12-24-2006 The Journal of Bone & Joint Surgery - GERALD NIZNICK, DMD

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TITANIUM, A METAL FOR SURGERY GOTTLIEB S. LEVENTHAL J. Bone Joint Surg. Am. 33:473-474, 1951.

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SYNOVIAL

n-I n- tn-In-A

27.

\ I . it. ; S’i’o ut’, in Vitro.

Ann.

5’,

(‘tultivatc’oi 28.

SHACKMAN,

29.

SMITH,

30.

SPRINZ,

RALPH: L.

:

W.

120:

Malignant

Synovioma

Am.

A Case

of

J.

STANFORD,

:32.

\\‘AGNER, l’xn-’isiorn

amid

33,

Warremn,

SHIELDS:

S., and L.

351-354,

E. A.: Tumor

HORSE,

Mn-n-lignant

C.:

Post-operative

R.

lit’gressn-tI

of

and

I).,

H.

fotund

nn-’oti-k of

the

surgeon

prior

to)

the

complete

been

i)roken,

the

Stmn-to’

to

fractun-t’s

.

tallmin-m,

tine

.

has the

to

was

Royal

Soc.

Bull.

Med.,

U.

J. Bone and Joint of Knee-joint.

S.

40:

Army

Surg., Excision;

25:

Tis.’utut’ 1947.

273-275,

Med.

Dept., Oct.

883-891,

Recurrence;

: 809-810, 1935. of the Leg. J. Missouri

101

9:

State

Med.

1943.

S’contl

Assn.,

45:

for

for

the

ann-I

Sungeon-ns,

a

metal

was

tendency a cen-stury

the

there

and

present

promises

Committee

the

good, the

to

be

on

alloys

have

however,

the

without

screws

Frat’t.ures

in-ieal

infection,

and

plates

have

an(I

metal

for

(Miner

n-n-se in

Traumas,

tine

fixation

of

characteristics of Viof the SMo metal Bothe, Beaton, in laboratory animals, found that “the

inert

“.

better,

to fuse

a half,

time,

1)0th times,

even

times,

physiologically

if not bone

At

loose,

at other

implanted

as for

years;

of a fracture.

characteristics

metals

several

for

“The

inavinng

tlnmn-t

Philadelphia

of fractures.

becoming

state!:

physical

titanium

At

used

fracture;

Meta.stases

PENNSYLVANIA

Hospital,

fixation

in reporting

various

over

been

fixation

l)e

more

Sinai

at

Pulmonary

1949.

SURGERY

Mount

screws

of the

with

Report

955-990,

PHILADELPHIA,

the

by

:

45

FOR

attempts

of

A Case .J.,

have for

rn-ninen-i

an-sd

l)turPoses.

extensively,

but

it has

extraction

a fairly

than

with

the

non-corrosive

Titanium

been

of the

goon-I

to

it”.

alloys, been

known

diffien-ult to extract is being carried out

very

metal

supply

has

within

a short

time

for more

at

a rca-

price.

Titanium

t)f 50,000 tinose

has

a tensile

pounds

of Si\Io

per

the

to

Stn-n-inless-st.eel

pron-huceol, elennent,

NO.

cuni-enf.s

is no

was

supplieol

2,

APRIL

per

pounds

properties

Titanium and

as

of 75,000 These

is silver-white

it is abon-it

stainless

60 per

steel,

and

square

inch

of titanium in

cent.. it

can

are

color;

heavier be

its

than

forged

and

a yield

almost weight

witin

60 per

is about

aluminum. and

strength

identical

welded.

It machines Titanium

is

cormo)sionn.

finere

Titaniuns 33-A,

steel,

plates

eddy

inch.

steel.

sn-n-me w’ay

i’esist.annt

stoengtis

sqn-nare

stainless

finn-n-f. of stn-n-inless about

iniginly

von..

,

testing

of bone

steel

been

mecinalnical

n-n-n element

*

Proc.

Metastases.

METAL

of Research,

organization

w’oiuln-I

.

tinere

commercial

an

Surg.,

M.D.,

satisfactory

College

1)avenport,

response

in

With

\Io’d.

LEVENTHAL,

stainless be

nullifying

Annei’ican

A

I)epartrnent

(‘In-n-v Rn-n-y ?n-1un-rray

tent.

S)’nlovial

1927.

: Synovioma:

\V.

Ohio

S.

n-inn-i SMo

i)een

so)nahle

Elbow.

the Soft Tissue

of

1rrmn-din-tion.

GOTTLIEB

Vifalliunn

as

355-364,

Ann.

Sarcoma

MAHAFFEY,

Followinng

l’r,,o

imn tinat

Left

3:

Malignant Synovioma. of Synovial Membrane

Treatment.

Synovial

BY

anti

the

Sarcoma

TITANIUM,

of tine

mn-nntl Nortnnmn-l

1948.

WILLIAMS,

usually

Sn-rt’onnn-

1944.

Pathol.,

Synovial

, : Sytiovimol

11. A

843-851,

1949.

:31.

34,

P. ; mn-ni(I Poto;n-uGEFF,

.

Surg.,

Synoviomata.

HELMUTH:

131-140,

A

473

SARCOMATA

an-nd screws n’ill develop chance through

have when

of en-idy the

currents

courtesy

to he handleti very carefully; they are n-nsed in the tissues. developing, of Remington

and Arms

one

does

Cot.

1951

Downloaded from www.ejbjs.org on December 24, 2006

for, Since not.

if nicks titanium have

to i)e

are is SO

474

G.

carefoul.

