The aim of this study was to compare the pull-out forces of bioabsorbable polylactide/glycolide (PLGA) tacks and screws in human cadaver parietal bones. Parietal bone pieces (c. 6 cm x 20 cm) were collected from five human male cadavers (age range: 47-75 years). Forty-nine BioSorbPDX (self-reinforced [SR] PLGA 80/20) tacks (1.5-mm diameter, 4.0-mm length), 47 BioSorbPDX (SR-PLGA 80/20) screws (1.5-mm diameter, 4.0-mm length), and 46 LactoSorb (PLGA 82/18) screws (1.5-mm diameter, 4.0-mm length) were applied. The tacks were applied to drill holes using a special applicator gun (no tapping or tightening). The screws were applied to drill holes in the traditional way using tapping and tightening with a screwdriver. A tensile testing machine was used. All the implants were tested thus: the head of the implant was held by an aluminum jig, and the jig was pulled with wire until implant failure. The testing pull speed was 10 mm/min. Means and SDs were calculated, and the data were analyzed using ANOVA. The pull-out force of the tacks was 115.9 +/- 8.3 N, that of Lactosorb screws was 112.9 +/- 12.1 N, and that of Biosorb screws was 110.4 +/- 8.9 N (statistically insignificant difference between the three groups). The most common reason for failure in the case of tacks was barb breakage (55.1%); it was thread breakage in the case of BioSorb screws (66%) and stem split in the case of Lactosorb screws (56%). Tacks seem to have a similar, perhaps even a little better, holding power to cranial bone as screws and can hence be recommended for clinical application, as the procedure saves time and, consequently, costs.
A new device (a tackshooter) to apply bioabsorbable tacks in craniofacial surgery has been developed. This new device was used in 15 children who underwent various cranioplasty procedures to demonstrate its reliability and simple technical application in cranial bone osteofixation. Bone segments were fixed together and to the cranial bones using Biosorb plates and tacks. Stable and secure fixation was obtained intraoperatively, with reduced operative time (10-15%) compared with earlier use of plates and screws. However, its use in very thin bone (<1 mm thick) is very limited because of bone fragility. In conclusion, use of tacks and a tackshooter reduces operative time, risk of infection and blood loss, and consequently costs. It is therefore very useful in selected craniofacial cases.
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