Making Hardware Removal Unnecessary by Using Resorbable Implants for Osteosynthesis in Children

Abstract

Introduction: Following osteosynthesis, children generally require a second surgery to remove the hardware. This becomes unnecessary, by using resorbable implants. Limiting the number of required surgeries and their associated risks, this technique provides critical aspects of minimally invasive surgery. This review focuses on resorbable implants for osteosynthesis for the treatment of fractures in children and discusses their clinical features. Method: We provide an overview of the two most common technologies used in resorbable osteosynthesis materials: polymer- and magnesium-based alloys. Clinical examples of osteosynthesis are presented using polymer-based ActivaTM products and magnesium-based Magnezix® products. Results: Polymer-based implants demonstrate surgical safety and efficacy. Due to their elasticity, initial placement of polymer-based products may demonstrate technical challenges. However, stability is maintained over the course of healing. While maintaining good biocompatibility, the rate of polymer-resorption may be controlled by varying the composition of polyesters and copolymers. Similarly, magnesium-based implants demonstrate good mechanical stability and resorption rates, while these characteristics may be controlled by varying alloy components. One of the significant shortcomings of magnesium is that metabolism results in the production of hydrogen gas. Both technologies provide equally good results clinically and radiographically, when compared to non-resorbable implants. Conclusion: Resorbable osteosynthesis materials demonstrate similar therapeutic results as conventional materials for osteosynthesis. Resorbable implants may have the potential to improve patient outcomes, by sparing children a second surgery for hardware removal.

Resorbable implants in paediatric orthopaedics and traumatology

“…In clinical practice, the advantages to avoid removal of implants have been widely emphasized [9,10]. We had a previous experience with resorbable screws, 2.8 mm diameter made of poly-L-lactide-poly-D-lactide acid and trimethylene carbonate.…”

Preliminary experience with bioabsorbable intramedullary nails for paediatric forearm fractures: results of a mini-series

“…Вопросы ортопедии reducing soft tissue damage. Moreover, it decreases anaesthesia-related risk, exposure to radiation, and potential irritation which is usually caused by a protruding titanium elastic nail tip [10][11][12].…”

“…Furthermore, surgeons often bend titanium elastic nails prior to insertion to create a curvature of the nail. It should not be performed with the Activa IM-Nail™, as the current PLGA material is too brittle and could be damaged if bent with force [8][9][10].…”

High Complication Rate and High Percentage of Regressing Radiolucency in Magnesium Screw Fixation in 18 Consecutive Patients

“…The first clinical studies compared the fixation of chevron osteotomies using conventional screws and magnesium-based MAGNEZIX ® CS screws [ 8 , 9 , 10 ]. Over time, further studies concerning chevron osteotomies followed [ 11 , 12 , 13 ], as well as studies concerning their use in children and adolescents [ 14 , 15 , 16 ]. In the meantime, MAGNEZIX ® CS screws have been used for different indications in various anatomical regions (foot/ankle, knee, elbow and shoulder), fracture fixation, osteochondral refixations and osteotomies [ 14 , 17 ].…”

“…In the meantime, MAGNEZIX ® CS screws have been used for different indications in various anatomical regions (foot/ankle, knee, elbow and shoulder), fracture fixation, osteochondral refixations and osteotomies [ 14 , 17 ]. Published clinical studies presented predominantly safe usage and promising outcomes [ 11 , 14 , 16 , 17 , 18 , 19 ].…”