Scresvs

nvifh

innperfectiounn Soft-tissue

size

react.ionn

into

tissn-ze

the

was

there

nicks

in them,

n’i1I nnot l)1tu(ilu(’e to

examined

any

should

tinreads layer

intervals

of

of induration.

two,

At

be discarded,

in the

studied of the

n’as

tissue

at

evidence

LEVENTHAL

however,

clean

titansitum

sn-nbcutaneous

S.

stuch

a mechanicn-n-l

by implanting dorsal aspect

bars of known weight. of rabbits.

The subcutaneous six, eight, and ten weeks.

At no time of two weeks, a glistening, but slightly

four,

the

for

hone.

end

and was

cy-

anotic, synovial-like layer was found at the site of the implant.

Study of the tissue revealed notiming finat con-uld account for this discoloration.

In subsequent weeks, the glistening layer was still present., but the cyanotic appearance had entirely disappeared.

A microscopa’

exn-n-minaf.ion

one

The

found.

revealed

flattened

a

finn-I on tine exposed

von-n-lt!

sul)(’tutaneon-us

tissue

flaftemned In-n-yeu of (‘ells. glitlt’t! ov(’r tine tifn-n-niunn

layer

serous

of endot.helial-like

sn-nrface

presented

of any

a perfectly

The n’alls o)f the “ cyst implant, biut an excess

Bun-nt’ mt’n-n-ctiotn-n\‘n-n-s st.titli(’(I i)y fine insertion first dnillooI, n-n-tnt! fine screw was then

twelve,

an-no! sixteen-n

ns’as

the

originally end

inserted.

put

in

of sixteen

when

an

at

;

the

At

twelve

svks,

the ‘as

revealen-I

no) reaction

st.mn-ucture

bone,

end weeks,

screws

attempt

made

metal

except

enclosing the implant of fluid in the cavity was 0-80

to

the

appeau-ance,

screws

The

into

were to

and

the

screw

of six weeks, the screws

remove

to the

so tight the

head

were

remained

the screws were more

that screw.

implants.

The

outside

the

bone than and

the femur examinations

t.rabecn-n-lation

the

or discolorawas inserted

were slightly tighter difficult to remove;

in one specimen Microscopic

was

for

femora of rats.

A sacnificen-I at six,

the

animals

what

could be gently not fon-nnd.

“

of

similar to

no

st’rew

svit.is ext’essive

been

reaction

an-nimal was there any infection, inn-iuration, in the soft tissues.

The site at which the screw

In

of the

enlarge(I

not

as it. had

we(’ks.

site

lining

No

normal

inserted.

110)10’ was

f.ioin abotut

joint.

just. when at the

was fractured of the bone

appeared

to i)e perfectly

normal.

Flat

plates

layer

tissue

After two insignificaint.

and

From surgery, becomes

of titanium

these

st.un-iies

hecatuse

of its

it has

loosen.

Since

ses.

sinown tiallv

been

the

felt

appear

an-Ihers

n-n-nd screws

that

its

may

he

the

these

by insertion

a surface

titanium

is a metal

to

tissue

failure

to bone,

cause

of some

rn-noiioltucent.

This

it may

i)een

prove

used

in

to be an

humans

subcn-utaneous centimeters. weight

may The

be fact

screws

not

hone

ideal

metal

no

reaction

loss

is

useful that

in bone

or pins

become

the

with

A titanium plate one-sixteenth to roen-nf.gen rn-n-ys. This radiolucency may

which

where

from

are

popular

and

be-

eventually

for such

prosthe-

clinically

or

of an inch in thickness be an advantage in some

roentgen-nogranns.

i)y

gram.

has

separate

the

square

reaction.

prostheses

remain

into

of 7.5

in cases

a disadvantage

use

would

have

loss

presented

amount of loss was .0002 limit of error in weighing.

ann-I past,

that

titanin-um

plates

Some

it wool-i sfrengtin

In

for weight bar

the the

to) titanium

temporarily.

can-use

studied

average

The

one-half months and is really within

attachen-i

placed

were

of rabl)its.

as

is parcases.

SUMMARY

on

5t.n-udies

femora of rats, ideal for fixation to determine eventually

nvhether plates and

NOTE:

Hospital,

titanmn-umni

for

man-ic

by

implanting

have demonstrated that of fractn-mres.

A sufficient

The author his kindness

or not screws

they can

int.o

titanium number

will break be produced

wishes to express gratitude in-i preparing and examining

stnbcut.aneotus

tissue

of rabbits,

is an inert metal which of plates and screws have

and

appears not been

in the treatment of fractures.

It is hoped which will not readily break. to

Dr. the

David R. mnnicroscopic

Meranze, sections.

Pathologist

at

Mount

to be n-used that

Sinai

REFERENCES

I

.

BOTHE,

Surg., 2.

Con1oTmE Annuual

R.

T.

L.

; BEATON,

Gyoneo.,

aonti Obst.o’t.., 0)5

Meeting,

FRACTUREs

Atlantic

I:. ; an-nd AND

City,

oTHER

New

H.

DAVENPORT,

71 : 598-602,

A.

:

Reaction

of Bone

to Multiple

Metallic

Implants.

1940.

TRAUMAS,

Jersey,

Janumn-ry,

College

American

of

Surgeons,

Proc.

Twenty-third

1945.

THE

JOURNAL

OF

BONE

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JOINT

SURGERY