Successful Surgical Fixation Using Bio-Absorbable Plates for Frail Chest in a Severe Osteoporotic Octogenarian

Waseda, Ryuichi; Matsumoto, Isao; Tatsuzawa, Yasuhiko; Iwasaki, Atsushi

doi:10.5761/atcs.cr.17-00223

Cited by 4 publications

(5 citation statements)

References 9 publications

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“…Regarding osteoconduction, numerous studies using rabbit models have demonstrated the osteoconductive ability and bone bonding features of u-HA/PLLA [7,8,9]. Thus, u-HA/PLLA is used extensively as bone plates and screws for osteosynthesis in different surgical specialties such as orthopedics, plastic surgery, or thoracic surgery [10,11,12,13]. However, these animal experiments only tested the osteoconductive ability of u-HA/PLLA using a rod inserted fully into the knee, such that there was full bone contact.…”

Section: Introductionmentioning

confidence: 99%

Bone Regeneration Potential of Uncalcined and Unsintered Hydroxyapatite/Poly l-lactide Bioactive/Osteoconductive Sheet Used for Maxillofacial Reconstructive Surgery: An In Vivo Study

et al. 2019

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Uncalcined and unsintered hydroxyapatite/poly l-lactide (u-HA/PLLA) material has osteoconductive characteristics and is available for use as a maxillofacial osteosynthetic reconstruction device. However, its bone regeneration ability in the maxillofacial region has not been fully investigated. This study is the first to assess the bone regenerative potential of osteoconductive u-HA/PLLA material when it is used for repairing maxillofacial bone defects. A total of 21 Sprague-Dawley male rats were divided into three groups—the u-HA/PLLA, PLLA, or sham control groups. A critical size defect of 4 mm was created in the mandible of each rat. Then, the defect was covered with either a u-HA/PLLA or PLLA sheet on the buccal side. The rats in each group were sacrificed at 2, 4, or 8 weeks. The rats’ mandibles were sampled for histological analysis with hematoxylin and eosin staining, histomorphometry, and immunohistochemistry with Runx2 and osteocalcin (OCN) antibody. The amount of newly formed bone in the u-HA/PLLA group was significantly higher than that of the PLLA group. The expression of Runx2 and OCN in the u-HA/PLLA group was also significantly higher. These results demonstrate that the u-HA/PLLA material has excellent bone regenerative ability and confirm its applicability as a reconstructive device in maxillofacial surgery.

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Section: Introductionmentioning

confidence: 99%

Bone Regeneration Potential of Uncalcined and Unsintered Hydroxyapatite/Poly l-lactide Bioactive/Osteoconductive Sheet Used for Maxillofacial Reconstructive Surgery: An In Vivo Study

et al. 2019

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“…4,5 The use of absorbable plates has also been described in the literature, although much less frequently. [11][12][13][14][20][21][22][23][24][25] One potential advantage of absorbable plates is that they will be resorbed over time gradually transferring the stress load to bone preventing stress shielding which is a reduction in bone density as a result of stress removal from the bone by an implant. 11,14 This transfer of the stress load may stimulate faster bone healing.…”

Section: Discussionmentioning

confidence: 99%

“…Most of these systems use metal for permanent fixation with excellent outcomes 4,5 . The use of absorbable plates has also been described in the literature, although much less frequently 11–14,20–25 . One potential advantage of absorbable plates is that they will be resorbed over time gradually transferring the stress load to bone preventing stress shielding which is a reduction in bone density as a result of stress removal from the bone by an implant 11,14 .…”

Section: Discussionmentioning

confidence: 99%

Prospective randomized trial of metal versus resorbable plates in surgical stabilization of rib fractures

