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[Investigations of contact tissues of Blount vitallium staples using the instrumental neutron activation analysis (author's transl)].

Instrumental neutron activation analysis with Gamma-spectroscopy is a very sensitive method for testing trace elements. Specimens of contact tissue around 5 Blount's vitallium clamps were, after preparation at the Nuclear Research Institute Jülich irradiated with thermic neutrons and their element-specific gamma spectra were measured after 33 and 125 days. In contact tissue a significant rise in concentration of the alloy-specific elements cobalt and chromium was found. The unspecific elements silver, caesium, iron, rubidium, antimon, scandium and zink were either within or very close to the normal. The metallosis of contact tissue is due to corrosion of the surfaces of cobalt-chromium implants.

Activation Analysis↗

[Allergic cobalt reaction (metallosis) following knee arthroplasty with vitallium endoprosthesis ad modum Walldius (author's transl)].

A case report is given on a woman with rheumatoid arthritis and deformed knee joints. She got a knee arthroplasty with a metal-to-metal Vitallium endoprosthesis ad modum Walldius. About one year after the arthroplasty she showed both a sterile fistulation from the knee joint and an eczema of the skin of the operated knee. An epicutaneous test for cobalt was positive. It is suggested that the metal-to-metal contact in the prosthesis and the proximity of the prosthesis to the skin is a possible explanation to the allergic reaction.

Adrenal Cortex Hormones↗

An unusual reaction in muscle in association with Vitallium plate: a report of possible metal hypersensitivity.

A case is reported in which fractures of the radius and ulna were fixed with Vitallium plates and screws. Seven years later a painful swelling appeared over the extensor aspect of the forearm. After eight years sarcoma was suspected and a pale tumour infiltrating muscle was found at operation. However, the histology excluded neoplasia and showed massive fibrosis and patchy necrosis of muscle, with chronic inflammatory changes peripherally. After the removal of the metal the swelling disappeared. A sinus down to the ulna followed operation and was not cured two years later. At this stage standard patch testing showed skin sensitivity to cobalt. Metal sensitivity is proposed as the cause of this extraordinary reaction in muscle.

Bone Plates↗

Use of vitallium prosthesis to relieve jaundice in patients with obstruction at the bifurcation of the hepatic duct.

Fourteen patients with hepatic duct obstruction were treated by inserting a Vitallium prosthesis through the strictured area. Eleven had proven cholangiocarcinoma; in 3 a definitive diagnosis wsa not obtained. Jaundice was relieved and patients were afforded good palliation. Obstruction of the prosthesis has not been a problem and the absence of external drainage tubes has been a factor in improving the quality of life of these patients. The simplicity of the operation is emphasized.

Adenoma, Bile Duct↗

The Moore vitallium femoral-head prosthesis in fractures of the femoral neck.

A follow-up is given of early and late results in 109 arthroplasties with the self-locking Austin T. Moore vitallium femoral head prosthesis in fractures of the femoral neck on 106 patients. Operative indication was usually fresh medical fracture of the femoral neck in an elderly woman, or its late complication. The surgery was performed in a unit for general surgery also engaged in pre- and postgraduate teaching activities. Many operations were performed by residents engaged in general surgery or orthopaedics. Point scores according to a modification of Merle D'Aubigné's classification showed excellent or at least good results in 81 per cent of the 69 mobile patients. Because of deteriorated general physical condition 11 patients were chronically bed-ridden. Five patients could not be reached. In three instances the prosthesis was removed. 21 patients died, three during the stay in hospital and 18 later for reasons not connected with the operative procedure. The mortality during 40 months of observation corresponded fairly well to that expected in the age group for the population as a whole.

Adult↗