Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: EC:3.4.15.1 (ACE)
 18,300 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

There is no major change in the indication of upper extremity fractures, although there is further refinement of plate design (LC-DCP), plate material (titanium), and operative technique ("biological osteosyntheses"). For lower extremity fractures, the external fixator has shown excellent results in the early phase of treatment, with some disadvantages the late phase. If a change to an intramedullary nail is planned, this should be performed in the early phase of treatment. The concept of the "pinless fixator" has shown great advantages for temporary stabilization, although further technical development is necessary. The claw interlocking nail allows easy distal locking without using X-rays. Unreamed nailing, with the advantage of less damage to the cortical blood supply and reduced pulmonary risk, will be of increasing importance, if the trend seen in current studies is confirmed.
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PMID:[New trends in the management of shaft fractures]. 179 49

AO/ASIF with its collaborating laboratories has developed cold worked pure titanium material for implants with an outstanding biocompatibility. The first prospectively controlled clinical series dates back to 1966 and was reported to be most successful. Pure titanium also became the material of choice for implants to be used in patients suffering from metal allergy. Today, a long-term and well-documented experience with these implants exists. It therefore seemed logical to use pure titanium for the new limited contact dynamic compression plate (LC-DCP) system described in the previous article by Perren. Pilot clinics started to implant titanium LC-DCP in 1987, and already 271 plates have been used, mainly for the treatment of fresh fractures. Some 57 plates have so far been removed. The preliminary results are most favourable; they confirm especially the outstanding biocompatibility of pure titanium.
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PMID:Clinical experience with titanium implants, especially with the limited contact dynamic compression plate system. 207 48

Seventy-five patients with 81 femoral shaft fractures were treated with unreamed antegrade intramedullary nailing using a titanium alloy implant (AIM femoral nail, ACE Medical) with static interlocking. There were 73 closed fractures and 8 open fractures. Six patients had bilateral femoral shaft fractures. In two cases there was an ipsilateral fracture of the femoral neck, two patients had an ipsilateral intertrochanteric fracture, in one case there was a concomitant subtrochanteric fracture, and four patients had sustained an ipsilateral fracture of the acetabulum in addition to their femoral shaft fractures. In 43 cases (53%) the fracture of the femoral shaft was a comminuted type fracture. Thirty-nine patients (52%) had suffered multiple injuries; the mean Injury Severity Score was 41.2. Sixty-nine fractures were stabilized primarily within 8 hours after admission and 12 fractures were treated secondarily, in a mean of 5.8 days after injury. Closed intramedullary nailing was performed in 73 femora and open nailing with cerclage wiring was done in 8. All 81 nails were implanted unreamed and static was used in every case. The diameters of the nails used were 9 mm (n = 68) and 10 mm (n = 13). Proximal interlocking was distally directed in 76 cases and proximally directed in 5 cases. Two patients died of severe head injuries and one patient died of multiple organ failure. The infection rate was 0%, and uneventful consolidation of the fractures was seen in all cases within a mean of 3.8 months. Neither in the case of nails nor in the case of interlocking bolts did an implant failure occur.
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PMID:Unreamed intramedullary nailing of femoral fractures. 776 Mar 98

From the beginning of 1988 to July 1991, ten Swiss and German clinics undertook to document all cases of internal fixation using the titanium LC-DCP as part of a prospective multicenter study. The follow-up period was 14.2 months on average. The clinical results of 504 fixations were convincing. The follow-up rate was 72%. Of these, 95% healed without complication. The most frequent complication was delayed healing which occurred in 2.5% of cases. The infection rate was low (1.1%). A separate comparison of DCP fixations on the tibial shaft in 1984-1988 demonstrated the obvious biological compatibility of the new plate and shows that excellent results can be obtained using plate fixation.
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PMID:[Clinical results with the limited contact DCP plate of titanium--a prospective study of 504 cases]. 803 37

We have demonstrated that we are able to meet both trauma and orthopedic goals with immediate plate fixation of femoral fractures in patients with blunt polytrauma. Our femoral fracture mortality rate is less than our predicted institutional mortality rate of patients with comparative injury severity scores. Ipsilateral femoral neck and shaft fractures are easily repaired with femoral plating. Infections, even in open fractures and systemically unstable patients, are rare. Implant failures have been infrequent and are easily reconstructed with intramedullary nails. Knee motion has been restored reliably. Stainless steel DCP plate fixation requires primary bone grafting. Achieving union and subsequent knee rehabilitation often requires that patients remain on crutches for up to 6 months. Our experience with titanium LCDCP plates is preliminary, but we are seeing a significant amount of callus formation and, perhaps, earlier union and bearing weight.
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PMID:Femoral plating. 809 Apr 75

