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Prognostic factors for predicting outcomes after intramedullary nailing of the tibia.

J Bone Joint Surg Am

October 2012

Division of Orthopaedics, Department of Surgery, University of Toronto, St. Michael's Hospital, Suite 800, 55 Queen Street East, Toronto, ON M5C 1R6, Canada.

Background: Prediction of negative postoperative outcomes after long-bone fracture treatment may help to optimize patient care. We recently completed the Study to Prospectively Evaluate Reamed Intramedullary Nails in Patients with Tibial Fractures (SPRINT), a large, multicenter trial of reamed and unreamed intramedullary nailing of tibial shaft fractures in 1226 patients. Using the SPRINT data, we conducted an investigation of baseline and surgical factors to determine any associations with an increased risk of adverse events within one year of intramedullary nailing.

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A major limitation on the supply of the short-lived medical isotope 90Y (t1/2 = 64 h) is the available quantity of highly purified 90Sr generator material. A radiochemical production campaign was therefore undertaken to purify 1,500 Ci of 90Sr that had been isolated from fission waste materials. A series of alkaline precipitation steps removed all detectable traces of 137Cs, alpha emitters, and uranium and transuranic elements.

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The suitability of polymeric biomaterials as surfaces for the attachment and growth of cells has often been investigated in cell culture. In this study the contribution that serum fibronectin (Fn) or vitronectin (Vn) make to the attachment and spreading of cells cultured from explanted human bone (bone-derived cells) during the first 90 min of culture was determined for metallic and ceramic surfaces. The requirement for Fn or Vn for attachment and spreading of bone-derived cells onto stainless steel 316 (SS), titanium (Ti) and alumina (Al2O3) and to polyethyleneterephthalate (PET) was directly tested by selective removal of Fn or Vn from the serum prior to addition to the culture medium.

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Adhesion of tooth-coloured restorative materials to the instruments used to place them is a clinical problem. This paper examines the low-stick properties and the durability of a 5 micron coating of titanium nitride on stainless steel when used with two composites (a hybrid and a microfilled) and a glass polyalkenoate (ionomer) cement. Titanium nitride-coated dies were compared to polished stainless steel for adhesion to the unset restorative material before and after a period of wear, and also for properties of surface hardness, contact angle with unfilled resin and frictional coefficient.

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