ABSTRACT
Forty-three high energy open tibial diaphyseal fractures were treated with unreamed locked intramedullary nails from 1989 to 1992, and were reviewed at a minimum of 1 year from injury. There were 6 Grade I, 2 Grade II, 16 Grade IIIA, 9 Grade IIIB, and 1 Grade IIIC open fractures. Ninety-eight percent of the fractures united in an average time of 6.1 months. However, 47% of the fractures required an additional procedure before union. Complications included 49% of fractures with malunions, 12% deep infections, 41% locking screw breakages, and 20% compartment syndromes. These results are similar to those achieved with external fixation of open tibial fractures. The unreamed locked intramedullary nail has not improved the outcome of open tibial diaphyseal fractures because the biologic consequences of the injury are of greater significance than the methods or techniques of fracture stabilization.
Subject(s)
Bone Nails , Fracture Fixation, Intramedullary , Tibial Fractures/surgery , Adult , Diaphyses/injuries , Equipment Failure , Female , Fractures, Ununited , Humans , Infections/etiology , Male , Postoperative ComplicationsSubject(s)
Benzopyrenes/metabolism , Bile/metabolism , Liver/metabolism , Methylcholanthrene/metabolism , Animals , Benzopyrenes/blood , Biological Transport , Cell Nucleus/metabolism , Cytosol/metabolism , Female , Half-Life , Liver/cytology , Microsomes, Liver/metabolism , Mitochondria, Liver/metabolism , Ouabain/metabolism , Protein Binding , Rats , Succinates/metabolism , Sulfathiazoles/metabolism , Time Factors , TritiumABSTRACT
Protector-II (Pr-II) of the Japanese morning glory (Pharbitis nil Choisy) was inactivated by exposure to polyphenol oxidase. An unidentified protector in the same molecular weight range obtained from sunflower was also inactivated by this enzyme. Earlier speculations that protectors might be lipoprotein in nature were negated by the fact that neither lipase nor protease inactivated the protectors. The protectors were also not inactivated by incubating with alpha-amylase, DNase, or RNase. Catechol mimics Pr and is inactivated by polyphenol oxidase. The oxidation of catechol to o-quinone is accompanied by a loss of chromophores that absorb ultraviolet light and the appearance of a reddish brown color. Similarly, when the relatively low molecular weight auxin protectors (Pr-II class) were incubated with polyphenol oxidase, their oxidation was also frequently associated with the formation of brown color, and oxidation with H(2)O(2) caused a loss of ultraviolet-absorbing chromophores. The data indicate that auxin protectors contain o-dihydroxyphenolic groups at their active site.That o-dihydroxyphenols inhibit indoleacetic acid oxidation has been demonstrated by numerous workers. It is suggested that the high molecular weight auxin protectors and the phenolic compounds described by other authors comprise part of a metabolic system concerned with the regulation of peroxidase-catalyzed redox reactions.