Five types of limited contact dynamic compression plates (LC-DCPs) of pure titanium with different surface treatments and an electropolished stainless steel LC-DCP were tested. The surface roughness parameters and chemical surface conditions were determined and checked for probable surface contamination. After an implantation period of 3 months on long bones of sheep, the soft tissue adjacent to the plates was evaluated histomorphometrically. The difference in roughness parameters was statistically significant for most surface conditions. A correlation was found between the surface roughness of the implants and the thickness of the adjacent soft tissue layer. The thinnest soft tissue reaction layer with a good adhesion to the implant surface was observed for the titanium anodized plates with coarse surface. Smooth implants, in particular the electropolished stainless steel plates, induced statistically significant thicker soft tissue layers. Profilometer roughness measurements combined with scanning electron microscopy techniques were useful methods to characterize the surface morphology.
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PMID:Evaluation of soft tissue reactions at the interface of titanium limited contact dynamic compression plate implants with different surface treatments: an experimental sheep study. 873 Sep 64

Infection rates for open reduction and internal fixation (ORIF) with the DCP in clinical studies are based on heterogeneous data on general risk factors and do not take into account the direct effect of the implant (material, design, surface, technique). The initial degree of bacterial contamination is generally unknown and the applied definition of the term infection is not mentioned. In our own prospective randomized clinical study including 281 cases of ORIF with the DCP (154 steel vs 127 titanium), the influence of the implant material on susceptibility to local infection was examined in relation to initial bacteria contamination (109 non-contaminated / 172 contaminated). Although in the group of contaminated DCPs the difference in the infection rates for stainless steel (sSt) and commercially pure titanium (cpTi) showed no statistical significance, a tendency was apparent. In an animal experiment, the lower rates of infection for c.p.Ti-DCP compared to sSt-DCP in the presence of a local bacterial challenge could be demonstrated with statistical significance. The need for further experimental research in the field of implant related local infection after ORIF will be discussed and strategies for further investigations proposed.
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PMID:Infection after open reduction and internal fixation with dynamic compression plates--clinical and experimental data. 903 51

We present a review of 28 femoral fractures in 28 elderly patients treated with an unreamed titanium intramedullary nail (AIM femoral nail, ACE medical, Figure 1). The series included 11 male and 17 female patients with an average age of 74.5 yr (range 63.5-93 yr). One fracture was open and the rest, closed (six pathological). Average follow up was 6 months (range 4.5-21 months). Mean time to bony union was 19 weeks (+/- 3.5). The union rate was 91 per cent with two delayed unions; one was a subtrochanteric pathological fracture and the other a diaphyseal fracture. Shortening of 2 cm occurred in one patient and one had malrotation. There was no implant failure in our series either with the screws or the nails. We feel that titanium unreamed intramedullary femoral nailing is an effective way of treating subtrochanteric and shaft fractures of the femur in old and frail patients.
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PMID:Femoral fractures in the elderly treated with an unreamed titanium nail. 974 49

After plate osteosynthesis changes in bone biology and bone mechanics are observed in the plated bone segment. Compromise of the vascular supply in the plate bed leads to a remodelling process and to a temporary porosity in the bone cortex underneath the plate. In addition, the plate takes over some of the physiological loading of the bone, which in turn alters the normal strain distribution of the cortical bone tissue. The aim of the present study is to determine the tissue deformation of the sheep tibia in vivo and the changes in tissue strain due to plating with plates of different rigidities. Measurements were performed on the intact bone at the mid diaphysis using the strain gauge technique. With different connections on the tension bridge (Wheatstone bridge), the strain was measured separately for pure axial loading, bending, and torsion before and after plating with a 4.5 mm stainless steel or titanium DCP. Under physiological load the sheep tibia is mainly deformed in torsion (62%) and bending (33%), and much less in axial loading (5%). Plating with a steel plate reduces the overall tissue strain by 18%, with a titanium plate by 13%. This reduction is mainly due to a reduction in axial tissue strain due to axial loading and bending and less to the reduction of tissue strain under torsion. In our in vivo model, plating with steel or titanium plates leads to a reduction of the physiological tissue strains. The difference between the different plates is small due to the fact that the high tissue strain under torsion is only slightly affected by plating. Thus, from the purely mechanical point of view and with regard to preserving normal tissue strains as much as possible, titanium plates offer little advantage compared with stainless steel plates. But, titanium as an implant material may offer advantages with respect to tissue compatibility and infection resistance.
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PMID:Strain distribution in plated and unplated sheep tibia an in vivo experiment. 1105 79

Sixty one femoral fractures treated with ACE unreamed titanium nail (AIM femoral nail, ACE Medical, Los Angeles, CA) were studied. Ten patients died before bony union and three were lost to follow up. Forty eight fractures were followed up for an average of 11.2 months (4-31 months). All fractures united except one in which plating and bone grafting was performed at 6 months due to failure of progression of union. The mean time to bony union was 6.2 months. There was no implant failure but one distal interlocking bolt broke at 6 weeks. No incidence of adult respiratory distress syndrome (ARDS) was observed. Malunion was seen in one patient whereas three cases had shortening of more than 2 cm. Our results show that unreamed femoral nailing using titanium nail is a safe and effective procedure for the treatment of femoral shaft fractures.
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PMID:Unreamed femoral nailing. 1108 59


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