- Email: [email protected]
Effect of corrosion on tissue
Volume 2 Number 1
ALLGOWER ET AL." NEW PLATE FOR INTERNAL FIXATION
MOLLER, M. E. (1961), ' Principes d'Ost6osynth~se ', Heir. chir. Acta, 28, 198. --ALLGOWER, M., and WILLENEGGER, H. (1965), Technique of b~ternal Fixation of Fractures. Berlin: Springer. OLERUO, S., and DANCKWARDT-LILLIESTR6M, G. (1968), ' F r a c t u r e Healing in Compression Osteosynthesis in the Dog ', J. Bone Jt Surg., 50B, 844. PERREN, S. M., HUGGLER, A., RUSSENBERGER, M., STRAUMANN, F., MOLLER, M. E., and ALLGOWER, M. (1969), ' A Method of Measuring the Change in Compression applied to Living Cortical Bone ', Acta orthop, scand., Suppl. 125, 7. ALLGOWER, M., MATHYS, R., SCHENK, R., WILLENEGGER, H., and MULLER, M. E. (1969), ' T h e Reaction of Cortical Bone to Compression ', Ibid., Suppl. 125, 19. --RUSSENBERGER, M., STEINEMANN, S., MOLLER, Requests for reprints should be addressed to:--Professor
47
M. E., and ALLGOWER, M. (1969), ' A Dynamic Compression Plate ', Acta orthop, scand., Suppl. 125, 31. RAHN, B., GALLINARO, P., BALTENSPERGER, A., and PERREN, S. M. (1970), ' Primary Healing of Osteotomies in Rabbits using New Compression Plates ', Ibid., in the press. RHINELANDER, F. W. (1968), ' T h e Normal Microcirculation of Diaphyseal Cortex and its Response to Fracture ', J. Bone Jt Surg., 50A, 784. SCHENK, R., and WILLENEGGER, H. 0967), ' Morphological Findings in Primary Fracture Healing ', Syrup. biol. hung., 7, 75. WILLENEGGER, H., SCHENK, R., and STRAUMANN, F. (1962), ' Methodik und vorl~.ufige Ergebnisse experimenteller Untersuchungen fiber die Heilvorg~inge bei stabiler Osteosyntbese an Schaftfrakturen ', Arch. klin. Chir., 301, 180.
M. Allg6wer, Chirurgische Universit~.tklinik,Btlrgerspital,Basle, Switzerland.
ABSTRACTS BONE REPAIR AND IMPLANTS Bone Repair and Fracture Healing This is one of the most easily understandable accounts of the process of bone repair, and brings the subject up to date with a well balanced review of the literature. Each phase of the process is fully discussed and clearly defined, yet Dr. Sevitt manages to convey the continuity of the events taking place. He begins with the histogenesis of repair and mentions possible control factors. Bone induction and osteogenesis from pre-existing embryologically determined cells are dealt with as the two concepts of histogenesis. Osteoclasts are given an active role rather than that of relatively passive onlookers to the process of bone resorption. Primary union and the factors necessary for its development are discussed. Union without callus is an essentially radiological rather than biological event, and not necessarily synonymous with primary union. It is of particular interest to see the usual form of bone union described under its correct title of secondary repair, and to see it take its logical place in the general discussion. The usual form of bone union is divided into two stages.
Stage I a. Local haemorrhage, necrosis, and inflammation. b. Proliferation of granulation tissue. c. Formation of new bone and cartilage around the fracture gap.
Stage 11 d. Union of the fracture gap. e. Remodelling of callus and original bone structure. What the surgeon often calls ' union ', is described more accurately as provisional union which is Stage I above. The point is made that Stage II may not occur until the fractured limb has become functionally normal.
The routes to union (secondary repair) by direct ossification and ossification after fibrous union and finally remodelling are described. Delayed union is dealt with as a failure of ossification after fibrous union. The profuse illustrations appear to have lost a certain amount of impact in reproduction as monochrome, but nevertheless help to underline points made in the text. SEvt'rT, S. (1970), ' B o n e Repair and Fracture Healing ', Br. J. Hosp. Med., 3, 693. Effect of Corrosion on Tissue Almost all the metals used in surgical implants (alloys and the elements composing them), also several that are under consideration for future use, were tested by implantation in rabbit's muscle for 6 months. The intensity of the tissue reaction was assessed by the thickness of the fibrous tissue pseudomembrane that developed around the implant and by the degree of vascularity and cellular infiltration in severe instances. The authors had on a previous occasion measured the quantities of chemical derivatives in the tissues around implants. Nickel, iron, chromium, cobalt, and molybdenum were amongst those that produced bad reactions but most stainless steels and most of the cobalt alloys were moderately good. Titanium and its alloys were mostly good. Of alloys not hitherto used in surgery, one or two nickel alloys and most zirconium alloys ought to prove good. The authors point out, however, that they have paid no attention to the mechanical and physical properties of the metals. This is valuable confirmation of a tissue reaction already known in man and also valuable confirmation and supplementation of relative toxicities arrived at by tissue-culture experiments many years ago. This test could be, and ought to be done on any newly introduced metal before being used surgically. The only experiment nearer to real-life conditions that remains to be done is a study of the reaction in bone. LAING, P. G., FERGUSON, A. B., jun., and HODGE, E. S. (1967), 'Tissue Reaction in Rabbit Muscle exposed to Metallic Implants, J. biomed. Mater. Res., 1, 135.
