Early failure of a locked titanium plate in a proximal humeral fracture: Case report and metallurgic analysis.

Angular stability locking plates are commonly used in proximal humeral fractures, especially in old patients with osteoporotic bones. These implants show good results in short and midterm follow-up, but complications are not uncommon. Here we present a case report to describe a case of early failure of a proximal angular stability plate implanted in a 72 years old female with a highly unstable two part proximal humeral fracture. An optical and metallurgic analysis was also conducted to study the modalities of failure. We concluded that anatomic reduction and restoration of the medial cortical support are crucial in order to minimize the mechanical load on the bone-metal interface and to prevent mechanical failure, in particular when the fracture rim drop in the weak point of the plate that was found in the proximal two symmetric holes (Holes E).

Clinical outcomes of ceramicized ball heads in total hip replacement bearings: a literature review.

BACKGROUND: Metallic ball heads for total hip replacement (THR) bearings with ceramicized surfaces were introduced in orthopedics during the second half of the 1980s, with the aim of decreasing the wear of polyethylene cups. METHODS: An analysis was made of the literature regarding outcomes for metallic ball heads with ceramicized surfaces now in clinical use (TiN, TiNbN, ZrN, monoclinic ZrO2), as well as carbon coatings (pyrolytic carbon, diamond-like carbon) and silicon nitride as coatings in ball heads for THR bearings. RESULTS: Notwithstanding the diffusion of ceramicized ball heads in THRs, there are few reports about their clinical outcomes in hip arthroplasty. In addition, several clinical studies and some registry data are putting under scrutiny the clinical advantages of ceramicized ball heads over cobalt chrome (CoCr) alloy and ceramic ball heads. CONCLUSIONS: The wear of THR bearings with ceramicized ball heads looks like it depends more on the behavior of the polyethylene cups than on the treatment of the ball head surface. The risk of coating damage and of its consequences has to be taken into account in selecting this type of bearing.

Lifetime estimation of a zirconia-alumina composite for biomedical applications.

OBJECTIVES: In this work long term stability of a zirconia toughened alumina (ZTA) composite was investigated. METHODS: Accelerated aging tests under hydrothermal environment, in autoclave and hot water, at different temperature, was conducted on material sample. Tetragonal to monoclinic transformation was evaluated by XRD analysis and the monoclinic content was plot as a function of the exposure time. The kinetic of transformation was studied by means Mehl-Avrami-Johnson (MAJ) nucleation and growth model. RESULTS: An activation energy for tetragonal to monoclinic transformation of 99 kJ/mol was found by the Arrhenius plot of reaction rate, value in agreement with other bibliography works regarding Y-TZP and alumina-zirconia composites. The in vivo hydrothermal stability simulation, estimated by the obtained activation energy, predicts in 65 years the time necessary to reach 25 vol% of monoclinic phase. SIGNIFICANCE: These results support the material suitability in biomedical field, especially in dentistry applications as implantology.