-10-19 2019-12-03 DePuy Synthes Products, Inc. Fluid delivery system

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US8974540B2 (en) 2006-12-07 2015-03-10 Ihip Surgical, Llc Method and apparatus for attachment in a modular hip replacement or fracture fixation device
CA2671523C (en) 2006-12-07 2013-02-12 Anatol Podolsky Method and apparatus for total hip replacement
US8579985B2 (en) 2006-12-07 2013-11-12 Ihip Surgical, Llc Method and apparatus for hip replacement
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Cited By (46)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
FR2695026A1 (en) * 1992-08-25 1994-03-04 Alexandre Worcel Device for maintaining compression of a fractured bone.
US5437674A (en) * 1992-08-25 1995-08-01 Alexandre Worcel Osteosynthesis device
WO1994004086A1 (en) * 1992-08-25 1994-03-03 Alexandre Worcel Osteosynthesis device
FR2698261A1 (en) * 1992-11-24 1994-05-27 Lacaffiniere Jean Yves De Device for guiding a double screw of the neck of the femur for locked trochantero-diaphyseal nail.
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