ALLGOWER ET AL." NEW PLATE FOR INTERNAL FIXATION
MOLLER, M. E. (1961), ' Principes d'Ost6osynth~se ', Heir. chir. Acta, 28, 198. --ALLGOWER, M., and WILLENEGGER, H. (1965), Technique of b~ternal Fixation of Fractures. Berlin: Springer. OLERUO, S., and DANCKWARDT-LILLIESTR6M, G. (1968), ' F r a c t u r e Healing in Compression Osteosynthesis in the Dog ', J. Bone Jt Surg., 50B, 844. PERREN, S. M., HUGGLER, A., RUSSENBERGER, M., STRAUMANN, F., MOLLER, M. E., and ALLGOWER, M. (1969), ' A Method of Measuring the Change in Compression applied to Living Cortical Bone ', Acta orthop, scand., Suppl. 125, 7. ALLGOWER, M., MATHYS, R., SCHENK, R., WILLENEGGER, H., and MULLER, M. E. (1969), ' T h e Reaction of Cortical Bone to Compression ', Ibid., Suppl. 125, 19. --RUSSENBERGER, M., STEINEMANN, S., MOLLER, Requests for reprints should be addressed to:--Professor
47
M. E., and ALLGOWER, M. (1969), ' A Dynamic Compression Plate ', Acta orthop, scand., Suppl. 125, 31. RAHN, B., GALLINARO, P., BALTENSPERGER, A., and PERREN, S. M. (1970), ' Primary Healing of Osteotomies in Rabbits using New Compression Plates ', Ibid., in the press. RHINELANDER, F. W. (1968), ' T h e Normal Microcirculation of Diaphyseal Cortex and its Response to Fracture ', J. Bone Jt Surg., 50A, 784. SCHENK, R., and WILLENEGGER, H. 0967), ' Morphological Findings in Primary Fracture Healing ', Syrup. biol. hung., 7, 75. WILLENEGGER, H., SCHENK, R., and STRAUMANN, F. (1962), ' Methodik und vorl~.ufige Ergebnisse experimenteller Untersuchungen fiber die Heilvorg~inge bei stabiler Osteosyntbese an Schaftfrakturen ', Arch. klin. Chir., 301, 180.
M. Allg6wer, Chirurgische Universit~.tklinik,Btlrgerspital,Basle, Switzerland.
ABSTRACTS BONE REPAIR AND IMPLANTS Bone Repair and Fracture Healing This is one of the most easily understandable accounts of the process of bone repair, and brings the subject up to date with a well balanced review of the literature. Each phase of the process is fully discussed and clearly defined, yet Dr. Sevitt manages to convey the continuity of the events taking place. He begins with the histogenesis of repair and mentions possible control factors. Bone induction and osteogenesis from pre-existing embryologically determined cells are dealt with as the two concepts of histogenesis. Osteoclasts are given an active role rather than that of relatively passive onlookers to the process of bone resorption. Primary union and the factors necessary for its development are discussed. Union without callus is an essentially radiological rather than biological event, and not necessarily synonymous with primary union. It is of particular interest to see the usual form of bone union described under its correct title of secondary repair, and to see it take its logical place in the general discussion. The usual form of bone union is divided into two stages.
Stage I a. Local haemorrhage, necrosis, and inflammation. b. Proliferation of granulation tissue. c. Formation of new bone and cartilage around the fracture gap.
Stage 11 d. Union of the fracture gap. e. Remodelling of callus and original bone structure. What the surgeon often calls ' union ', is described more accurately as provisional union which is Stage I above. The point is made that Stage II may not occur until the fractured limb has become functionally normal.
The routes to union (secondary repair) by direct ossification and ossification after fibrous union and finally remodelling are described. Delayed union is dealt with as a failure of ossification after fibrous union. The profuse illustrations appear to have lost a certain amount of impact in reproduction as monochrome, but nevertheless help to underline points made in the text. SEvt'rT, S. (1970), ' B o n e Repair and Fracture Healing ', Br. J. Hosp. Med., 3, 693. Effect of Corrosion on Tissue Almost all the metals used in surgical implants (alloys and the elements composing them), also several that are under consideration for future use, were tested by implantation in rabbit's muscle for 6 months. The intensity of the tissue reaction was assessed by the thickness of the fibrous tissue pseudomembrane that developed around the implant and by the degree of vascularity and cellular infiltration in severe instances. The authors had on a previous occasion measured the quantities of chemical derivatives in the tissues around implants. Nickel, iron, chromium, cobalt, and molybdenum were amongst those that produced bad reactions but most stainless steels and most of the cobalt alloys were moderately good. Titanium and its alloys were mostly good. Of alloys not hitherto used in surgery, one or two nickel alloys and most zirconium alloys ought to prove good. The authors point out, however, that they have paid no attention to the mechanical and physical properties of the metals. This is valuable confirmation of a tissue reaction already known in man and also valuable confirmation and supplementation of relative toxicities arrived at by tissue-culture experiments many years ago. This test could be, and ought to be done on any newly introduced metal before being used surgically. The only experiment nearer to real-life conditions that remains to be done is a study of the reaction in bone. LAING, P. G., FERGUSON, A. B., jun., and HODGE, E. S. (1967), 'Tissue Reaction in Rabbit Muscle exposed to Metallic Implants, J. biomed. Mater. Res., 1, 135.