Ashley¹,

Christie²,

Long³

et al. 2022

J Trauma Acute Care Surg

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BACKGROUND:Surgical stabilization of rib fractures has gained popularity as both metal and resorbable plates have been approved for fracture repair. Is there a difference between metal and resorbable plate rib fixation regarding rib fracture alignment, control of pain, and quality-of-life (QOL) scores (Rand SF-36 survey)? METHODS:Eligible patients (pts) included 18 years or older with one or more of the following: flail chest, one or more bicortical displaced fractures (3-10), nondisplaced fractures with failure of medical management. Patients were randomized to either metal or resorbable plate fixation. Primary outcome was fracture alignment. Secondary outcomes were pain scores, opioid use, and QOL scores. RESULTS:Thirty pts were randomized (15 metal/15 resorbable). Total ribs plated 167 (88 metal/79 resorbable). Patients with rib displacement at day of discharge (DOD) metal 0/14 (one pt died, not from plating) versus resorbable 9/15 or 60% (p = 0.001). Ribs displaced at DOD metal 0/88 versus resorbable 22/79 or 28% (p < 0.001), 48% in posterior location. Patients with increased rib displacement 3 months to 6 months: metal, 0/11 versus resorbable, 3/9 or 33% (p = 0.043). Ribs with increased displacement 3 months to 6 months metal 0 of 67 versus resorbable 6 of 49 or 12.2% (p < 0.004). Pain scores and narcotic use at postoperative Days 1, 2, 3, DOD, 2 weeks, 3 months and 6 months showed no statistically significant difference between groups. QOL scores were also similar at 3 months and 6 months.Trauma recidivism in outpatient period resulted in fracture of resorbable plates in two pts requiring a second surgery. CONCLUSION:Metal plates provided better initial alignment with no displacement over time. Clinical outcomes were similar regarding pain, narcotic use, and QOL scores. Routine use of resorbable plates for posterior rib fractures is not warranted. Lateral repairs were technically most feasible for using resorbable plates but still resulted in significant displacement. Resorbable plates may not maintain rib alignment when exposed to subsequent injury.

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“…After 13 years, Oyamatsu et al (26) proposed a U-shaped bioresorbable plate (SuperFIXSORB MX40) with ethibond 0/0 nonabsorbable fixing points for the treatment of flail chest. Recently, Waseda et al (27) described the same procedure in a severe osteoporotic octogenarian with serious flail chest due to a traffic accident, using resorbable Vicryl threads for fixation. The device would be partially reabsorbed at the 4-year follow-up and theoretically completely reabsorbed with another 2 years.…”

Section: Bioresorbable Materialsmentioning

confidence: 99%

Reconstructive options of the chest wall after trauma: a narrative review

Divisi¹,

Vico²,

Zaccagna³

et al. 2023

AME Surg J

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Background and Objective: Trauma remains the third leading cause of death in the world and the involvement of the chest with multiple rib fractures is an aggravating factor in the patient's outcomes. We perform a review of the literature, examining the current surgical options, in order to evaluate the most effective method of restoring quickly the excellent general conditions. Methods:We carried out research of the papers in literature by performing a search on the MEDLINE database through PubMed including works from the past 10 years using the following criteria: "chest trauma AND chest wall". A total of 1,385 results were obtained and 1,108 articles were identified after the duplicates were removed. Only 214 were rated relevant after reading the full text.

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Successful Surgical Fixation Using Bio-Absorbable Plates for Frail Chest in a Severe Osteoporotic Octogenarian

Cited by 4 publications

References 9 publications

Bone Regeneration Potential of Uncalcined and Unsintered Hydroxyapatite/Poly l-lactide Bioactive/Osteoconductive Sheet Used for Maxillofacial Reconstructive Surgery: An In Vivo Study

Bone Regeneration Potential of Uncalcined and Unsintered Hydroxyapatite/Poly l-lactide Bioactive/Osteoconductive Sheet Used for Maxillofacial Reconstructive Surgery: An In Vivo Study

Prospective randomized trial of metal versus resorbable plates in surgical stabilization of rib fractures

Reconstructive options of the chest wall after trauma: a narrative review

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