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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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AND
JOINT
SURGERY